1MA
REVAKI
Physiotherapy in internal diseases
OEDEMA TREATMENT – H. VERBELEN, N. GEBRUERS
YORICK VAN HULST
,Physiotherapy in Internal Diseases 1e master jaar Revaki UA
1 INHOUDSOPGAVE
2 HC 1 – Breast cancer and lymphedema .................................................................................. 3
2.1 Breast Cancer .......................................................................................................................... 3
2.1.1 Introduction ..................................................................................................................... 3
2.1.2 What is breast cancer? .................................................................................................... 4
2.1.3 Types of breast cancer? ................................................................................................... 4
2.1.4 Metastases ...................................................................................................................... 4
2.1.5 Risk factors ...................................................................................................................... 4
2.1.6 Diagnosis.......................................................................................................................... 6
2.1.7 TNM staging system ........................................................................................................ 7
2.1.8 Treatment ........................................................................................................................ 8
2.1.9 Survival .......................................................................................................................... 12
2.2 Arm lymphedema after breast cancer .................................................................................. 13
2.2.1 Definition ....................................................................................................................... 13
2.2.2 Incidence ....................................................................................................................... 13
2.2.3 Risk factors .................................................................................................................... 15
2.2.4 Complications ................................................................................................................ 15
3 HC2 – evaluation, prevention and treatment of lymphedema .............................................. 17
3.1 Evaluation .............................................................................................................................. 17
3.1.1 Circumference measurements ...................................................................................... 17
3.1.2 Water displacement method ........................................................................................ 18
3.1.3 Perometer...................................................................................................................... 19
3.1.4 Tonometer ..................................................................................................................... 19
3.1.5 Ultrasound ..................................................................................................................... 20
3.1.6 Lymphoscintigraphy ...................................................................................................... 20
3.1.7 Lymphofluoroscopy ....................................................................................................... 21
3.1.8 CT/MRI ........................................................................................................................... 21
3.1.9 Questionnaires .............................................................................................................. 21
3.2 Prevention ............................................................................................................................. 22
3.2.1 Identify patients at risk.................................................................................................. 22
3.2.2 Preventive treatment of patients at risk ....................................................................... 23
3.3 Treatment .............................................................................................................................. 27
3.3.1 Decongestive lymphatic therapy ................................................................................... 27
3.3.2 Intermittent pneumatic compression ........................................................................... 30
3.3.3 Elevation ........................................................................................................................ 30
1
,Physiotherapy in Internal Diseases 1e master jaar Revaki UA
3.3.4 Lymphtaping .................................................................................................................. 30
4 HC3 – Arm en breast morbidity after breast cancer .............................................................. 31
4.1 Epidemiology ......................................................................................................................... 31
4.1.1 Loss of mobility .............................................................................................................. 31
4.1.2 Pain ................................................................................................................................ 32
4.1.3 Loss of strength ............................................................................................................. 34
4.1.4 Shortened muscles ........................................................................................................ 35
4.1.5 Sensory disturbances..................................................................................................... 36
4.1.6 Axillary web syndrome .................................................................................................. 37
4.1.7 Scapula alata.................................................................................................................. 38
4.1.8 Seroma........................................................................................................................... 39
4.1.9 Breast edema................................................................................................................. 39
4.1.10 Conclusion ..................................................................................................................... 40
4.2 Prevention and treatment ..................................................................................................... 41
4.2.1 Information.................................................................................................................... 41
4.2.2 Stretching and mobilization AWS .................................................................................. 41
4.2.3 Mobilization ................................................................................................................... 41
4.2.4 Soft tissue techniques ................................................................................................... 41
4.2.5 PNF ................................................................................................................................ 41
4.2.6 Scar tissue treatment .................................................................................................... 41
4.2.7 Posture exercices........................................................................................................... 41
4.2.8 Exercise program ........................................................................................................... 42
4.2.9 Conclusion ..................................................................................................................... 42
2
, Physiotherapy in Internal Diseases 1e master jaar Revaki UA
2 HC 1 – BREAST CANCER AND LYMPHEDEMA
Upper limb lymphedema
2.1 BREAST CANCER
2.1.1 Introduction
- 10% of all cancers worldwide are breast cancers (GloboCan 2002)
- 35% of all cancers in women are breast cancers
- 1 man for every 100 women gets diagnosed
- 2014: 91 men and 10466 women with breast cancer in Belgium (www.kankerregister.org)
- ! Incidence is increasing !
