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Topic: Armpit pain 3 months after radiation (no node biopsy)

Forum: Pain —

Share important questions and provide support to others experiencing breast cancer and treatment-related pain.

Posted on: Sep 9, 2019 08:27PM

euphonious wrote:

I'm wondering if others have advice or experiences:

Diagnosed with DCIS, I had a lumpectomy in March followed by radiation, finishing in May. The last 3 or so weeks, I've been experiencing pain right belowish my armpit on the radiated side when I stretch up or out. And I notice some weakness when lifting weights (I've been using light handweights) on that side as well.It's not consistent, all the time pain. I'm just wondering if I need PT or something? Or just to wait it out?

I'm planning to mention it to my bc surgeon who I am seeing this week for a check up. I'm figuring she's going to refer me to my RO...

Any thoughts? Experiences? Thanks!

Dx 1/22/2019, DCIS, Right, 1cm, Stage 0, Grade 2, ER+/PR+ Surgery 3/1/2019 Lumpectomy: Right Radiation Therapy 4/2/2019 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 9, 2019 08:54PM edj3 wrote:

I'm still limited in range of motion from radiation (ended in June). According to my OT, this is normal and to be expected for several months post-radiation. I'll be honest, that's not what I wanted to hear.

Dx 4/9/2019, DCIS/IDC, Left, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Dx 5/6/2019, LCIS, Left, <1cm, 0/1 nodes Surgery 5/6/2019 Lumpectomy; Lymph node removal: Sentinel Radiation Therapy 6/3/2019 Whole-breast: Breast Hormonal Therapy 9/23/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 9, 2019 09:40PM Spoonie77 wrote:

I second what EdJ3 posted - RADs is the gift that keeps on giving for months and months later. Can even have SEs that appear out of nowhere 3 to 6 months down the road when all was fine to that point.

I'd suggest getting that referral for PT. They can give you range of motion excesses that will definitely help with the tightness and pain. My armpit used to feel like a ball of fire that would tear in half at the slightest movement, due to my Lymphedema and cording. Now I don't feel a thing.

Good luck and keep us posted.

Life long "Spoonie" that entered BC World @ 41. DXd @ 42 w/MS. Treatment: LX/SLNB/RADs. Plan A: 5mg Tamox = 0 QOL. Plan B: OS/AI = Rare allergy to OS meds. Plan C: Only option left, Diet & Exercise. PS: Not a dr, just an avid Googler. Dx 7/20/2018, IDC, Left, 3cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH) Dx 8/30/2018, DCIS, Left, 1cm, Stage 0, Grade 2 Surgery 8/30/2018 Lumpectomy: Left; Lymph node removal: Left, Sentinel Radiation Therapy 10/1/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 3/30/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 7/2/2019 Zoladex (goserelin)
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Sep 10, 2019 02:20AM jessie123 wrote:

I also am experiencing things that may or may not be related to radiation. My upper back, neck and shoulders have been really, really stiff which started 2 weeks after radiation was over 3 months ago. I've never had this type of problem before and it is horrible. I've just started PT as I've tried everything I know of to get rid of the tension to no avail. My physical therapist said that radiation could have caused it. Today they had me lift both arms above my head and yes there was a strong pull on the inside of my armpit. I'm going to ask my Oncologist next week if this is a radiation side effect. My arms pits were not radiated since I had no lymph node involvement.

Dx 11/2018, LCIS/ILC, Left, 2cm, Stage IB, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 2/21/2019 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 4/15/2019 Whole-breast: Breast
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Sep 10, 2019 04:52AM ksusan wrote:

Radiated skin tightens up. I get a myofascial massage once a month to loose the area.

Mutant uprising quashed. Dx 1/2015, IDC, Right, Stage IIA, 1/1 nodes, ER+/PR+, HER2- Dx 1/2015, DCIS, Left, Stage 0, Grade 3, 0/2 nodes Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lymph node removal: Sentinel; Mastectomy: Left, Right Radiation Therapy Whole-breast Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Sep 10, 2019 06:31AM Spoonie77 wrote:

Jessie, even though your armpit may not have received direct radiation, all of the muscles that connect into your armpit (meaning the chest pectoral muscles) did receive treatment. RADs causes stiffening and shortening and hardening of muscles and tissue. The same muscles and tissues that find their way up into your armpit.

It's quite common to have cording, or a feeling of pulling/limitation when extending range of motion, develop daysŷweeks/even months after or during RADs.

My PT even discovered that my RADs direct effect (to chest muscles) caused secondary effects (pulling of shoulder & arm muscles to compensate for primary effect) that led to a rib fracture on my Left side plus Rib Dysfunction on the left posterior lower ribs. So while your RMO or RO may say, no its not a direct side effect of RADs it definitely can be a secondary effect of it. If that makes better sense.

Good luck with the PT. Hope you find some relief. I know I would be lost without my LE therapist.

