Breast cancer rated 5th in cancer mortality and is one of the cancers along with the other two forms of cancer – Lung cancer and colorectal cancer which accounts for a third of cancers. With the diagnostic and treatment progress and breast cancer physiotherapy, the prognosis of the disease has improved, and survival rates have improved over the years.

This has, in turn, increased the numbers of breast cancer survivors and hence much research has been done into aids for improving the quality of life of survivors. Physiotherapists play an essential part in the care of survivors in addition to in the rehab care of women during and following a diagnosis of breast cancer.

Breast cancer originates in the tissues of the breast. After a tumour is formed it might metastasize to other areas of the human body and may grow and destroy tissue where it grows. Not all growths in breast tissues are cancerous, some that are non-cancerous are called benign. Benign conditions such as cysts, hyperplasia and tumours like intraductal papilloma may form. It is essential that patients are urged to speak to their healthcare staff, should they detect any lump in their breast.

1. Changes in the texture of the skin 

Breast cancer may lead to changes and inflammation in skin tissues, resulting in skin texture changes. Examples of these texture changes comprise:

• Scaly skin around the nipple and areola, like the skin, is sunburned or exceptionally tender
• skin thickening in any part of the breast
• These modifications might cause itching
• These skin changes might be symptomatic of an infrequent breast cancer kind named Paget’s disease.

2. Nipple discharge

Some women might notice a thick or thin discharge from the nipple. The discharge may vary in colour from clear to milky, to yellowish, green, or reddish.

Although it is common for those that are breastfeeding to have a discharge from the nipples, it is recommended to see a gynaecologist for any nipple discharge other than milk in lactating women.

Even though many times, the discharge is noncancerous, for a few it may signify the presence of cancer and hence the same must be reviewed by a doctor.

3. Dimpling

A sudden dimpling in the breast may sometimes be an indication of inflammatory breast cancer, which is yet another aggressive kind of breast cancer. Cancer cells may give rise to a buildup of lymph fluid from the breast contributing to swelling in addition to dimpling or pitted skin. It is very important to seek the guidance of a physician.

The dimpled skin looks much like the surface of an orange.

4. Lymph node changes

Lymph nodes are small nodes that are part of the immune system that filters body fluids to trap potentially harmful cells including viruses, bacteria, and cancer cells.

If there is a cancer cell in the breast and it leaves the breast, it mostly travels to the underarm lymph node area adjacent to the breast and it may result in swelling in this region.

Once the cancer cells have impacted the axilla, they may also spread near the collarbone forming small swollen lymph nodes in the armpit. They feel like small rubbery lumps and might be tender to touch.

5. Nipple or Breast pain

Breast cancer may cause changes in the skin tissues causing tenderness, pain, and discomfort in the breast. Though breast cancer is frequently painless, it is crucial not to dismiss any symptoms or signs and get a doctor for consultation. In case of pain, you are recommended to get physiotherapy treatment for breast cancer which will help you ease the pain in breasts.

6. Nipple retraction or inversion

Cancer may lead to cell changes. These changes could lead to nipple turning inward into the breast or it could seem different in its size or texture as compared to how it was previously.

The nipples may often look different during lactation and ovulation or even at different times in the menstrual cycle, but individuals should visit a physician if they notice changes without any of the above-mentioned associated reasons.

7. Redness

Breast cancer may cause changes to the skin which may make it look discoloured and swollen and its skin may have a bluish/reddish/ purplish tint.

If someone hasn’t experienced recent injury to the breast to describe these modifications, they ought to visit their physician. It is also crucial to seek medical guidance if breast discoloration doesn’t disappear, even while an injury was the trigger.

8. Swelling

Cancer may cause an area of the breast or the entire breast to swell. There might not be a different bulge following this swelling, however, the breast might differ in size compared to the previous and normal version of the breast.

Even though it is possible for individuals to have breasts which are somewhat different in size in any way times, this swelling could give a change and deviation from the standard breast size.

Doctors understand that breast cancer occurs when some breast cells start to grow abnormally. These cells divide faster than healthy cells and continue to collect together, forming a lump or mass. These cancer cells can spread (metastasize) throughout the breast into some lymph nodes or to other portions of the body.

Breast cancer often starts with cells from the milk-producing ducts (invasive ductal carcinoma). However, it might also start from the glandular tissue called lobules (invasive lobular carcinoma) or other tissue or cells inside the breast.

Scientists have identified hormonal, environmental and lifestyle factors that might increase the risk of prostate cancer. Nevertheless, it is not clear why a few men and women who do not have any risk factors develop cancer, however, others with risk factors remain active and healthy. It is very likely that breast cancer is due to an intricate interaction of genetic makeup as well as the environment.

