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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