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Questions to the doctor about rehabilitation after mastectomy

Surveys BEFORE THE OPERATION and before treatment, see HERE

You have undergone breast cancer surgery (for cancer): you have saved your breast or removed it completely. Now you need to make sure that your disease does not return, and if it all the same happens - to "catch" this moment at an early stage.

Observation after breast cancer surgery

Before the operation, you underwent examinations to detect possible metastases: checked your lungs, liver, and bones. But metastases could be very small and go unnoticed.

The quality of research depends on the equipment, training of a specialist and on his motivation to do his job as efficiently as possible.

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Then you received additional treatment (chemotherapy, hormone therapy, targeted treatment, radiation therapy). All these measures were aimed - to kill possible metastases. But to guarantee the success of treatment is 100% impossible. Unbroken tumor cells might remain.

If they stayed, they will grow. At first, they can be identified only by the results of surveys and do not manifest themselves in any way. If they were not sought or not noticed, they will begin to destroy those organs - in which they are located, and then signs of the disease of these organs will begin to appear.

It is better for the patient to identify the return of the disease according to the results of examinations, and not when complaints appear - when the tumor metastasis has not yet destroyed the organ. Then the treatment will be more effective.

When to be examined after breast cancer surgery

If you have not undergone a full examination before the start of treatment, go through it at least during the treatment: of course, you may not even notice something (it has become invisible during treatment), but at least you will get the results of the correct examinations, with which you can will compare the subsequent ones, and if something comes to light, we will at least have a clear understanding of the true state of your illness and (if necessary) we will correct further treatment.

For more information on how you should be examined before the operation, see HERE

It is advisable to perform the first examination 3 months after the completion of chemotherapy and / or radiation therapy: it is unlikely that metastases will grow during treatment with these methods: they are quite effective. Then do them in the rhythm below.

Oksana Antonovna, what complex of rehabilitation measures is indicated in the postoperative period? What are the contraindications and limitations?

To begin, let's discuss what are the main changes in the body of a woman:

  • Shoulder stiffness and poor posture
One of the complications of radical treatment for breast cancer is stiffness of the shoulder joint as a result of the scarring process in this area. Clinical manifestations of stiffness are pain when trying to lift and raise the arm. Shoulder stiffness and impaired posture are most successfully eliminated by performing exercises of therapeutic exercises, a special set of exercises in water, using compression-elastic bandages and a posture corrector.

  • Lymphatic edema, lymphostasis
  • To increase the effectiveness of the operation during a mastectomy, not only the tumor is removed, but also the lymph nodes, blood vessels, and also, if necessary, part of the pectoralis major and minor muscles, cartilage tissue. As a result of the operation, there is a difficulty in the outflow of lymph, it accumulates in the area of ​​surgical intervention and the upper limb, can be allocated from the postoperative wound in the form of lymphorrhea, and subsequently manifests itself as lymphophasis of the hand.

    One of the serious complications of the radical antitumor treatment of breast cancer is the development of lymphatic edema (secondary lymphedema) of the upper limb on the side of the operation. In this case, immediately after a radical mastectomy, the latent period can be from 1-2 weeks to several years. In patients with late edema, in most cases, a violation of the venous outflow in the axillary-subclavian segment of the vein is detected, which is explained by the development of cicatricial changes.

    Prevention and treatment of lymphatic edema of the upper extremities are an integral component of rehabilitation. The tactics of carrying out rehabilitation measures and the sequence of procedures may vary depending on the presence of concomitant complications (erysipelas) and the stage of edema. To consolidate the results of treatment, a prerequisite is the wearing of a compression sleeve. The use of a sleeve for lymphostasis will not solve the problem itself, but in a short time it will bring relief to the patient: quickly and effectively relieve swelling, reduce pain, thereby significantly improving the quality of life. At all stages of the development of the process, hydrokinesis therapy in a swimming pool and therapeutic gymnastics are required the condition of which is also the use of a compression sleeve.

    Contraindications in the treatment of lymphatic edema: - Patients with relapse / metastases should not be treated for relieving lymphatic edema, so as not to provoke further spread of the tumor,

    - Patients with a history of cardiovascular disease, as well as those taking anticoagulants, must undergo ultrasound and Doppler examination before treatment to exclude deep vein thrombosis. During treatment, they must timely pass all necessary tests (prothrombin time, etc.,

    - If pain occurs, treatment should be stopped until the causes are clarified and the pain stopped,

    - Erysipelas is also a contraindication to the use of compression therapy,

    • Hydrokinesitherapy (pool)
    After the operation to remove the mammary gland, the attending physicians and physiotherapists recommend starting swimming as soon as possible. For medical gymnastics, all types of swimming are recommended, but primarily breaststroke. Regular long swimming exercises in a gentle mode lead to physical strengthening of the body and improvement of posture.