Medicines for treating breast cancer most frequently consist of chemotherapy medications and hormone replacement medications. Chemotherapy drugs are often used in mixtures of 2 or three at a time. Two frequent groups comprise anthracyclines and taxanes. Anthracyclines like, Epirubicin and Doxorubicin, are very similar to antibiotics which destroy the cancer cells’ genetic material. Taxanes like, Paclitaxel and Docetaxel, on the other hand, interfere with the division of the cells. Paclitaxel and Docetaxel are classified as plant alkaloid anti-inflammatory drugs.

All these are given intravenously and used chiefly to treat solid tumours like ovarian and breast cancers. Toxicities are common in cancer therapy and every medication isn’t alike. The acute toxicity of Docetaxel is hypersensitivity along with a rash and delayed degeneration ends in neurotoxicity, fluid retention, neutropenia, alopecia, and bone marrow depression. Hormone treatments like the medication Tamoxifen block the development, spread, or recurrence of ER-positive tumours by preventing estrogen from reaching the microbes. Tamoxifen is a combined estrogen antagonist and agonist that blocks the estrogen activation from the breast and reduces growth variables in the breast tissues.

The side-effects are much like postmenopausal symptoms: hot flashes, nausea, irregular menses, vaginal bleeding, and weight reduction, in addition to slightly increase a woman’s risk for endometrial cancer. Tamoxifen is the most common medication used for premenopausal women to help stop the recurrence of breast cancer along with a different medication, Toremifene is the more recent estrogen receptor antagonist which is used in cases of breast cancer. Tamoxifen also seems to have a preventative effect on women having a high risk of breast cancer and has been accepted as a chemopreventive agent in this population.

A potential surveillance version for breast cancer physiotherapy and exercise which may be incorporated with disorder therapy to make a more detailed approach to survivorship healthcare was proposed. The aims of the model would be to market protection for frequent physiological impairments and functional limitations related to breast cancer therapy; to give instruction to facilitate early diagnosis of impairments; to present rehab and exercise intervention when bodily impairments are recognized; and also to encourage and encourage physical activity and exercise behaviours throughout the trajectory of illness treatment and survivorship.

Upper Extremity Infection – Around 7 out of 8 people who undergo surgery for breast cancer encounters recurring shoulder or arm issues, amongst others. Issues that may endure up to 1 year following operation include scar stiffness, oedema from the axilla, and neck-shoulder pain. Include carrying, lifting, and accomplishing. Physical therapy treatment ought to be prescribed based on the requirements of the individual and can include

• an assortment of motion and strengthening exercises
• Soft tissue and joint mobilizations
• Functional training & Postural evaluation

In-home workout programs, specific rehabilitation protocols along with physical treatment are required for breast cancer survivors.

Power and Mood Disturbances – Muscle fatigue and mood disturbances frequently occur secondary to cancer. Cantarero-Villanueva et al published a randomized controlled trial in 2011 that analysed the efficacy of an 8-week physical treatment program that concentrated on core stability exercises and myofascial release/massage on bodily (intensity) and emotional (disposition) results in breast cancer survivors. According to their analysis, the authors reasoned that a multimodal program focusing on core stability massage and strengthening decreased fatigue, anxiety and depression, and improved strength and vitality, both in the close of the analysis and in a 6-month follow-up. The protocol which the writers used can be observed.

How Can Physical Therapy Help?

Even physical therapy might help. Prehabilitation is described as care period between the time of real and identification of cancer therapy. The evidence is showing that the outcomes of a therapy can enhance. 4,5 therapy in prehabilitation’s Objective would be to:

• Evaluate baseline dimensions – ROM of shoulders backbone, and circumference of upper extremities.
• Identify any impairments that might influence healing like muscle fatigue, postural pain, and dysfunction.
• Teach in lymphedema and hazard reduction.
• Establish a workout program before and the following operation.

Post-Surgical Physical Therapy

The objective of physical therapy following surgery and through cancer therapy (chemotherapy, radiation) will be to minimize the side effects listed above and to maximize function. Physical Therapy interventions include

• Exercise – Exercise through each of the stages (before, during and following) is of critical significance and has been demonstrated to decrease or eliminate the unwanted effects of therapy.  Physical treatment will offer an individualized application with objectives.
• Manual Therapy – Manual Therapy is described as skilled hands-on therapy into the joints, tendons, fascia, and scar. This could aid with pain array of movement and
• Postural Training – Physical treatment will tackle the postural adjustments after an operation with postural exercises and ergonomic evaluations.
• Lymphedema Therapy – This therapy incorporates manual lymphatic drainage, compression bandaging, test for clothes, and education in exercise and self-care.