Basic Skills to Manage Breast-Cancer-Related Edema
Presented by Linda T. Miller
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Meet your instructor
Linda T. Miller
Linda T. Miller, PT, DPT, CLT, served as the founder and clinical director of the Breast Cancer Physical Therapy Center in the Philadelphia area for over 20 years. She has over 300 hours of training in lymphedema management and has been an international student of lymphedema, including training in the UK, Italy, Spain,…
Chapters & learning objectives
1. Etiology of Breast-Cancer-Related Edemas
At the root of swelling following treatment for invasive breast cancer is the surgical removal of lymph nodes. However, not all who undergo this procedure develop persistent lymphedema. Those that do can benefit from treatments tailored to the specific precipitating event.
2. Microcirculation and the Lymphatics
Breast-cancer-related edema may occur in the tissue of the UE and its adjacent trunk. Normal tissue fluid balance will be discussed as will the specific hemodynamic imbalances that have been demonstrated in breast-cancer-related edema. An understanding of the pathophysiology of this condition will help dictate appropriate treatment options.
3. A Deep Dive into the Pathophysiology Breast-Cancer-Related Edema
The pathophysiology of breast-cancer-related edema, specifically the role that venous insufficiency plays in many cases, separates it from other lymphedemas. Understanding the contribution of impaired lymphatic flow and venous return, including what happens when edema presents, is an underpinning to determine treatment choices.
4. The Six Tenets of Edema Management
Effective edema management is rooted in a good understanding of the anatomy and physiology of edematous tissue and the impact treatment techniques have at the tissue level. Chronic edema is defined by its high protein content. Fibrinogen, the foundation of fibrin, is excessive in chronic edema. Fibrin is scar tissue. Thinking of chronic edema management as “scar modification,” including making permanent changes at the tissue level over time, reframes the treatment rationale and expected outcomes.
5. New Insights into Treatment Options
New diagnostic imaging and research on treatment techniques have given fresh insight into treatment options and the application of treatment options depending upon edema presentation, including size of the limb and tissue texture. A variety of treatments will be presented, including the current evidence of their effectiveness.
6. Using Clinical Findings to Develop Guidelines for Treatment Options
Evolving data suggests that modifying treatment programs, including frequency, intensity, and specific elements to choose may lead to better long-term compliance and outcomes. This chapter includes a discussion on how the timing of the onset, location of the edema, size of the limb, and tissue texture can be used to develop a tailored edema management program.