  • Physiotherapy
  • After surgery, women often have problems with the spine, lower back pain, shoulders and muscles. Therefore, it is recommended to do gymnastics. You need to do it regularly on a daily basis for 10-15 minutes in a well-ventilated area and in comfortable clothes.

    Rehabilitation after a mastectomy can be completed quickly and efficiently using modern exoprosthetics. A correctly selected prosthesis not only allows a woman to feel confident, but also is a therapeutic and prophylactic agent that promotes rapid postoperative adaptation. Such a prosthesis compensates for weight imbalance, preventing secondary deformations of the body (violation of posture, curvature of the spine, drooping shoulders, etc.).

    Contraindications to exoprosthetics are:

    - progression of the underlying disease,

    - relapse into a postoperative scar,

    - complications after complex treatment: the divergence of the edges of the postoperative wound as a result of repeated courses of chemotherapy or radiation therapy according to the radical program,

    In addition to a properly selected exoprosthesis, special underwear is of great importance, the main function of which is the reliable fixation of the exoprosthesis. Special bras are designed for use with exoprostheses and provide the necessary safety and comfort when wearing these prostheses. Special design straps: they have lining, are expanded in the shoulder area, do not cut into the skin, reduce pressure on the shoulders, preventing lymphedema. The bra should fit tightly so that the prosthesis does not change position when moving and tilting. The main thing in choosing a bra is functionality that does not exclude attractiveness.

    Loss of the mammary gland is not only a physical disability, but also a severe mental trauma that affects the adaptation of women in everyday life and society. Women who have undergone a mastectomy tend to exaggerate the cosmetic consequences of the operation, negatively assess their appearance, focus on the changed, in their opinion, attitude of others around them.

    Approximately 25% of women after a mastectomy experience severe depression (difficulties in reconciling with their appearance, with breast loss, fear of relapse), up to and including thoughts of suicide. The inability to reconcile with the incident and return to normal life requires the help of an experienced psychotherapist. At the same time, quick and effective cosmetic correction of a postmastectomy defect (exoprosthetics and selection of specialized underwear) can reduce the level of astheno-anxiety-depressive state, which contributes to the successful adaptation of women in everyday life and society.

    Among the psycho-corrective methods of rehabilitation, one should single out those that prevent self-isolation processes and immersion in the disease. From these positions, any type of psychotherapy should be carried out in vivo group communication, allowing to remove the inferiority complex and believe in recovery. At the stage of active rehabilitation, it is necessary to create conditions for attracting women to specialized groups of recreational swimming. Of particular importance in overcoming depression belongs to the climatic factors of spa treatment. Once in a new setting of a sanatorium-resort institution, patients cease to fix their somatic sensations and quickly get out of a difficult stressful situation. As a rule, after a correct (based on belief in recovery) complex of rehabilitation measures, post-mastectomy depression can be overcome.

    Mammography or MRI of the mammary glands

    Or alternating mammography with MRI - for early detection of a possible relapse of a tumor in the stored mammary gland, the following are performed:

    • Premenopausal women (operated breast) every 3-6 months for the first 3 years, then annually. Healthy m / gland - annually,
    • Postmenopausal women (both mammary glands) - 1 time in 6-12 months.

    For patients who have been operated on in our Center, we install special titanium marks in the bed of the removed tumor in order to see this place under control mammograms (CT) and pay closer attention to it for relapse (only during organ-guarding operations). These labels do not interfere with MRI.

    Mammograms with labels (staples, clips) in the bed of the removed tumor. In control studies (by these marks), more attention is paid to the area of ​​the removed tumor. In addition, these marks are used to focus the apparatus for radiation therapy - during irradiation after surgery to remove a breast cancer tumor.

    How long after surgery can I choose and wear a silicone exoprosthesis?

    The primary mammary gland exoprosthesis is intended for the early rehabilitation period (a few days after the operation) of soft cotton or microfiber. There are many bras for primary compensation with a pocket for a prosthesis made of cotton and microfiber for different tastes. Fashionable design, functionality and optimal reliability will help to solve the problem for the first time after a mastectomy.

