We've talked about diagnosis, treatment and lymphedema in the last 3 articles. Now let's move onto two common, manageable secondary outcomes of breast cancer, CRF and Cording, "the other stuff". These conditions are so common that every woman going through breast cancer needs to become educated on what they are and how to address them. Read on!
Cancer Related Fatigue (CRF) is experienced by 70 - 100% going through breast cancer treatment. Women describe it as a whole-body tiredness that isn't relieved by rest or sleep. We think CRF is due to many factors, including the cancer itself, radiation, chemo and stress. It may come on suddenly, isn't associated with activities or exertion and may continue after treatment is over. The thyroid may become underactive especially if the lymph nodes in the neck have experienced radiation, causing increased fatigue by reducing your ability to metabolize. The combo of radiation and chemo may lead to anemia, increasing our fatigue by reducing the availability of oxygen in our blood. Our appetite may be reduced as well, making us less likely to eat nutritiously. Some medications that are prescribed during treatment may also cause fatigue. Then, there's our emotional health as we go through medical interventions and treatments, causing stress, fatigue and sometimes depression. We know that healthy lifestyle choices can hugely impact CRF. Energy conservation is important, wisely choosing where, when and what you'll in a day. Don't try to maintain your normal daily routines. Set gentler, kinder, more compassionate goals. The CRF Golden Rule is "Never Go Below 25% in Your Tank". If you feel fatigue coming on, recognize that you simply don't have a "reserve tank" on board. Stop at the first sign of fatigue, before you're depleted, or it may take days to recover. Talk with your doctor about your thyroid function and iron levels as you may need support in these areas. When eating is a challenge, choose only the most calorie dense, colourful and nutritious foods. One wise woman taught me that adding plain yogurt to her food made it more palatable as well as easier to chew, swallow and digest. Guard your sleep and rest time with dedication and ferocity! Recognize that you are in restoration and rebuilding mode. Exercise can help by cleverly changing your metabolism and giving you more energy. It's important to "start low and progress slow" and be consistent. An important proviso is that radiation treatment is a time to maintain rather than gain.
Axillary Web Syndrome or Cording is another common outcome from breast cancer surgery and treatment, seen in between 20 to 80% of women; its incidence depends on what kind of surgery and treatment you've had. Cords look like a guitar string that pops up under your skin anywhere from your chest to your armpit, elbow, wrist or palm. Women often see it for the first time when they stretch to put on their seatbelt or coat. A cord is your lymphatic vessel tightened up. They "mate once for life" and don't heal, so helping them release and get back to work is important. If you have cording, you also have a raised risk for lymphedema down the road. Your breast cancer physio can help you reduce or lose cording with lymphatic manual therapy, myofascial release and gentle stretching. You can regain full lymphatic function, release your lymph vessels/skin tissue and find full spinal and arm movement in the mix!
We began by introducing breast cancer, risk factors and how we find it. We went on to talk about surgery, radiation, chemotherapy and hormonal therapy. After all this medical intervention, we are still one in eight women in Canada, finding our way and living out the rest of our lives. What challenges may we still face?
Hormonal Therapies may be recommended; these are longer term medication, called Tamoxifen or Herceptin (and others). These are medications that are taken over a period of 5 - 10 years depending on the type of breast cancer that you have, how soon it was diagnosed, and your menopausal status. They offer some protection from cancer returning.
Lymphedema is a condition in which there is a reduction in the natural lymph flow somewhere in the body. After breast cancer surgery and/or radiation there may be an interruption of the lymph flow through its watershed. The lymph system's job is to support your immune system and to interact with your circulatory system; it should flow uninterrupted, like a river. During breast cancer surgery, the tumour and local lymph nodes may be injected with a tracer and some dye. The surgeon is then able follow the dye to see which lymph nodes may be communicating with your tumour and remove them. Once your lymph nodes have been impacted by surgery and/or radiation, you are at a lifetime risk of developing lymphedema. Your job is to pay attention to mild sensational changes of heaviness, density or tingling in the arm. Lymphedema can't be cured, but it can be managed and treated with manual lymph drainage, compression garments specially designed for you and excellent personal care. We used to use of a machine called a lymphopress. Although the lymphopress may reduce the volume of a limb, it also may cause tightening or hardening of the tissues over the long term. We've advanced in our knowledge and treatment, so prevention is the key!
Lymphedema Risk Reduction Practices are your job on a daily basis. You will know when and where to advocate for yourself and to ask for help.
