Managing Upper Extremity Dysfunction In Breast Cancer Survivors
Education about symptom management and simple exercises before initiation of treatments is an effective and simple way to prevent upper extremity dysfunction. Jesuel Padro-Guzman, MDTweet this quote
With an increased number of breast cancer survivors and patients with metastatic disease living longer, it is imperative for oncology care providers to manage issues of new and chronic upper extremity dysfunction as a result of the malignancy itself or its treatment. As one of my patients suffering from persistent shoulder and arm dysfunction following her breast cancer treatment said, I am grateful to be alive, but what is life if I cant comb my hair, cant put my clothes on properly, and need help with almost everything?
Studies suggest that approximately 60% of patients with breast cancer experience shoulder pain, and 67% have decreased strength in their upper body. A combination of factors can contribute to shoulder dysfunction, including age, weight, prior shoulder problems, surgical method, use of aromatase inhibitors, and cervical dysfunction. We also know that patients who undergo mastectomy, extensive radiation, and lymph node dissection have an increased risk of developing shoulder dysfunction compared with patients who have breast-conserving surgery or less-aggressive radiation treatment.
Contributing Factors to Shoulder Problems
By Step Guide On How To Perform Breast Self Exam At Home:
Look at your breasts in the mirror Position your shoulders straight and place your arms on your hips. See if your breasts have their usual size, shape, color and whether they have visible swelling or change in shape. Check that they dont have dimpling or puckering of the skin, or that they became red, sore, swollen or have rash. Also check your nipples to see if they became inverted or changed their position.
Raise your arms and look for the same changes. Squeeze the nipple and check if fluid comes out of one or both nipples. The discharge can be a watery, milky, or yellow fluid or blood.
Check your breast when lying down Use your right hand to feel your left breast and then vice versa. When feeling your breast with your hands, keep your fingers together and use the first few finger pads applying small circular motions covering the entire breast area and armpit.
Check yourself in the shower Many women find that it is easier to check for changes in the breast when their hands are wet and slippery with soap and water. Cover your entire breast, using the same hand movements as when lying down and check for any lumps or thickening in your underarm area too.
If you find something suspicious with your breast dont panic, as most of the lumps are not cancerous and many breast changes are not associated with cancer, but for your own peace of mind call your doctor if you have any concerns.
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Arm/shoulder Problems Common After Breast Cancer Surgery
- Tags:Lymph Nodes Removed, 0 Involved, Lymph Nodes Removed, 10+ Involved, Lymph Nodes Removed, 1-9 Involved, Lumpectomy, Lymph Node Removal, Mastectomy, Axillary Lymph Node Removal/Dissection, Sentinel Lymph Node Removal/Dissection, Weakness, Ductal Carcinoma In Situ, Invasive or Infiltrating Ductal Carcinoma, Invasive or Infiltrating Lobular Carcinoma, Lymphedema, After Surgery, and Pain
A study found that most women who had breast cancer surgery had some type of arm problem even 1 1/2 years after surgery. The research was presented at the 2008 American Society of Clinical Oncology Breast Cancer Symposium.
After breast cancer surgery, some women experience numbness, swelling, weakness, or tingling in the arm and shoulder area on the same side of the body on which surgery was done. These problems are more likely to happen after mastectomy surgery and less likely to happen after lumpectomy. The possibility for arm and shoulder problems depends quite a bit on whether any lymph nodes were removed during surgery and if so, how many were removed.
The researchers studied more 250 women for 18 months after breast cancer surgery. Every 3 months, the women reported any arm problems and had a physical exam to check for any movement or function problems. The researchers tested upper body strength and endurance, hand grip, flexibility, and range of motion.
The results:
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What Is The Difference Between Breast Cancer And Cyst Symptoms
- Breast cancer is cancer of the breast tissue, and is the second-most common type of cancer in women, and the second-leading cause of cancer deaths in women.
- Breast lumps are common, and are signs of changes in breast tissue. Most breast lumps are not cancerous.
- Symptoms of breast cancer and breast cysts that are similar include breast lumps , nipple discharge, and changes in the skin overlying the breast.
- Early breast cancer usually has no symptoms. As breast cancer progresses, symptoms that are different from breast cysts may include nipple inversion, weight loss, and shortness of breath.
- Symptoms of breast cysts that are different from breast cancer include breast pain, infections , and abscesses.
- Causes of breast cancer include risk factors such as female gender , advanced age, Caucasian ethnicity, personal history of breast cancer, family history of breast cancer , hormones, being overweight or obese, increased alcohol consumption, and radiation treatment to the upper body.
- Causes of breast lumps include cysts, fibrocystic changes, or breast cancer.
- Treatment for breast cancer usually involves surgery , radiation therapy, chemotherapy, hormonal therapy, or specialized targeted therapy.
- Breast pain and cysts may be treated with medication. Surgery may be needed to remove a lump and if an abscess is present it must be drained.
