Last Modified: December 7, 2007
Dear OncoLink "Ask The Experts,"
Other than choosing an experienced breast cancer surgeon, are there any preoperative or postoperative steps that can be taken by the patient to mitigate risk of side effects in axillary lymph node dissection?
Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds:
Women who are strong and flexible pre-operatively are in a better position to avoid shoulder problems post-operatively. Having said that, we know that it is hard to exactly predict the specific surgical and cancer therapies (chemotherapy, radiation therapy) that may later be required to eradicate the cancer.
Persons who undergo axillary lymph node dissection (AND) have a higher incidence of side effects than those undergoing sentinel lymph node (SNB) procedures. The incidence of musculoskeletal disorders of the shoulder (loss of range of motion and muscle weakness), loss of sensation in the breast/axilla/medial aspect of the upper arm, and lymphedema of the breast/arm/trunk occur more often following AND. Those undergoing axillary clearance also generally require more extensive cancer therapies, i.e. radiation, which increases the risk of lymphedema. There is also strong medical evidence that recovery of function (return to normal activities, work, use of the arm) occurs more quickly following SNB.
Having said all of this, I see MANY women who do extremely well following axillary node dissection. It is always best to check with the surgeon/nurse practitioner about activity limitations and follow those instructions meticulously. Premature exercise or use of the arm delays healing of tissues and reanastomosing (reconnecting) of delicate lymphatics. Your surgeon will have a specific protocol for you to follow.
If you do notice any of the symptoms mentioned, please discuss these with your surgeon/nurse practitioner and question if you will need to see a physical therapist who specializes in cancer rehabilitation and is a certified lymphedema therapist (CLT). Preferably you will want to work with a physical therapist who is LANA certified. This is evidence that the therapist has passed a national certification examination. This person will have the initials PT or MPT or MSPT or DPT followed by CLT-LANA following their name.