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Managing side effects
It will take some time to recover from the physical and emotional changes caused by treatment for breast cancer. Treatment side effects can vary. Some people will experience just a few side effects, while others will have more.
Lymphoedema is a swelling (oedema) that develops when lymph fluid builds up in the tissues of part of the body, such as an arm or breast. When lymph nodes have been damaged or removed, lymph fluid may not be able to drain as it should and instead builds up in the tissues, causing swelling.
Some breast cancer treatments, such as surgery to remove lymph nodes or radiation therapy to the armpit, can cause lymphoedema. People who have had surgery followed by radiation therapy to the armpit are more at risk of experiencing this side effect.
Lymphoedema can affect people at any time – during active treatment or months or years after treatment. Most people who are at risk never develop lymphoedema.
Signs to look for include swelling; a feeling of tightness, heaviness or fullness in the fingers, wrist or the whole arm; and aching in the affected area. These signs may begin gradually, and they may come and go. Some people experience pain, redness or fever, which can be caused by an infection called cellulitis in the area with lymphoedema. If you have any of these symptoms, see your doctor as soon as possible. The condition is easier to manage if it is diagnosed and treated early.
Preventing and managing lymphoedema
Who provides treatment – If you are at risk of developing lymphoedema or for ongoing care, see a lymphoedema practitioner. This may be an occupational therapist, physiotherapist or nurse with specialist training in treating and managing lymphoedema.
When to start treatment – See a lymphoedema practitioner for regular check-ups after cancer treatment, rather than waiting for signs to appear. Taking action at an early stage can help reduce the risk of developing lymphoedema and the severity of lymphoedema if it does develop.
What treatment involves – The swelling can be reduced by wearing a professionally fitted
compression sleeve or by massage from a lymphoedema practitioner. You may also benefit from low-level laser treatment by a lymphoedema practitioner. If you develop lymphoedema in the breast (breast oedema) you may be more comfortable wearing a bra designed for breast oedema. Ask your lymphoedema physiotherapist or breast care nurse where you can be fitted for the bra.
How to find a lymphoedema practitioner – The Australasian Lymphology Association maintains an online national register of trained lymphoedema practitioners. Visit lymphoedema.org.au and click on “Find a Practitioner”.
Also known as axillary web syndrome, cording can happen weeks or months after surgery. It’s caused by hardened lymph vessels and feels like a tight cord running from your armpit down the inner arm, sometimes to the palm of your hand. You may see and feel raised cord-like structures across your arm, and these “cords” may limit movement. Sometimes cording may occur on the chest wall or breast.
This condition usually improves over a few months. Gentle stretching exercises during the first weeks after surgery can help. If there is no improvement or it is getting worse, try physiotherapy, massage or low-level laser treatment by a lymphoedema practitioner.
Mastectomy, sentinel node biopsy and axillary dissection can cause nerve pain in the arm, and mastectomy can cause nerve pain on the chest wall. This may feel like pins and needles. It usually settles within a few weeks. If pain is ongoing, ask your doctor about ways to manage it.
Certain chemotherapy drugs can damage nerves in the hands and feet. This is called peripheral neuropathy or chemo-induced peripheral neuropathy (CIPN), and it can cause numbness, pins and needles and, occasionally, pain. These symptoms are usually temporary, but can be permanent. If you have any symptoms, tell your health care team so they can adjust your treatment. Your doctor will help you manage pain from any permanent nerve damage. A psychologist or counsellor can also teach you coping strategies to manage any ongoing pain.
Some people diagnosed with breast cancer notice changes in the way that they think and remember information. This is called cancer-related cognitive impairment, but people may also refer to it as “cancer fog” or “chemo brain”.
The exact cause is unknown, but studies show that thinking and memory changes may be caused by the cancer itself, emotions such as anxiety and depression, cancer treatments, medicines given for surgery such as anaesthetic, and treatment side effects, such as fatigue, trouble sleeping, pain and hormone changes.
For most people, thinking and memory problems get better within the first year of finishing treatment. Others may experience more long-term effects. Ways to cope with changes include:
- adjust your daily routine, e.g. write lists, use smartphone reminders, avoid distractions, pace yourself
- maintain a healthy lifestyle, e.g. exercise, relax, eat healthy foods
- improve your thinking and memory, e.g. crosswords, brain training
- tell your family and friends, and ask your health care team for help.