CV Advance October 2018 Breast Cancer 201
Breast Cancer 201…..the details after diagnosis. We discussed how we develop breast cancer and how we might find it in Breast Cancer 101.
How do we understand the label on our diagnosis and how do we begin to sleuth through treatment options? After we've been told we have cancer, we need to become an instant expert. We have to make decisions based on the information that we're presented at each medical visit. I'm hoping this information will help us all learn now…..perhaps for ourselves or perhaps to compassionately support a woman that we know and love.
Numbers and Letters…
Each breast cancer has a name and a number and letter to help us understand the type, nature and potential spread of the disease.
Stage 0means that there are atypical cells, but no spread of the cancer into the ducts, lobules or surrounding tissues. It's early and non-invasive and accounts for around 20% of all breast cancer cases. Ductal or Lobular Carcinoma in Situ are in this category.
Stage 1means that the tumour is under 2 cm. and has not spread into the lymph nodes or outside the breast tissue.
Stage 2 (A and B)means the tumour is 2 - 5 cm. and may include up to 3 lymph nodes but has not spread further.
Stage 3 (A and B)means that the tumour is larger that 2 cm. and may include up to 9 underarm lymph nodes and, with B, may have spread into the skin, chest wall, muscles and ribs. Inflammatorybreast cancer is an aggressive type of Stage 3B cancer, which also involves a reddened, inflamed breast.
Stage 4tells us that the cancer has spread beyond the breast, chest and lymph nodes outwards to distant organs.
Recurrentbreast cancer is the name used when it has returned; it may appear in the breast or elsewhere in the body.
Now what? How do we go ahead?
Most women will choose some type of surgery, their choice dependent on their type of cancer, impact on recovery and long term prognosis. Surgery a "local" treatment, used to remove tumour cells, to inspect/remove lymph nodes and to reconstruct the breast.
Lumpectomyis a breast-conserving surgery and the least invasive procedure. The cancer is removed, along with some adjacent breast tissue and associated lymph nodes. Most women choosing this option will also need radiation.
Total Mastectomyinvolves the surgical removal of the breast and lymph nodes as needed but the tissue beneath the breast is left intact. This is the most common surgery used to treat breast cancer.
Radical Mastectomyis less common now, involving removal of the breast, pectoral/chest muscles and all of the lymph nodes.
Reconstruction Surgerymay be begun during the initial surgery or it may be delayed. It may involve silicone or saline (salt water) implants or tissue flap surgery. The latter, tissue flaps, may mean taking some of a tummy muscle, buttock muscle or a back/shoulder muscle to be transplanted over to form breast tissue. More commonly now, your surgeon may recruit some tummy fat and blood vessels, called a DIEP Flap Reconstruction. This reconstruction has a natural feel and look, ages more naturally but takes time and multiple medical visits over some months.
Radiation is a "regional" treatment, by directing high energy rays in order to destroy cancer cells. It can be given externally or internally (called brachytherapy). Most of the side effects of radiation (wait for the next article for more on this!) can be minimized and are not permanent.
Chemotherapyis a whole-body or "systemic" treatment in which drugs are given through an IV or by mouth when they travel through the bloodstream and impact cancer cells. It may take some months to complete a series of treatments.
Hormonal/Targeted Therapiesare a second form of systemic treatment. Hormonal therapy is used to reduce the risk of cancer returning or to treat cancer that has come back or spread. It changes the hormonal impact on the breast or simply reduces our hormonal load.
Written by Joanne Gailius, October 2018
Breast Cancer. 1 in 8 of us women in Canada will be diagnosed with breast cancer in our lifetime. No one can imagine hearing those words. Beyond the initial shock, there is a steep learning curve as well as great hope. So, let's take a deep breath, dive in and learn together.
Breast cancer is diagnosed when a malignant tumour grows within the cells of the breasts. It can appear in the milk ducts, the lobules (which produce milk), the lymphatic system and/or within the surrounding breast tissue. Early detection has resulted in earlier diagnosis and treatment. Treatment may include surgery, raditation, chemotherapy, targeted therapies and hormonal therapy. In addition, physios may have special training to help women with the challenges that occur in movement, posture, alignment, lymphatic function, bone health, pelvic health and heart health. Yoga therapy also provides help in breathing, stress management and restorative practices. Creston has these options, along with a group of women who meet monthly to support each other through this journey.