Breast Pain And Breast Cancer In Men
As with breast cancer in women, breast cancer in men is often painless. That said, it tends to press on nearby structures sooner than a tumor would in most women. In addition, hormone-induced breast pain is also less likely to occur in men. If you are a man experiencing breast pain, play it safe. Breast cancer can and does occur in men. In fact, 1 in every 100 breast cancer diagnoses in the United States is in a man.
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Statistics On Breast Cancer & Pain
A breast tumora hard clump of breast cancer cellsusually doesnât usually cause breast pain unless it reaches the size of two centimeters in diameter or greater. But a tumor can be larger than two centimeters and still not cause pain.
In fact,only about 5% to 15% of women newly diagnosed with breast cancer complain of breast pain. Only 7% of those diagnosed with breast cancer seek a doctor because of breast pain, excluding other symptoms.
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What Causes Breast Pain
There are a number of harmless causes for breast pain and tenderness that may primarily be related to changes in hormone levels. These can include:
- Puberty in girls and sometimes for boys, too
- Menstruation and premenstrual syndrome
- Pregnancy more often during the first trimester
- Days following childbirth as milk comes in Breastfeeding Mastitis, which is caused by a milk duct that is not properly draining and becomes infected, should be treated. It has no correlation with cancer, but it can become a serious infection if left untreated.
- Menopause
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Postsurgery Treatments And Exercises To Try
After surgery, its not uncommon to experience symptoms such as swelling, pain, and stiffness.
If you do experience these symptoms, its best to first seek an evaluation from an orthopedic specialist or a physical therapist. They can teach you how to move and exercise safely.
If you arent injured, you can usually proceed with starting an exercise program. You may not feel up to doing very much, but its important to move when you can.
At this stage, even gentle range-of-motion exercises can help keep you from losing too much mobility and prevent you from developing lymphedema.
Shoulder Pain And Breast Cancer
Q: I am a breast cancer survivor who had a mastectomy, chemotherapy, and radiation therapy. The shoulder on my affected side hurts, especially at night or when I lift my arm overhead. What might be the problem, and how should I address this?
Shoulder problems are very common after treatments for breast cancer such problems are normally not a sign that your cancer has returned or spread. Up to 68% of patients with breast cancer experience shoulder pain and/or restricted motion of the shoulder during or after treatment this problem can result from 1 of 2 common causes.
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Metastatic Breast Cancer & Pain
Metastatic breast cancer may also cause pain. It could be from a larger tumorthese are often over two centimeters in diameteror pain in other regions of the body due to the spread of cancer. If breast cancer spreads to your bones, it may cause bone pain in your chest, or back pain with leg weakness. If cancer spreads to your brain, it may cause headaches.
If breast cancer travels to the adrenal glands, you may feel a dull back pain. If your breast cancer spreads to your liver, you could have pain in the upper right part of the abdomen and develop jaundice .
How Is This Related To Breast Cancer
Those who have had breast cancer surgery are prone to rotator cuff problems. The more invasive the surgery, the more likely it is that they will have trouble. Some women experience lymphedema following surgery, which is a swelling of the lymph nodes that snake around the chest area and up to the arm pits. Some speculate that this contributes to rotator cuff pain after surgery.
According to BreastCancer.org, rotator cuff pain after breast cancer surgery is a fairly common problem:
- 85% of women have mild or worse shoulder problems six months after surgery
- 50% of women reported moderate to severe shoulder problems six months after surgery
- lymphedema, or swelling of the lymph nodes, was not the best indicator of shoulder problems, as 44% of women who did not havelymphedema still had shoulder problems six months after surgery
So while the lymph nodes may be related to the problem, it does not appear that lymphedema itself is the only cause. Some of the many possible contributing factors are protective posturing , scar tissue formation , or radiation damage. Lymphedema may contribute by adding weight to an already overtaxed and underused muscle system around the time of surgery.
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What Can You Do About It
One of the first things to remember is that a high percentage of women get this kind of pain. While it may help to do some small amount of range of motion exercises while healing from surgery, never do an exercise after surgery unless your doctor has okayed it. You also dont want to do exercise if you are still in pain from surgery, as that can have a deleterious effect on your healing.
It is not likely, but pain can be a potential sign of cancer spreading. Because cancer can form on the head of the humerus, it can interfere with movement and make it painful. Therefore, your first course of action should be to see your doctor to rule out any spreading of cancerous tumors. Dont get too worried though. The odds of it being cancer are quite low as the development of these tumors generally takes years to develop, has the added symptom of arm weakness, and is becoming quite rare.
Once your doctor confirms that you are not dealing with any cancerous issues in your rotator cuff area, you can concentrate on healing. While time will help, physical therapy, anti-inflammatories, and gentle exercise can certainly be useful in shortening the time it takes to heal from this kind of problem. Before you throw yourself into a PT regime, however, make sure to check with your doctor. He or she will tell you how much you should be using or not using your arm for the best level of healing.
