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ONCOlOGY 347
Table 5-9. Surgical Inrcrvcnrions for Breasr Cancer
Surgical lnrcrvenrion
Tissues Involved
Radical l11
Removal of breast tissue, skin, pecroralis
major and minor, rib. and lymph nodes
Modified ratilcal m3'ireCromy
Remov31 of breast. skin, and sampling
axillary lymph nodes
Slillpic or ror;]1 m::t'irectol11)1
Removal of breast, then, in another procedure,
a sampling of [he axillary lymph nodes
Partial ma<;teclOmy
Removal of tumor and surrounding wedge
of tissue
LUIllPCCrol11Y or local wide
Removal of rumor and axillary lymph nodes
eXCISion
resection in separ3re procedure
Reeo Il!) t r lIet i on-i 111 pi all (5
Saline implanred surgically beneath the skin
or muscle
Rcconsrrunion-l11u.,clc nap
Muscle from stomach or back, including
rrnn!)fcr
layers of skin fat and fascia, transferred to
crcate a breast
Clinical Tip
• The physICal therapist should check the physician's
orders regarding upper-extremity range-of-motion restriclions, espeCially with muscle transfers. The therapist mUSt
know what muscles were resected or transferred during
the procedure, the location of the incision, and whether
there was any nerve involvement before mobilization.
Once this Information is clarified, the therapist should
proceed to assess the range of motion of the shoulder and
neck region, as it may be affected during surgical interventions for breast cancer.
• Pallents may exhibit postoperative pain, lymphedema,
or nerve injury due to trauma or traction during the operative procedure.
• Postoperative drains may be in place immediately after
surgery, and the physical therapist should take care to
avoid manipulating these drains. Range-of-motion exercises may cause the drain to be displaced.
348 ACUfE CARE HANDBOOK FOR PHYSICAl TI-IERAl'lsrs
•
Incisions, resulting from muscle transfer flaps involving
the rectus abdominis, pectoralis, or latissimus dorsi,
should be supported when the patient coughs.
• The physical therapist should instruct the patient in the
logroll technique, which is used to minimize contraction of
the abdominal muscles while the patient is getting out of
bed. The therapist should also instruct the patient to minimize contraction of the shoulder musculature during
transfers.
•
Lymphedema may need to be controlled with lymphedema massage, elevation, exercise while wearing nonelastic wraps, elastic garments, or compression pneumatic pumps, especially when surgery involves lymph nodes that
are near the extremities. These techniques have been
shown to be of value in decreasing lymphedema."-2' Circumferential or water displacement measurements of the involved upper extremity may be taken to record girth
changes and to compare with the noninvolved extremity.
• The physical therapist should consider the impact of
reconstructive breast surgery on the paticnr's sexuality,
body image, and psychological state.'
Gastroillteshllai and Gellitouri,.,ary Callcers
Gastrointestinal cancers can involve the esophagus, stomach, colon,
and rectum. Cancers of the liver and pancreas, although considered
gastrointestinal, will be discussed separately. Genitourinary cancers
can involve the uterus, ovaries, testicles, prostate, bladder, and kidney.
Surgical procedures used to treat genirourinary cancers arc listed in
Table 5-10; surgical procedures used to treat gastrointestinal cancers
are described in Table 5-11.
Clinical Tip
•
Patients with genitourinary cancer may experience urinary incontinence. Bladder control training, pelvic Aoor
exercises, and biofeedback or electrical stimulation may be
necessary to restore control of urinary flow. 22-24