One of the most terrifying moments in life must be when you hear the words, “I’m afraid that you have cancer”. The message would naturally trigger a cacophony of thoughts and emotions that could only be somewhat controlled by the knowledge that there is treatment that will tackle the cancer.
In the case of breast cancer, the treatment options depend upon the individual circumstances, for example:
- The type of breast cancer you have
- The size of your breast tumour
- The stage of your breast cancer
- The grade of your cancer cells
- Whether you have had your menopause
- Whether your cancer cells have particular receptors
- Your general health
Many people diagnosed with breast cancer will have surgery. There are different types of breast surgery that are performed and this is fully discussed with the individual, taking into consideration their circumstances and wishes.
Following breast surgery, either a mastectomy or involving the armpit, you will be encouraged to start moving your arm that can become stiff and sometimes painful. There can also be swelling as a result of the procedure. Of course these symptoms are common after any surgery but the arm is affected due to the removal of tissue that involves the chest and the arm and will certainly impact upon the local nerve network. There can also be cording that is tissue that becomes ‘cord-like’ through the axilla that can sometimes be seen on lifting the arm.
Understandably there is some pain after the surgery, this being controlled with medication. There are several mechanisms that can contribute to this experience, from both the wound and from the local nerves that become sensitised; neuropathic pain. These different pain mechanisms need different approaches and thought behind the therapies that can help.
Neuropathic pain is often described as burning, lancinating, spontaneous (ectopic firing that results in sudden pain with no obvious provocation) and altered sensation. This type of pain can lead to central sensitisation that in short can result in amplified responses to painful stimuli, painful responses to normally innocuous stimuli and a reduced ability to inhibit signalling. Concurrent with the pain, one can also experience an altered sense of the affected area, a frequent feature of persisting pain–although often not volunteered by the patient for fear of disbelief.
The change in the sense of body is a genuine and significant part of the scenario–I always ask patients. If a patient describes an altered perception of their body, a wise therapist takes note as this description demonstrates a change in the way that the brain is constructing the sense of self. Following surgery for breast cancer it is often the arm that feels strange; perhaps detached, alien, larger or lacking in control. This is a characteristic that needs attention and specific training as part of the desensitisation process and restoration of function, or normality. Understandably, there maybe other concerns following breast surgery, such as coping and adapting to a different body shape and form and in particular what this signifies to the individual.
Post-operative physiotherapy and rehabilitation in these cases necessitates techniques and strategies that focus on tissue health and healing, but also upon the controlling systems that process the signals from the body and create the experiences: the nervous system and the immune system. The development of modern therapies for persisting pain play a significant role in retraining normal body perception so that the affected area can once again feel part of the integrated self and function normally.