3. breast cancer: Scranton 2026

what is the second leading cause of cancer deaths

breast cancer

breast cancer: cancer origin; clinical signs/symptoms

Primary Bone Disease

Curative

Primary Goal: Tumor Control

Secondary Goal: Functional Outcome

Metastatic Bone Disease

Impending pathological fracture

Existing pathological fracture

Restore skeletal strength

Pain management

Limb salvage versus amputation

BIPHOSPHONATES: a group of drugs often used to treat osteoporosis.  These drugs have the ability to block the progression of tumor cells in the bone, leading to dramatically fewer bone lesions and bone fractures in patients with bone cancer who take them.  In the bones, the osteoclast cell is stimulated by the cancer to break down and resorb bone matrix and calcium, leading to pain and fractures.  These drugs block the osteoclast cells and keep the bones strong.  Bisphosphonates tend to work well with osteolytic metastases.  They don't work as well for treating osteoblastic metastases.

Rehab Implications:

Reinforce WB’ing precautions  Gait   Bed mobility and *transfers (trapeze, bedrails)

Monitor for radicular/neurological symptoms  Monitor  weakness due to compression of spinal cord or nerve roots

(summary of ortho)…Exact surgical procedure: Know what muscles, nerves, and vascular supplies were affected. Know your anatomy! Ex. Excision included resection of part of obturator nerve- ↓ ability to contract adductors.  Needed to teach compensatory mechanisms (leg lifter). ↓ sensation medial thigh

Pt may have skin grafts, pedicle muscle flaps, bone grafting, or hardware placement for soft tissue/bony defects.

WB status: Mrs. F. Soft tissue resection- reconstruction performed with gastroc. NWB, since any type of WB would cause disruption to the reconstructed site.

Communication: Mrs. E- calcaneal tumor excision.  Ortho saying ok to transfer bed-chair, but plastics requesting a specific dangling protocol first to ensure integrity of the flap.

Monitoring for sites of infection especially important for patients that are receiving Chemo/RT.

There are several surgical procedures we will discuss.  The goals of surgery are to remove the primary tumor, achieve clean margins meaning at least 2-3 cm approx. 1” of tissue surrounding tissue is removed, and to maximize functional status.  Sometimes it is necessary to have wide margins meaning more than 1” of surrounding tissue is removed.

Remove tumor

Achieve clean margins

Pain control

Maximize functional status

most aggressive and worst prognosis

Triple negative Breast Cancer

types of breast cancer:

ductal breast cancer (origin, types, percent)

lobular breast cancer (origin, types, percent)

triple negative breast cancer (tell me about it; percent)

inflammatory breast cancer (percent)

breast cancer diagnosis

sentinel node biopsy

With the dye, the first couple that it touches are the sentinel nodes

axillary node dissection

breast cancer treatment options:

types of breast cancer surgery

types of hormone therapy for breast cancer

A forequarter amputation is removal of entire upper extremity, scapula, and clavicle.  It is indicated for lesions of shoulder girdle and proximal humerus.  OT will be involved in creating a shoulder prosthesis for cosmetic purposes.  PT treatment will focus on safety with mobility particularly balance since there is a change in body weight distributi

Indications: lesions of the scapula and proximal UE with involvement of neurovascular bundles and/or chest wall

on. MENTION PROSTHESIS

tissue expander (what is it, type of graft)

Rotationplasty is another limb salvage procedure.  This is performed with tumors of distal femur whose skeletal growth is not yet complete.  The femur is amputated at the proximal growth plate.  The tibia is then rotated 180 degrees and then fused to the femural stump.

❑Indications

❑Tumors of the distal femur

❑Age of patient

❑Procedure

❑Amputation of limb at distal femur

❑Rotate tibia and reinsert to residual limb

latissimus flap (indication and procedure)

Pedicle Tram

free/muscle sparing tram

DIEP tram

lymphedema: what is it; location

lymphedema risk factors

lymphedema: complete decongestive therapy

rehab implications

breast cancer: metastatic disease: common sites, when it may develop

breast cancer: metastatic disease: PT implications

Tight cord in axilla: axillary cord syndrome (fibrosis of something) – shell have pain with movements, shes also newly diagnosed so she may be emotional

Measure ROM, strength in arm, do DASH, think about sensation

outpatient PT initial evaluation based on case study

2. outpatient PT initial evaluation based on case study

treatment plan and goals

This is where we would be practicing

goal sessionL: what shes impaired doing, life goals at home and as a parent, improving posture and biomechanics

treatment plan

In 4 weeks patient will have a verbal decrese in pain by 3 points – with PT it would be with the treatment of PT – can do some desensitixationtechniques, also just increase in strength and ROM will help

In 2 weeks patient will improve AROM and PROM by 10 degrees in order to promote increase functional independence

Increase in strength in scapulat: serratus anterior

We think that there was a development of metastasis (usually worse at night (more fluid retention at night) , gets worse instead of better)

If you aren’t treating her arm, we are now treating the back pain (teaching spine precautions, log rolling techniques, function, maybe using a walker for better posture and give her most support)