    For permanent use, silicone breast exoprostheses are best suited, ideally providing a sense of naturalness and reliability. Exoprostheses have almost all the characteristics that are characteristic of a healthy mammary gland: color, texture, shape, surface, elasticity. New generation exoprostheses have a soft inner surface that provides minimal touch and friction with their own tissues, especially in the area of ​​the postoperative scar. External silicone prostheses completely imitate the nipple-areolar region of the gland. In the form of prostheses are round, drop-shaped, symmetrical, asymmetric, sectoral.

    Within two months after the operation, temporary lightweight prostheses are used that do not interfere with the healing of the sutures. Postoperative prostheses - lungs, do not interfere with the healing of sutures, do not injure the skin of the chest - are intended for temporary (2 months) use.

    Then various exoprostheses are prescribed according to indications:

    - for constant daily wear use 1 month after the operation,

    - special dentures for gymnastics and swimming,

    - prostheses, which can be recommended for large volumes of mammary glands - lightweight prostheses for women leading an active lifestyle. In addition, the use of lightweight prostheses is convenient in hot weather,

    - prostheses, which can be recommended for lymphatic edema of the hand on the side of the operation,

    - prostheses that can be recommended for cardiovascular diseases,

    Silicone prosthesis can and should be worn already 6-8 weeks after surgery. If the seam has completely healed - constantly. If a woman is undergoing radiation therapy or the postoperative scar has not yet fully formed - 2-3 hours a day. This will avoid the development of complications in the form of scoliosis.

    Today, there are symmetric (it is possible to use both on the right and left sides) and asymmetric (left and right) breast prostheses. The shape of symmetrical exoprostheses can be different: drop-shaped, oval, etc. The shape of asymmetric prostheses should fully correspond to the shape of a healthy breast.

    A correctly selected mammary gland exoprosthesis is not only a cosmetic product that helps women to hide postoperative tissue deficiency, but is also used as a therapeutic and prophylactic agent that helps to quickly adapt injured tissues. In combination with special underwear or a swimsuit, an exoprosthesis literally becomes part of the woman herself.

    What characteristics of the prosthesis are it important to focus on when choosing a manufacturer?

    Exoprostheses should be made of environmentally friendly modern materials that have passed strict dermatological and physiological control (have various quality certificates, for example, international - TUV).

    A good prosthesis is that prosthesis that you won’t think about for a minute.

    How many hours a day can you wear exoprostheses?

    The female breast is unique and differs not only in the volume of the cup, but also in its shape. To achieve the perfect fit and fit, most manufacturers offer three different forms of exoprosthesis cups - for mature, medium and full breasts.

    Women with a small volume under their breasts most often have full breasts, while women with a large volume under their breasts tend to have mature breasts.

    How to choose the right size of the exoprosthesis: First you need to measure the volume of the breast and determine the appropriate cup.

    Outdated orthopedic views on the need to eliminate weight imbalance after mastectomy by primitive selection of an exoprosthesis with the same mass are currently recognized as one of the reasons for the development of postmastectomy syndrome due to increased load on the vessels of the shoulder.

    The process of selecting an exoprosthesis consists of three steps:

    Keep in mind whether the fullness of the remaining breasts is: (1) mature, (2) medium full, or (3) full?

    Looking at the remaining mammary gland, you can determine which of the following forms are more suitable (if both mammary glands were removed, then what size and shape would a woman choose: (c) symmetric, (a) asymmetric (e) Additional volume, (y) universal.

    Generally speaking, symmetrical forms are better after a standard mastectomy, and an asymmetric breast shape is more suitable if lymph nodes and a large amount of tissue under the armpit have been removed.

    To determine the size and shape of the breast, it is necessary to measure the volume under the breast and the distance from the middle of the chest through the highest point of the remaining mammary gland, to the middle of the back, in order to determine the size of a suitable bra. The fit of the bra is crucial for giving the breast a natural shape, which is very important.

    When is a massage exoprosthesis recommended?

    The new ABC Massage Form exoprosthesis is one of the most fashionable and popular breast prostheses of this American brand, completely hiding any breast asymmetry that occurred after removal of part of the gland tissue during a mastectomy operation. These massage breast prostheses from the USA belong to the Pink Line ABC line and are an ideal breast form for women who want to feel more confident and easy in any environment, both statically and during sharp and heavy movements.