If you have severe or lasting changes to your thinking and memory skills, you can also see a clinical psychologist or neuropsychologist for cognitive rehabilitation. Speak to your health care team about accessing cognitive rehabilitation services, which may be available through some hospitals or psychologists.
A breast prosthesis is a synthetic breast or part of a breast that is worn in a bra or attached to the body with adhesive. They help give the appearance of a real breast and can be used after breast surgery.
Temporary prosthesis – In the first month or two after surgery, you may choose to wear a temporary light breast prosthesis called a soft form. This will be more comfortable next to your scar. A free bra and soft form are available through Breast Cancer Network Australia as part of the My Care Kit. To order a kit, speak to your breast care nurse. Cancer Council SA can also provide you with a temporary soft prosthesis, call 13 11 20 for more information.
Permanent prosthesis – When you have recovered from treatment you can be fitted for a permanent breast prosthesis. A permanent breast prosthesis is mostly made from silicone gel and has the shape, feel and weight of a natural breast. It is recommended that you see a trained fitter who can help you choose the right prosthesis. To find a local fitter, call Cancer Council 13 11 20 or ask your breast care nurse.
If you lose your hair during chemotherapy, you may want to wear a wig, scarf, turban or hat while it’s growing back. Another option is to leave your head bare. You can buy or borrow a wig – some hospitals and cancer care units provide wigs for free or a small fee. Call Cancer Council 13 11 20 or ask your treatment team for more details about borrowing or buying wigs. Some private health funds cover part of the cost of wigs – check with your health fund.
Having breast cancer can affect the way you feel about yourself (self-esteem) and make you feel self-conscious. You may feel less confident about who you are and what you can do. Give yourself time to adapt to any changes. Try to see yourself as a whole person (body, mind and personality) instead of focusing on the parts that have changed.
You may find that having a breast reconstruction or wearing a breast prosthesis improves your self-confidence. Or you may prefer to not have a reconstruction and “go flat”.
Areola tattooing is the process of tattooing the areola and nipple onto the breast following a mastectomy. Areola tattoos are typically done on breasts with implants, with and without nipple reconstruction. For some people getting a decorative tattoo to cover scars is a way to take control of their body and express themselves in a beautiful way.
Breast cancer can also reduce your desire for sex (libido). You may miss the pleasure you felt from the breast or nipple being stroked or kissed during sex. This may be the case even if you have a reconstruction. If breast stimulation was important for arousal before surgery, you may need to explore other ways of becoming aroused.
Some treatments for breast cancer can cause vaginal dryness, which can make penetration during intercourse painful.
For most people, sex is more than arousal, intercourse and orgasms. It involves feelings of intimacy and acceptance, as well as being able to give and receive love. Although sexual intercourse may not always be possible, closeness and sharing can still be part of your relationship.
Chemotherapy can cause your periods to stop for a time and affect your ability to become pregnant. If your periods stop permanently (early menopause), you won’t be able to have children naturally. If you may want to have children in the future, it is important to talk to your doctor before your treatment starts. There may be ways to reduce the risk of early menopause or to preserve fertility.
Symptoms of menopause can include hot flushes, trouble sleeping, vaginal dryness, reduced sex drive (libido), tiredness, dry skin, mood swings, weight gain and osteoporosis. Talk to your doctor or breast care nurse about ways to relieve the symptoms of menopause.
If you learn you may not be able to conceive a child, you may feel a great sense of loss. Talking to a counsellor or someone in a similar situation may help – call Cancer Council 13 11 20 for information about counselling services and support groups in your area.
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This information is reviewed by
This information was last reviewed July 2020 by the following expert content reviewers: Prof Bruce Mann, Professor of Surgery, The University of Melbourne, and Director, Breast Tumour Stream, Victorian Comprehensive Cancer Centre, VIC; Dr Marie Burke, Radiation Oncologist, and Medical Director GenesisCare Oncology, QLD; Dr Susan Fraser, Breast Physician, Cairns Hospital and Marlin Coast Surgery Cairns, QLD; Ruth Groom, Consumer; Julie McGirr, 13 11 20 Consultant, Cancer Council Victoria; A/Prof Catriona McNeil, Medical Oncologist, Chris O’Brien Lifehouse, NSW; Dr Roya Merie, Staff Specialist, Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, NSW; Dr Eva Nagy, Oncoplastic Breast Surgeon, Sydney Oncoplastic Surgery, NSW; Gay Refeld, Clinical Nurse Consultant – Breast Care, St John of God Subiaco Hospital, WA; Genny Springham, Consumer.