Physical Recovery

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 Regular Follow-Up •  Clinical Breast Examination • Mammography
 MRI • Breast Self Examination (BSE)

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Regular Follow-Up
Even after the most complete treatment, there's always a chance that cancer will recur. Most recurrences happen two or three years after surgery. The longer you go without a recurrence, the greater are your chances of remaining free of disease. But you can never say that the cancer has been completely cured.

Because of this possibility, you need regular follow-up visits with a healthcare professional. It could be your family physician, your oncologist, or your breast surgeon. What's important is to have a single person in charge of the follow-up care. Usually you'll be seen as often as every few weeks immediately after treatment, and perhaps only every six months later on. There is no "right" schedule. Eventually, you will probably be down to a single annual visit.

What does follow-up involve? Most physicians suggest a physical examination to look for signs of local recurrence—new lumps within the breast after lumpectomy, ortiny hard nodules in the surgical scar after mastectomy.

In addition, mammography will be scheduled on a regular basis, and you may have a number of blood tests that will assess the function of your liver, bone marrow, and other organs, and a chest X-ray. Other tests such as CEA (a protein found in the blood of patients with cancer) and bone scans are not used routinely.

Currently, many experts feel that there is little to be gained by performing multiple tests on patients that are asymptomatic—that is patients who have no symptoms.Such tests may detect a recurrence a few months earlier, but earlier diagnosis will not change the outcome of whatever treatment you might need.

 

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Clinical Breast Examination
CBE will be part of your regular check ups. The physician will probably spend additional time examining the scar and areas where enlarged lymph nodes may be found—under the arms, and around the collar bones.

 

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Mammography
Every woman who has had breast cancer should have a mammogram once a year, regardless of age.

If you had a lumpectomy, the films may be more difficult to interpret, so make sure that previous mammograms are available for comparison.

If you had a mastectomy, you should have mammograms of the other breast. If you are sensitive near the post-surgical scar, ask the technologist for a Mammopad—a soft sheet of special padding that fits on the mammography device.

 

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MRI
For women with especially dense breasts, or women who present unusual diagnostic challenges, MRI is often an effective although expensive option.

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Breast Self Examination (BSE)

One of the key components of follow-up is your monthly breast self-examination, or BSE. Recently you might have read that BSE is not effective in saving lives. But many leading experts and patient advocacy groups remain convinced that women who are well trained in BSE should continue to examine their own breasts. BSE is particularly important for women at higher risk of breast cancer—and that includes you and your first degree relatives.

BSE is not a skill that you can learn from a brochure or a shower card. The best way to learn it is from your healthcare provider, or from a good breast self exam video. Check the Library section at the end of the book to find out how you can get the most up-to-date instructional videos on BSE.

A thorough BSE should include: Looking: Using a mirror, check the shape and size of your breasts, and the color and texture of your skin, first with your arms down, then with your arms in the air. Try to learn what's normal for you, so that you can spot any changes immediately. Check your breasts in two other positions—pushing down on the hips, to tighten your chest muscles, and bending forward at the waist, with your arms relaxed. This will help you spot dimpling—the tugging on the skin or nipple often caused by a growing tumor. Next, lie down with a folded towel under your shoulder. Extend the arm out at an angle to spread the breast tissue more evenly. You will need to examine the breast as well as the area where breast tissue may be found—from the armpit, to the breast bone, and from the collar bone to the bra line. Use three middle fingers to examine the breast. Use the pads because they're more sensitive than the tips. Keeping the fingers straight with the pads flat against the breast, make three dime-sized circles. One just lightly, one deeper, one deeper still. This will enable you to check the full thickness of your breast.

When you move your hand, don't lift the fingers away from the skin, to avoid missing a spot. Cover the entire area, spot by spot, going up and down in strips about as wide as your three fingers. When you've finished, lower your arm and examine your armpit for possible lymph node enlargement. Then check the other breast the same way. If you had a mastectomy you are not likely to find a lump within the flap tissue used for reconstruction. Local recurrences are more likely to appear as tiny firm beads along the incision line. If you had a lumpectomy, you will probably feel irregular lumpiness at the surgical sight shortly after the lumpectomy heals. You need to become familiar with the new look and feel of your breasts, so that you can report any changes promptly.

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Care of the Surgical Arm
After a mastectomy and particularly if you also had a lymph node dissection, your arm may feel numb and tingly due to nerve damage during surgery. Later, you may feel shooting pains due to nerve re-growth. You may also have decreased range of motion or weakness in the shoulder as a result of nerve damage or as a result of prolonged disuse. There is not much that you can do to reverse numbness due to nerve damage. Some of it may improve as the nerves heal over the years.

Your healthcare professional will tell you which exercises are appropriate to help your arm regain its mobility and strength. It is very important to follow the exercise schedule faithfully so you can recover your full range of motion. You will find a description of some of the exercises in the mastectomy section of the Surgery Chapter. Once you regain your full range of motion, you will not need to continue these exercises.

Lymphedema is swelling of the arm due to scarring of the lymph ducts after surgery or radiation. This condition occurs in approximately ten to twenty women out of a hundred, sometimes months or years after surgery.

It is important that you always follow your medical team's recommendations about how to avoid injury to the arm to reduce the chances of developing lymphedema.

Precautions that will help protect your arm from lymphedema:

• Avoid sunburns or burns while cooking

• Have all injections, vaccinations, blood samples, and blood pressure tests done on the other arm whenever possible

• Use an electric razor with a narrow head for underarm shaving to reduce the risk of nicks or scratches

• Carry heavy packages or handbags on the other arm

• Wash cuts promptly, treat them with antibacterial medication, and cover them with a sterile bandage; check often for redness, soreness, or other signs of infection

• Never cut cuticles; use hand cream or lotion instead

• Wear watches or jewelry loosely, if at all, on the operated arm

• Wear protective gloves when gardening and when using strong detergents

• Use a thimble if you sew

• Avoid harsh chemicals and abrasive compounds

• Use insect repellent to avoid bites and stings

• Avoid tight elastic cuffs on blouses and nightgowns

• If your arm becomes red, swollen, or feels hot, call your doctor at once.

 

 

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