Breast Cancer
Pathology: Breast cancer can result from abnormal tissue growth within the breast region. The cause of breast cancer is unknown, however, genetic mutation of BRCA1 and BRCA2 are present in about 10% of all breast cancers (Goodman & Fuller, 2009).
Demographics:
Risk factors include (LaRusso, L., 2010): Female, older than 50, personal or family history of breast cancer, changes in breast tissue, Caucasian, increased exposure to estrogen, increased breast density, radiation therapy before age 30, overuse of alcohol. Many women who get breast cancer do so without any of these factors, except age. Increased exposure to estrogen can occur with menarche <12 years old or late menopause (>55 years old) (Goodman & Fuller, 2009).
Clinical Presentation: No notable physical signs may be seen in the clinic. Upon palpation, a lump may be felt in the breast region. It is recommended that patients do self breast exams monthly to detect early signs of breast cancer.
Symptoms (LaRusso, L., 2010): No symptoms may present during early stages of the disease. As the tumor grows the following changes can occur:
Differential Diagnosis:
Screening questions associated with increased risk of cancer (Deyo, R., 1988):
Guidelines from the American Cancer Society (2011):
Breast cancers are one of the most common types of cancers to spread to the spine (Goodman & Snider, 2007). If a patient has thoracic spine pain and has a past history or present history of breast cancer, a referral to a physician to rule out a spinal tumor in the thoracic or lumbar region is recommended. Refer to thoracic spinal tumor for more information.
Bottom Line: Refer Out
If cancer is suspected, the patient needs an immediate referral to their physician. A physical therapist cannot treat breast cancer. A physical therapist may however treat a patient for musculoskeletal impairments even if they have cancer. Cancer is a contraindication for many modalities and treatment. Contraindicated treatments should not be used throughout treatment of a patient with cancer.
A patient may receive physical therapy after breast cancer removal. Patient may need treatment regarding lymphedema, axillary cord restriction limiting abduction, general limitation in range of motion and strength.
To refer to the references used in compiling this page, please refer to the "Cancer" section in the references list.
Demographics:
Risk factors include (LaRusso, L., 2010): Female, older than 50, personal or family history of breast cancer, changes in breast tissue, Caucasian, increased exposure to estrogen, increased breast density, radiation therapy before age 30, overuse of alcohol. Many women who get breast cancer do so without any of these factors, except age. Increased exposure to estrogen can occur with menarche <12 years old or late menopause (>55 years old) (Goodman & Fuller, 2009).
Clinical Presentation: No notable physical signs may be seen in the clinic. Upon palpation, a lump may be felt in the breast region. It is recommended that patients do self breast exams monthly to detect early signs of breast cancer.
Symptoms (LaRusso, L., 2010): No symptoms may present during early stages of the disease. As the tumor grows the following changes can occur:
- A lump or thickening in the breast region
- A change in the size or shape of the breast
- Nipple discharge or tenderness or an inverted (pulled back) nipple
- Ridges or pitting of the breast skin (like the skin of an orange)
- A change in the look or feel of the breast region (ex. Warm, swollen, red, or scaly breast, areola or nipple)
Differential Diagnosis:
Screening questions associated with increased risk of cancer (Deyo, R., 1988):
- Past history of cancer*
- Age > 50* or <20 years
- Recent, unexplained weight loss*
- Failure of conservative management*
- No relief with complete bed rest *
- Severe pain unaffected by posture or position
- Night pain disturbing sleep
Guidelines from the American Cancer Society (2011):
- Women should perform a self breast exam monthly after the age of 20.
- Clinical breast exams should be performed every 3 years until age 40. After the age of 40, patients should have a clinical breast exam and a mammogram yearly.
Breast cancers are one of the most common types of cancers to spread to the spine (Goodman & Snider, 2007). If a patient has thoracic spine pain and has a past history or present history of breast cancer, a referral to a physician to rule out a spinal tumor in the thoracic or lumbar region is recommended. Refer to thoracic spinal tumor for more information.
Bottom Line: Refer Out
If cancer is suspected, the patient needs an immediate referral to their physician. A physical therapist cannot treat breast cancer. A physical therapist may however treat a patient for musculoskeletal impairments even if they have cancer. Cancer is a contraindication for many modalities and treatment. Contraindicated treatments should not be used throughout treatment of a patient with cancer.
A patient may receive physical therapy after breast cancer removal. Patient may need treatment regarding lymphedema, axillary cord restriction limiting abduction, general limitation in range of motion and strength.
To refer to the references used in compiling this page, please refer to the "Cancer" section in the references list.