    The front layer of the ABC exoprosthesis Massage Form is made of light silicone, and the back layer of standard silicone. Каналы силиконового геля на заднем слое обеспечивают оптимальную циркуляцию воздуха и "массажный" эффект на стенки грудной клетки, что приводит к снижению количества пота в течение всего дня. Сама массажная форма протеза является асимметричной и заполняет дефицит ткани молочной железы, создавая максимальную безопасность от смещения и комфорт. Этот массажный экзопротез молочной железы лучше всего носить с бюстгальтером, обеспечивающим поддержку и фиксацию груди. Эффект постоянного массажа, создаваемого экзопротезом "АБС-массаж", особенно необходим женщинам, с лимфедемой и лимфостазом руки, образовавшимися после мастэктомии.

    Oksana Antonovna, what advice can you give on psychoemotional care for women after a radical mastectomy? How can a close environment help a woman survive the postoperative recovery period more comfortably?

    One of the serious consequences after a radical mastectomy is postmastectomy depression. Loss of the mammary gland is not only a physical disability, but also a severe mental trauma that affects the behavior of women in everyday life and society. Women who have undergone a mastectomy tend to exaggerate the cosmetic consequences of the operation, negatively assess their appearance, focus on the changed, in their opinion, attitude of others around them.

    Approximately 25% of women after a mastectomy experience severe depression (difficulties in reconciling with their appearance, with breast loss, fear of relapse), up to and including thoughts of suicide. The inability to reconcile with the incident and return to normal life requires, in some cases, the help of an experienced psychotherapist. At the same time, fast and effective cosmetic correction of a postmastectomy defect (exoprosthetics and selection of specialized underwear) can reduce the level of depression, which contributes to the successful adaptation of women in the family and society.

    Of the psycho-corrective methods of rehabilitation, it is worth highlighting those that impede the processes of self-isolation and immersion in the disease. From this point of view, all types of psychotherapy should be carried out in vivo group communication, allowing to remove the inferiority complex and believe in recovery. At the stage of active rehabilitation, it is necessary to create conditions for attracting women to specialized groups of recreational swimming, yoga therapy, etc. A special place in overcoming depression belongs to climatic factors in the spa treatment. Getting into the new environment of the sanatorium institution, patients quickly come out of a difficult stressful situation.

    As a rule, after the correct (based on belief in recovery) carrying out a complex of rehabilitation measures, post-mastectomy depression can be overcome.

    The “Pantry of Health” thanks for the interview Candidate of Medical Sciences, Associate Professor Oksana Antonovna Shabasova.

    Beginning of rehabilitation after mastectomy

    Before discharge from the hospital, patients are given recommendations for further treatment and follow-up.
    Rehabilitation begins immediately after the operation and includes physiotherapy, massage, physiotherapy of various sizes, psychotherapy, and, later, after removing the stitches, wearing the right prosthesis and underwear.
    Surgical treatment of a particular volume (organ-preserving or complete removal of the mammary gland) often leads to postoperative complications and functional disorders - a decrease in the range of motion in the upper limb on the side of the operation, edema (lymphostasis) of the upper limb and chest, pain, impaired posture, weakness soft tissue dysfunction, pain, fatigue.

    Conducting full-fledged rehabilitation in such patients helps to accelerate the healing process of the postoperative wound, reduce edema in the area of ​​the operation, improve lymph outflow, restore conduction in nerve structures affected by trauma, compression, reduce pain, prevent development and eliminate already formed stiffness and contracture. To achieve this, a special massage is carried out, a specially developed complex of physiotherapy exercises and physiotherapy procedures allowed for such patients are prescribed.

    Compression sleeve after mastectomy

    Compression therapy is the basis of treatment and prevention lymphedema ("Stagnation of lymph"). To choose the right model of compression hosiery will help only a rehabilitation doctor. Compression underwear in a short time will bring relief to a woman: relieve swelling, reduce pain, thereby improving the quality of life. While swimming in the pool and therapeutic exercises wearing a compression sleeve is mandatory. But there are some contraindications to compression therapy: erysipelas, the appearance of severe pain.

    Exoprostheses and special underwear after mastectomy

    Exoprostheses are artificial lining made of soft materials. They mimic the shape and size of the patient’s real chest. Exoprostheses are selected individually for each woman and are worn constantly after the permission of the attending physician. A correctly selected exoprosthesis will give a woman confidence, and will also become a therapeutic and prophylactic means of rapid postoperative adaptation.