Survival after breast cancer
- Survival = % of survivors on the long term
- 5 year survival in Belgium:
o 88,0% in women
o 78,2% in men
- Good survival compared to other cancers
- Importance of QOL is growing
- Prevention and treatment of complaints related to breast cancer and its treatment
3
REVAKI
Physiotherapy in internal diseases
OEDEMA TREATMENT – H. VERBELEN, N. GEBRUERS
YORICK VAN HULST
,Physiotherapy in Internal Diseases 1e master jaar Revaki UA
1 INHOUDSOPGAVE
2 HC 1 – Breast cancer and lymphedema .................................................................................. 3
2.1 Breast Cancer .......................................................................................................................... 3
2.1.1 Introduction ..................................................................................................................... 3
2.1.2 What is breast cancer? .................................................................................................... 4
2.1.3 Types of breast cancer? ................................................................................................... 4
2.1.4 Metastases ...................................................................................................................... 4
2.1.5 Risk factors ...................................................................................................................... 4
2.1.6 Diagnosis.......................................................................................................................... 6
2.1.7 TNM staging system ........................................................................................................ 7
2.1.8 Treatment ........................................................................................................................ 8
2.1.9 Survival .......................................................................................................................... 12
2.2 Arm lymphedema after breast cancer .................................................................................. 13
2.2.1 Definition ....................................................................................................................... 13
2.2.2 Incidence ....................................................................................................................... 13
2.2.3 Risk factors .................................................................................................................... 15
2.2.4 Complications ................................................................................................................ 15
3 HC2 – evaluation, prevention and treatment of lymphedema .............................................. 17
3.1 Evaluation .............................................................................................................................. 17
3.1.1 Circumference measurements ...................................................................................... 17
3.1.2 Water displacement method ........................................................................................ 18
3.1.3 Perometer...................................................................................................................... 19
3.1.4 Tonometer ..................................................................................................................... 19
3.1.5 Ultrasound ..................................................................................................................... 20
3.1.6 Lymphoscintigraphy ...................................................................................................... 20
3.1.7 Lymphofluoroscopy ....................................................................................................... 21
3.1.8 CT/MRI ........................................................................................................................... 21
3.1.9 Questionnaires .............................................................................................................. 21
3.2 Prevention ............................................................................................................................. 22
3.2.1 Identify patients at risk.................................................................................................. 22
3.2.2 Preventive treatment of patients at risk ....................................................................... 23
3.3 Treatment .............................................................................................................................. 27
3.3.1 Decongestive lymphatic therapy ................................................................................... 27
3.3.2 Intermittent pneumatic compression ........................................................................... 30
3.3.3 Elevation ........................................................................................................................ 30
1
,Physiotherapy in Internal Diseases 1e master jaar Revaki UA
3.3.4 Lymphtaping .................................................................................................................. 30
4 HC3 – Arm en breast morbidity after breast cancer .............................................................. 31
4.1 Epidemiology ......................................................................................................................... 31
4.1.1 Loss of mobility .............................................................................................................. 31
4.1.2 Pain ................................................................................................................................ 32
4.1.3 Loss of strength ............................................................................................................. 34
4.1.4 Shortened muscles ........................................................................................................ 35
4.1.5 Sensory disturbances..................................................................................................... 36
4.1.6 Axillary web syndrome .................................................................................................. 37
4.1.7 Scapula alata.................................................................................................................. 38
4.1.8 Seroma........................................................................................................................... 39
4.1.9 Breast edema................................................................................................................. 39
4.1.10 Conclusion ..................................................................................................................... 40
4.2 Prevention and treatment ..................................................................................................... 41
4.2.1 Information.................................................................................................................... 41
4.2.2 Stretching and mobilization AWS .................................................................................. 41
4.2.3 Mobilization ................................................................................................................... 41
4.2.4 Soft tissue techniques ................................................................................................... 41
4.2.5 PNF ................................................................................................................................ 41
4.2.6 Scar tissue treatment .................................................................................................... 41
4.2.7 Posture exercices........................................................................................................... 41
4.2.8 Exercise program ........................................................................................................... 42
4.2.9 Conclusion ..................................................................................................................... 42
2
, Physiotherapy in Internal Diseases 1e master jaar Revaki UA
2 HC 1 – BREAST CANCER AND LYMPHEDEMA
Upper limb lymphedema
2.1 BREAST CANCER
2.1.1 Introduction
- 10% of all cancers worldwide are breast cancers (GloboCan 2002)
- 35% of all cancers in women are breast cancers
- 1 man for every 100 women gets diagnosed
- 2014: 91 men and 10466 women with breast cancer in Belgium (www.kankerregister.org)
- ! Incidence is increasing !
Survival after breast cancer
- Survival = % of survivors on the long term
- 5 year survival in Belgium:
o 88,0% in women
o 78,2% in men
- Good survival compared to other cancers
- Importance of QOL is growing
- Prevention and treatment of complaints related to breast cancer and its treatment
3