What factors make it more likely for us to develop breast cancer? Living in Canada with a relatively high income puts us at risk. If we're between 50 and 69 years old, are Caucasian, have a family history of breast or ovarian cancer, family genetic mutations (to the BCRA 1 or BCRA2 gene or a few other specific genetic mutations), have dense breasts, began menstruation at a young age (menarche) and/or late onset of menopause (after age 55), have never been pregnant, already had radiation therapy to the chest area, previously had breast cancer, used hormone replacement therapy for a long time and/or used oral contraceptives for more than 10 years, drink more than one alcoholic drink per day, are obese, are physically inactive and smoke, we're at a higher risk. A great deal of research has shown that deodorants, antiperspirants, tight bras and breast implants are not related to any rise in breast cancer statistics. The important thing to remember is that some of the breast cancer risk factors are not in your control. Breast cancer can simply appear in your life without you having caused it, done anything, inherited anything……it just is. But you can affect so many of these factors by keeping a healthy weight, exercising, quitting smoking and reducing your alcohol consumption on a daily basis.
Mammograms. If we're over 50, we can have a mammogram every 2 years in BC. It is a low level radiation picture of your breast. A radiologist will look for any growths, note your breast density and compare to your last mammogram. Your personal monthly breast self examination is important. You know your body and your breasts best. Pay attention if you feel a lump, a swelling/change in size or shape, see skin redness/discolouration, find dimpling/thickening or puckering of the skin, nipple changes/retraction/discharge or enlarged lymph nodes in your armpits. Many breast changes are notcancer, but if your notice one or more of these symptoms that doesn't go away within two weeks, visit your doctor.
What happens if you find a lump? Your doctor will usually start with a mammogram. From there, if there is continued concern, you'll have an ultrasound. If concerns continue, you'll have a biopsy which can be of three kinds: surgical (remove part of or all of the lump), fine needle or core biopsy (extracted fluid and cells from the tumour are removed) or a sentinel lymph node biopsy (a radioactive tracer and dye are injected into the tumour so the surgeon can follow the dye to find the lymph nodes connected to the tumour itself). The removed tissue is sent away to a pathology lab for testing.
In Breast Cancer 201, we'll talk about:
Numbers and Letters: No two breast cancers are alike, but we use Stages (I to IV) and the letters A and B to help us understand the type and stage of cancer that has been found. This guides our treatment options from the day of diagnosis as well as along the treatment road.
Treatment Options: Surgery (breast conserving, total/simple mastectomy, radical mastectomy and reconstructive options. Radiation therapy, chemotherapy, hormonal therapy and targeted pharmacological/drug therapies.
Written by Joanne Gailius, March 2019
Cancer is a diagnosis that none of us wants to hear, yet 33 to 50% of us will experience that moment in a doctor's office……"You have cancer." There are so many advances in oncology (cancer medicine) from diagnosis to treatment yet cancer patients and survivors continue to face unique challenges in their physical and mental health over their lifetime.
A December 2018 "white paper" (a concise report that informs readers about a complex issue) explored the growing literature available to us regarding the effects of yoga on the continuum of cancer care. Medical research has shown that yoga increases strength and flexibility, improves balance and prevents falls, helps maintain a healthy body weight, improves psychological well-being, lowers blood sugar and cholesterol levels, improves sleep and reduces fatigue, reduces stress, enhances the immune system, reduces inflammation and improves quality of life. We health care providers seek evidence-informed, cost-effective ways in which we can help people to manage the short and long term effects of cancer and its treatments. This paper clearly supports cancer-specific yoga intervention as a supportable part of cancer intervention.
Yoga is a complex, holistic system that includes movement and postures, breathing, restorative and relaxation practices that support physical and mental health. PubMed gathered 435 studies from observational studies to clinical trials regarding yoga as a part of cancer care. The general conclusion is that yoga can help adult cancer patients and survivors manage symptoms and side effects as well as lead longer, healthier lives. A variety of cancers were studied, although the most numerous studies were on breast cancer; they studied people before, during and after treatment. Yoga is not a cure-all, but there is ample evidence that well-planned yoga classes, done consistently and over time, have measurable benefits on healing and long term health.
From all the studies, these are the conclusions regarding yoga for people with cancer:
Yoga comes in many forms and classes vary greatly. Again, from all the studies, these are the conclusions regarding the best options of yoga for people with cancer and cancer survivors:
Creston is a wonderful valley in which to live. We have many opportunities to help us all live our lives well over our lifespan, through our ages and stages. Should you face a cancer diagnosis, please ask for community support. There are support groups, mental and physical health options, home visiting nurses, care aids, PTs and OTs and cancer-specific yoga classes at The Yoga Room in NW Blvd. at the east end of town.