    An exoprosthesis compensates for weight imbalance, preventing secondary deformations of the body, such as curvature of the spine, drooping shoulders, impaired posture. It is also worth noting the importance of special underwear that will fix the exoprosthesis. Special bras are worn with exoprostheses. They provide safety and comfort when wearing exoprostheses.

    The straps of special bras are lined, widened in the shoulder area, do not cut into the skin, reduce pressure on the shoulders, preventing lymphedema. The underwear should fit tightly so that when moving and tilting the prosthesis does not change position.

    Time for a silicone prosthesis

    Of course, patients are concerned with the question of when they can get silicone prostheses. In the first days after surgery, it is not recommended to wear them.
    Silicone prostheses are contraindicated for women undergoing radiation and chemotherapy. During this period, the sensitivity of scars and skin around the joints increases, sweating intensifies. Silicone pads do not absorb moisture well, so they can rub and cause inflammation. We recommend tissue prostheses that do not irritate the skin and accelerate recovery.
    Today it is possible to conduct reconstructive operations (simultaneous or delayed) using silicone endoprostheses. The tactics of such treatment should be discussed with your doctor.

    What is forbidden after a mastectomy

    There are many recommendations for the prevention of complications after surgery. It is better to consult with a specialist about this in each case.
    We will name only a few:
    DO NOT: measure the pressure on the arm from the side of the operation, wear rings, tight bracelets, watches, sleeves with elastic bands, bags at the elbow, shoulder, lift more than 2 kg with your hand on the side of the operation.
    DO NOT: sleep on the arm from the side of the operation.
    DO NOT: take blood, carry out infusion on the arm from the side of the operation.

    Diet and diet after mastectomy

    There are no well-studied diets that would be recommended for women after breast cancer treatment. However, some foods are best excluded from the diet: fatty foods, preservatives, alcohol. Intraday intake of omega-3 fatty acids (fish oil), selenium, and vitamin D is believed to make it easier to tolerate antitumor therapy.

    Tips for the rehabilitation of Western specialists.
    WebMd's Rehab Magazine focuses on proper nutrition and movement. At the end of 2018, the magazine published the basic rules for selecting a diet for patients after a mastectomy:
    To cope with loss of appetite, nausea, weakness after surgery, nutrition in small portions will help. Avoid solid foods at first, it is better to include yogurt and kefir in the diet.
    After mastectomy, women need protein, building material, an “assistant” in restoring strength and fighting infection.
    Protein is rich in lean meat. Despite the usefulness of cheese, nuts, excessive passion for them is fraught with the development of pancreatitis.
    Antioxidants protect cells from damage. They are found in broccoli, blueberries, carrots, liver, mangoes, tomatoes, apricots.
    Western and Russian doctors say that everything is useful, but in moderation. Abuse is unacceptable, because the opposite effect may occur!

    It is also known that there is no panacea for cancer. To treat oncology means to be observed by a doctor and strictly follow his recommendations.

    Sport, cottage, sea after removal of the mammary gland

    Exercise is useful for the physical and mental conditions of women after treatment. Especially suitable for swimming and water aerobics, Nordic walking. Avoid sports that use repeated vigorous, counteracting hand movements on the side of the operation (tennis, etc.), strong temperature fluctuations (skiing, ice skating). It is also better to exclude traumatic sports, basketball, volleyball, wrestling.

    After the removal of the mammary gland with the permission of the doctor, you must definitely do physical education. Weight gain - a chance to return breast cancer. It’s worth starting with walks.
    The main complex of exercise therapy:
    1. Before gymnastics, be sure to warm up the muscles:
    1) Sitting hands on knees, we squeeze fingers into a fist as much as possible, then we unclench, we relax and we repeat 5-7 times.
    2) Sitting, hands are bent at the elbows, fingers are relaxed: palms are turned with the back side up, then the palms are gently raised and lowered 7-10 times.
    3) Hands on shoulders, gradually raise and lower the elbows, 7-10 times.
    4) We press our hands to the body, smoothly raise and lower from 7-10 times.
    2. After warming up, the main complex.
    1) Alternately strain and relax the muscles of the arm. In the voltage phase, we try to linger for at least 3-4 seconds.
    2) We straighten the hand in front of us, then we take it to the side, lower it. When stretching - inhale, when lowering - exhale.
    3) Brushes on the shoulders, smoothly do circular movements clockwise, then - against.
    4) Start the wrists behind your back, slowly stretch your shoulder blades back.
    5) Hands are lowered, alternately doing circular movements with the shoulder joint, first clockwise, then counterclockwise.
    6) Sitting we try to raise a hand from the operated side. In the first classes, she can be helped with the other hand.
    7) We make the body tilt to the side of the operated side, hold for a couple of seconds in this position and return to the starting position. When tilting, exhale is done, while straightening, inhale.
    8) We lean our backs on the wall, raise our hands and try to spread them apart.
    9) With your back to the wall, raise your hand from the operated side up and linger a bit in this position. Each time we try to reach with this hand a little higher than in the previous lesson.