Warning Signs Of Breast Cancer
More women die of breast cancer than any other cancer, and men, although in a distinct minority with barely one percent of the cases, are not immune. According to 2019 statistics released by Cancer.net, a doctor-approved patient website, 42,260 people will die of breast cancer by the end of the year. This ubiquitous disease is on the rise among women, despite advances in medicine and treatment measures. Among the cancers among women, breast cancer trails only skin cancer as the most diagnosed. There will be 268,250 women in this country diagnosed with invasive breast cancer, with almost 63,000 with in situ breast cancer.
As is the case with most cancers, the sooner it is detected the better the chances of vanquishing it. Breast cancer should not be allowed to linger for long, because time is on its side as it spreads through the lymph nodes from an ignominious start as a small tumor in the breast tissue.
The hard fact is that it cant be treated if it isnt diagnosed in the first place, and we bring you seven detectable signs of breast cancer that will give you a head start.
Seven Signs of Breast Cancer
That brings us to the second sign.
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Coping With Chest Wall Pain
Any type of breast pain can be very distressing, and many women worry they may have breast cancer. However, in most cases pain in the breast isnt a sign of breast cancer.
Having breast pain doesnt increase your risk of breast cancer. However, its still important to be breast aware and go back to your GP if the pain increases or changes, or you notice any other changes in your breasts.
Itchy Breast Redness And Pain
The American Cancer Society mentions that while the most common symptom of breast cancer is a new lump, other possible symptoms include skin irritation and dimpling, as well as redness, scaliness or thickening of the breast skin.1
Its common for breasts to be sore and sensitive during menstruation, but this symptom could mean something more serious if you have sore breasts sensitivity that persists after that period. There may also be swelling involved with skin that is warm to the touch, indicating the less common forms of inflammatory breast cancer.
It is worth noting that it is rare that breast pain or sore breasts after period is a sign of cancer. Doctors from Harvard Medical School say that sore tender breasts are usually not connected with breast cancer.
Cancer Research UK says that itchy breasts can be a sign of inflammatory breast cancer, however this is very rare. With this type of cancer, the area of skin over the tumor can become red, inflamed, painful and itchy.2
Inflammatory cancer may also cause swelling and pain in the chest. The skin may look scaly or have small blue marks similar to hemorrhages, somewhat like cellulite holes on the breast.
Doctors on WebMD say that a reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer. They also mention a marble-like area under the skin or indentation on the breast, which may indicate a tumor that cannot be seen or felt.3
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How Is Lymphedema Diagnosed
There are no tests for lymphedema. Instead, your healthcare provider will ask about your medical history and give you a physical exam. Youll be asked about:
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Past surgeries youve had
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If youve had severe swelling in the past
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What medicines youre taking
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What other health conditions you have, such as high blood pressure, heart disease, or diabetes
Imaging tests, measures of volume, blood tests, and other tests may be used to diagnose lymphedema.
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Moffitt Cancer Centers Approach To Pancoast Tumors
The multispecialty team in Moffitt Cancer Centers Thoracic Oncology Program leverages leading-edge technologies and focused expertise to efficiently identify Pancoast tumors and create refined treatment plans. As a high-volume cancer center with specialists who focus solely on lung cancers, our team routinely treats Pancoast tumors and spearheads an ambitious clinical trial program to facilitate treatment breakthroughs. A testament to our commitment to research, Moffitt is a National Cancer Institute-designated Comprehensive Cancer Centerthe only such cancer center based in Florida.
If youve been experiencing possible symptoms of a Pancoast tumor, Moffitt can work with your primary care provider to help you find answers and specialized lung care. Contact us at or complete a new patient registration form to consult with a Moffitt physician. We provide every patient with rapid access to our cancer experts within a day, which is faster than any other cancer hospital in the nation.
Medically reviewed by Dr. Lary Robinson, Pancoast Tumor Program director
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Brief Sharp Pains Or Ongoing Duller Pain In A Breast Will Put The Fear Of Cancer In Many Women
Inflammatory breast cancer is much more associated with pain than is the regular kind of breast cancer .
How often does the more typical kind of breast cancer cause pain?Quite rarely most are picked up by screening imaging, as lesions would need to be quite large or located near the chest wall or armpit to cause discomfort, says Mark Levandovsky, MD, Founder and Medical Director of Preventive Medicine and Cancer Care. Dr. Levandovsky is a board certified internist and oncologist/hematologist in practice for 20 years.
So if regular breast cancer rarely causes pain in a breast, this means that there are cases in which the patient experiences pain.
There are certainly women who, prior to their BC diagnosis, were having unexplained pain in the breast where the tumor was eventually found.
In inflammatory BC, the skin of the breast appears inflamed, reddish and may resemble the skin of an orange.
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