More
women are now living for many years after breast cancer treatments. But
when treatment ends, new problems can begin.
For most women the end of treatment is accompanied by lingering side
effects. Problems resulting from treatment also can come up years
later. This is why you should keep records of your treatment (including
a written summary of your disease characteristics, treatments received,
and complications) and have regular contact with a health practitioner
who knows about delayed treatment effects.
All cancer treatments can cause some long-term side effects. Be aware
that:
Surgery will result in scarring and other changes to your breast.
Scarring
is an inevitable consequence of breast surgery. The appearance of the
scar depends not only on the extent of the surgery but on your skin,
your body type, the size of your breast, and the type of surgery you
had. It can take more than a year for a mastectomy incision to heal
completely. After a lumpectomy, your breast may look foreign and
disturbing to you; it may have a dent, look shrunken, or appear to be
pulled to one side. There is nothing wrong with being concerned about
how you look. You've been through a very unpleasant and life-changing
experience; you're entitled to do what you can to make its aftermath as
comfortable as possible. If you are troubled by your appearance months
or years after surgery, talk to a plastic surgeon about all the
possibilities and decide what's best for you.
Surgery can result in long-term pain.
While most women experience some pain in the weeks after surgery,
especially mastectomy, many will have such pain for years afterward. In
some instances, the pain begins years after the operation. Forty-nine
percent of patients who have breast cancer surgery say they have some
sort of ongoing pain or change in sensation, and 10 percent say it
interferes with their daily lives. This pain may be in the mastectomy
scar, the arm, even the muscle under the breast. It may be necessary
for you to consult a pain specialist to get the proper treatment.
Options may include massage, acupuncture, and antidepressants, which
have an effect on damaged nerves.
Lymph-node dissection can cause side effects.
If you had a lymph-node dissection, you may experience a stiff or
frozen shoulder a month after breast surgery. When your armpit hurts,
it's natural to try to protect it by keeping your arm immobilized. But
when you don't use your arm, your shoulder muscles grow weak and the
tendons and ligaments tighten. This can lead to more pain and, in some
instances, to frozen shoulder, where the joint becomes locked. To
prevent or reverse these problems, start with gentle exercise, like
walking your fingers up a wall or circling your arms. Swimming is
especially good. Massage often can help to reduce this soreness, while
a physical therapist can help you devise a program to increase your
strength and flexibility.
Radiation can cause some delayed problems, including muscle soreness.
Radiation can result in muscle soreness, especially in the pectoralis
major muscle, which runs above and behind the breast. That's because
radiation causes inflammation of the muscle, and as it begins to
regenerate, it can get sore and stiff. Many women commonly mistake this
pain as the cancer spreading, since the radiation has been over for
months and they're not expecting new side effects from it. Exercise,
with the assistance of a physical therapist, if needed, can help you to
develop strength and flexibility, while massage often can help to
reduce this muscle soreness.
Chemotherapy can result in decreased cognitive function (what patients call "chemo brain").
Many women who have had chemotherapy complain of "chemo brain." The
most common problems are difficulty paying attention, learning new
things, and speedily processing information. Researchers are currently
trying to assess whether specific groups of women are more susceptible
than others and whether cognitive retraining can overcome the
difficulties. Most oncologists probably don't warn women who are
considering chemotherapy that they may lose a significant part of their
brain function. For someone who needs the treatment to survive, it's
worth it, but in cases where chemotherapy offers only a miniscule
survival improvement, it may not be.
Chemotherapy can cause fatigue.
I think of it as "the poop-out syndrome." Your body is still trying to
heal, and usually we've underestimated how long it takes to get back to
normal after your body has been assaulted by surgery, radiation, and
chemotherapy. Much of the fatigue while on chemotherapy and after is
caused by anemia. This can be treated by transfusions or by
erythropoietin (brand name Epogen), a drug that stimulates the bone
marrow to produce more red blood cells. Several studies also have found
that aerobic exercise can help decrease the fatigue.
Chemotherapy can cause weight gain.
Although the cause of weight gain with chemotherapy is not clear, one
study revealed that 50 percent of patients gained more than 10 pounds.
This was independent of type of chemotherapy, age, and menopausal
status, although the women who gained weight did have a decrease in
activity. There is some data suggesting that overweight women have a
higher mortality than lean ones. This has increased interest in
nutritional and exercise programs for survivors.
Chemotherapy and hormone treatments can lead to bone loss.
Premenopausal women whose chemotherapy and hormone treatments lead to
premature menopause and postmenopausal women who use aromatase
inhibitors may experience accelerated bone loss. Women who have had
breast cancer should follow the general recommendation from the
National Osteoporosis Foundation: first bone density test at 65 or at
the end of therapy.
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