    When doing housework, gardening, or other work that could result in even minimal damage, use gloves. Try to avoid any hand injury on the side of the operation (bumps, cuts, sunburn or other burns, sports injuries, insect bites, scratches). Injury to the skin of the operated hand is dangerous infection and the development of erysipelas.
    Regarding rest at sea, climate change (trip to the south) - discuss with your doctor, because this is decided individually and only after treatment is completed.

    Terms of rehabilitation after mastectomy

    The duration of rehabilitation depends on functional disorders that occur after surgery.
    During rehabilitation, good psychological support from family and friends is important. This helps a woman quickly adapt to a new life situation.
    In oncology, it is very important after treatment that regular follow-up examinations as prescribed by the doctor.
    After the initial treatment, it is recommended to conduct an examination from 1 to 4 times a year (depending on the specific clinical situation) for the first 5 years, then annually.

    Ultrasound of the liver, zone of operation, zone of regional lymph nodes

    Supraclavicular, cervical, axillary, comparing the side of the operation with the opposite - to detect relapse of the tumor in the area of ​​the operation and the appearance of metastases in the lymph nodes (or MRI, CT of these zones - as more informative methods):

    • During the first 2 years - 1 time in 3 months,
    • The next 3 years - 1 time in 6 months,
    • Subsequent years - 1 time per year.

    Give space to emotions: psychologist's help after a mastectomy

    Psychologist "NMIC Oncology them. N.N. Blokhina »Ministry of Health of the Russian Federation Galina Tkachenko:

    - It is unlikely that there will be at least one person who will calmly accept the news of cancer. Tears, fear, depression, despair - this is a normal reaction. However, if the treatment is finished, the doctor says that you are healthy, but according to your feelings you don’t feel it, you need to consult a psychologist. Another reason to meet with a specialist is the difficulty with adapting to your usual life. If something interferes with your quality of life: you suffer from insomnia, constantly think about the disease, feel anxiety and fear for your future, cannot cope with depression, do not be shy or afraid to talk with a psychologist.

    Psychologist of the service "Clear Morning" Lyubov Cherkasova:

    - Our specialists, oncopsychologists, are also addressed before treatment. First, we figure out what the person’s emotional reaction to the news about the diagnosis is. Each is expressed in its own way. Someone is shocked by the heard and upcoming treatment, surgery. Someone withdraws into himself, closes, and someone says that this could not happen to him. In any reaction, you need to give room to emotions, give a person the opportunity to express their feelings, in a word - give space to emotions.

    When the emotional component is discharged, we move on to the information component. The psychologist clarifies that the patient knows about his illness, methods of treatment, complements his knowledge. If the disease is detected in the initial stages and can be treated, we say that now is the 21st century, if all the recommendations of doctors are followed, there is a good prospect.

    After emotions we pass to fears. Fears are different: what if it doesn’t help, but what if it helps, but then there will be a relapse? We express all fears. We always note that it is important to discuss everything with your doctor, ask him all questions, and not look for answers and recipes on the Internet.

    We are talking about the values ​​that were before the invasion of the disease. It can be anything - creativity, hobbies, professional activities. Even small things are important - for example, a person loved to bake cakes before an illness or appreciated a morning cup of coffee. Any detail, the simplest and at first glance insignificant, will then become that hook, for which we will pull a person to life. (This also applies to postoperative time).
    After a cure, people often experience apathy or depression. What caused this? A frequent situation: the patient imagined that when he hears the doctor’s joyful message about remission or healing, he will jump on one leg, throw a feast, invite everyone to the ball. But nothing! Passive reaction. “Well, yes, good and nothing more. Why is this happening, where have my feelings gone, ”the person thinks.
    No wonder: emotional resources were exhausted, wasted in the previous stages. The emotional system is exhausted. A pause is needed, and the body turns it on. This is normal, so you need to give this state to be! Some patients at this stage are afraid to fall into clinical depression. And the hooks that we spoke about before the start of treatment will help us - we remember things, deeds, interests that brought joy. Please, music, reading, walking. Do not be confused by such a commonplace as food. Yes, it can also bring joy, cheer up (of course, we only choose what is allowed by the doctor after the operation).
    I will give you one of the exercises that I often resort to:
    It consists of 8 questions, we execute it several times a day:

    • What do I see
    • What i hear
    • What do I touch
    • What do I smell
    • What taste in the mouth
    • What I feel
    • What would I like to do if there were no restrictions (first of all, material ones)
    • What will I actually do now

    This helps to recognize oneself, set the volume of emotions, set to search “what to do”, “where to look for yourself”.
    On average, working with a psychologist is 1 year. This includes consultations before treatment, during and after. It happens that patients return, for example, to work with the fear of relapse. But it happens that they “released” into life, and the patient found new interests or developed old ones, and no longer appears.

    Relatives and close friends, of course, can support a person with a diagnosis of cancer who defeats oncology. A careful, warm attitude is important. And remember that before treatment and after our loved one it is important to feel necessary and useful. This must be maintained and developed. It cannot be isolated or avoided, left alone with your thoughts, questions.

    Text: Alexandra Gripas

    Breast Cancer Blood Tests

    On: total calcium (increases with bone metastases), lactate dehydrogenase (LDH) and alkaline phosphatase - increase with distant metastases

    • During the first 2 years - 1 time in 3 months,
    • The next 3 years - 1 time in 6 months,
    • Subsequent years - 1 time per year.

    Breast tumor markers

    They are not a standard for examining breast cancer, as well as for diagnosing this disease: since with already proven signs of disease progression, they respond only in 1 out of 5 patients with advanced breast cancer: CEA and CA15-3:

    • the first 2 years - 1 time in 3 months,
    • the next 3 years - once every 6 months,
    • subsequent years - 1 time per year.

    You can read more about tumor markers HERE

    What are the most informative examinations for breast cancer

    Если позволяют Ваши возможности, вместо УЗИ печени и зоны операции на молочной железе, рентгенографии лёгких и сцинтиграфии костей скелета - можно выполнять более информативные исследования (разумеется, если делать их у грамотных и мотивированных специалистов на современном оборудовании):

    КТ (компьютерная томография) зоны операции, лёгких и печени, костей скелета (прицельно, после ОСГ),

  • МРТ (магнитно-резонансная томография) зоны операции (сохранённой молочной железы) и печени
  • ПЭТ (позитронно-эмиссионная томография) - after the operation (if it was not performed before it), then - 6 months after the operation for 3 years, then - annually.
  • Examination before breast surgery

    Breast recovery after removal can be done no earlier than 4 months after completion of radiation therapy and no earlier than 2 months after completion of chemotherapy (targeted treatment). In our institution, we do such quota operations as part of the compulsory medical insurance policy (for residents of all regions of the Russian Federation) and for a fee.

    Before such an operation, it is necessary to prove that your disease left you: CT of the chest, OSG, ultrasound of the liver. You can contact us with the results of these examinations to resolve the issue of reconstructive surgery.

    Oncologist examination and monitoring after breast cancer

    Demonstration of examination results (if something new was revealed that was not in previous surveys), paying special attention to long-term undesirable effects, in particular, manifestations of osteoporosis:

    • every 3-6 months during the first 3 years,
    • every 6-12 months - over the next 2 years,
    • further - annually.
    Prevention (treatment) of swelling of the hand after breast surgery, see HERE.

    DX oncotype and momma analyzes

    These tests - a molecular analysis of breast cancer - are done in developed countries by all insurance patients. The test results predict the effectiveness of the planned chemotherapy or hormone therapy.

    With in situ ductal carcinoma (DCIS) and invasive breast cancer (breast cancer), the test result appears as a scale with points where the risk of local recurrence is noted (the lower the score, the lower the risks). Based on this, it is sometimes possible to abandon the chemotherapy planned according to the traditional canons (with a low score) or, on the contrary, assign it to a patient when she was only scheduled to undergo hormone therapy (with a high score).

    A low test score demonstrates a low prospect from adding chemotherapy to hormonal treatment for a particular patient, while a high score indicates the potential benefits of chemotherapy.

    According to the test results, in 37% of the operated patients with breast cancer, the traditional subsequent planned treatment was changed (based on personalized data on the biological properties of the tumor).

    It is recommended for use by the American Society of Clinical Oncology® (ASCO®) and the National Comprehensive Cancer Network® (NCCN®).

    Genext recently opened its office in St. Petersburg. She offers a similar test - EndoPredict (Endo-Predict). The test is performed in Munich (Germany). For this, it is necessary to provide paraffin blocks of the tumor (breast cancer) and conclude an agreement. Price - 140 tons Tel Employee: 8 (965) 080-72-77, Andrey Vdovin.

    The ONCOTYPE DX and MAMMA PRINT tests are justified only:

    • for post- and premenopausal patients
      • with estrogen-positive tumor receptors (ER +),
      • lymph nodes not affected by metastases (No),
      • negative receptors for epidermal growth factor (Her2 / neu “-” or “1+”),
      • stage of breast cancer: ductal carcinoma in situ (DCIS), I, II and (sometimes) IIIa.
    • for postmenopausal patients
      • with minor damage to the lymph nodes,
      • with estrogen or progestin-positive tumor receptors (PR + and / orER +),
      • negative receptors of epidermal growth factor (Her2 / neu "-" or "1+").

    Read more about the Oncotype DX and MammaPrint tests HERE. For citizens of our country, analysis can be performed only on a paid basis (about 4.100 USD). We can assist in organizing these analyzes.

    Anastrozole, femara prescribed

    Hormone therapy is not tamoxiifen and not torimefen. These drugs can provoke osteoporosis (which may be without them): OSG (osteoscintigraphy) of skeleton bones is shown once a year, and vitamin D and calcium preparations (for example, Nycomed calcium D3 can be prescribed for prevention)

    Weight Gain Prevention

    Adipose tissue is the source of the synthesis of female sex hormones:

    regular physical activity (sports, aerobics are not contraindicated)

    Gymnastics (exercises, exercise therapy) after breast surgery, see HERE.

    Where to get examinations after breast surgery

    On the page "Where to be examined"will open the coordinates of specialists who have established themselves as conscientious in St. Petersburg.

    Formally, examinations should be carried out by oncologists in polyclinics at the place of residence. But there are problems:

    • The amount (compensation from insurance companies for surveys) does not cover their cost. Therefore, doctors of polyclinics can prescribe only what is regulated by him for patients. For example, if money is allocated to provide an ultrasound scan, and the patient needs to perform computed tomography or magnetic resonance imaging, or PET (as more informative diagnostic methods), then only ultrasound can be provided.
    • If an oncologist is regulated, for example, 3 computed tomography scans for all his patients for half a year, then he will not prescribe this examination to the fourth patient, even if he himself knows that she "really needs".
    • If the performed examination did not reveal a pathology (metastases were not found), then this is interpreted as "appointment not according to indications". For this, the doctor is reprimanded, and the insurance company may refuse the clinic to pay the doctor’s work and reimburse the funds for the examination performed “not according to indications”.
    • Some examinations are not standard in countries with low levels of health care funding, therefore, for example, OSG, CT, and PET are often not even spoken to patients.
    • Patient complaints lead to the dismissal of their doctor, since the administration of honey. institutions treats informing patients about the lack of something for their treatment and examination - only as an action provoked by doctors against the administration. Therefore, doctors prefer not to say that something is missing, but to explain it by saying “you don’t need” or “we have something to replace”.

    Therefore, (most often) examinations are prescribed only when the early signs of the return of the disease are already missed, and signs of disruption of the affected organs are manifested.

    Another nuance is whether you undergo examinations by experienced specialists or not, on modern equipment or outdated.

    You should know that today in the country there is no legal mechanism for encouraging well-functioning doctors. The work of the doctor who takes you to the polyclinic according to the compulsory medical insurance policy is estimated by the state in the amount of 50 rubles (about 1 USD): that is how much the state pays him for the fact of your appointment (your consultation). The quality of work is not evaluated. The doctor has nowhere to go, everywhere the same rules of work. To make money, he takes more consultations, incurring losses in quality. Be prepared that for a quality modern examination by good specialists you will have to bear the costs, or somehow stand out from the general background of other patients (in order to draw his attention to your problems and interest in doing more for you than is regulated). Or your observation and examination - as in a lottery, will largely depend on chance.

    If the information on our site was useful to you - please leave your feedback about it and recommendations on the Internet for other patients.

    Author: Chizh Igor Aleksandrovich
    Head, kmn, oncologist of the highest qualification category,
    surgeon of the highest qualification category, plastic surgeon