Life long "Spoonie" that entered BC World @ 41. DXd @ 42 w/MS. Treatment: LX/SLNB/RADs. Plan A: 5mg Tamox = 0 QOL. Plan B: OS/AI = Rare allergy to OS meds. Plan C: Only option left, Diet & Exercise. PS: Not a dr, just an avid Googler. Dx 7/20/2018, IDC, Left, 3cm, Stage IIA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (FISH) Dx 8/30/2018, DCIS, Left, 1cm, Stage 0, Grade 2 Surgery 8/30/2018 Lumpectomy: Left; Lymph node removal: Left, Sentinel Radiation Therapy 10/1/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 3/30/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 7/2/2019 Zoladex (goserelin)
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Sep 11, 2019 07:43AM mjane68 wrote:

yes! get PT. I wish I wouldve gone earlier.

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Sep 11, 2019 02:39PM edj3 wrote:

I'll echo what Spoonie said.

My armpit wasn't radiated but it sure as hell hurts and it's from my pec. My entire breast was radiated, which is typical and normal, and that means my pec was too. It's pulling super tight, and that means where it attaches into my armpit hurts a lot.

My armpit was a bit cranky from the sentinel node surgery and now it's downright furious. As part of my cross training, I lift weights--that's off the table for now per my OT because when I do, I experience even more pain. For example, today I said screw it and did light weights any way. Now my entire chest is mad.

(Yes, sometimes I'm not so good at following medical advice)

Dx 4/9/2019, DCIS/IDC, Left, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Dx 5/6/2019, LCIS, Left, <1cm, 0/1 nodes Surgery 5/6/2019 Lumpectomy; Lymph node removal: Sentinel Radiation Therapy 6/3/2019 Whole-breast: Breast Hormonal Therapy 9/23/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 11, 2019 04:16PM Lexica wrote:

I've had the same issues with neck, shoulder, rib cage, armpit...pretty much that entire area. I had rads to chest wall, supraclav and IM nodes. I am 18 months out from rads and have been going to PT pretty religiously. It has gotten better, but if I take a break from PT, it pretty much erases everything that I've worked on in PT in a matter of a few weeks. So frustrating. I wish there was a more permanent solution to this problem. I also find that when I take a break from PT and my muscles tighten up, I am more prone to severe migraines. I'm sure that rads was necessary, and hopefully did the clean up job it was supposed to do, but ugh, these side effects...

ksusan - do you go to PT for the myofascial massage or is it a certified massage specialist?

Diagnosed at 34. 2 years of Ibrance via PALLAS trial (ends 4/2019) Dx 7/2017, IDC, Left, Stage IIIC, Grade 2, ER+/PR+, HER2- (IHC) Surgery 12/15/2017 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right Dx 12/27/2017, DCIS/IDC, Left, 6cm+, Stage IIIA, Grade 3, 5/11 nodes, ER+/PR+, HER2- (IHC) Radiation Therapy 1/16/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Aromasin (exemestane) Chemotherapy AC + T (Taxol)
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Sep 17, 2019 06:34PM euphonious wrote:

Thank you! All these responses are really helpful. I got a referral for PT and start in a couple of weeks.

Dx 1/22/2019, DCIS, Right, 1cm, Stage 0, Grade 2, ER+/PR+ Surgery 3/1/2019 Lumpectomy: Right Radiation Therapy 4/2/2019 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 19, 2019 05:25AM - edited Sep 19, 2019 05:27AM by macb04

I had ridiculous tightness. I had this PT pulling things loose, so painful when my axilla was pulled on the tears ran down my face. The radiation fibrosis really tight, my skin and muscles weird and woody. Then I got Hyperbaric Oxygen Therapy, also known as HBOT, as well as Fat Grafting with reconstruction. .

Pain and tightness disappeared almost completely. Most notable was the stiff, " wood-like" quality of my skin is gone and my skin feels supple and normal again. I couldn't have lived with that insane tightness.

Please look into HBOT, and potentially Fat Grafting, even if you don't do reconstruction because it actually Heals the damage from rads.

________________________________________________________________________________________________________

Radiother Oncol. 2004 Mar;70(3):217-24.

Non-randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema and tissue fibrosis after radiotherapy for early breast cancer.

Gothard L1, Stanton A, MacLaren J, Lawrence D, Hall E, Mortimer P, Parkin E, Pritchard J, Risdall J, Sawyer R, Woods M, Yarnold J.

Author information
1
Department of Radiotherapy, Royal Marsden NHS Trust, Sutton, Surrey SM2 5PT, UK.
Abstract BACKGROUND:

Radiation-induced arm lymphoedema is a common and distressing complication of curative treatment for early breast cancer. Hyperbaric oxygen (HBO(2)) therapy promotes healing in bone rendered ischaemic by radiotherapy, and may help some soft-tissue injuries too, but is untested in arm lymphoedema.

METHODS:

Twenty-one eligible research volunteers with a minimum 30% increase in arm volume in the years after axillary/supraclavicular radiotherapy (axillary surgery in 18/21 cases) were treated with HBO(2). The volunteers breathed 100% oxygen at 2.4 ATA for 100 min in a multiplace hyperbaric chamber on 30 occasions over a period of 6 weeks. The volume of the ipsilateral limb, measured opto-electronically by a perometer and expressed as a percentage of contralateral limb volume, was selected as the primary endpoint. A secondary endpoint was local lymph drainage expressed as fractional removal rate of radioisotopic tracer, measured using lymphoscintigraphy.

RESULTS:

Three out of 19 evaluable patients experienced >20% reduction in arm volume at 12 months. Six out of 13 evaluable patients experienced a >25% improvement in (99)Tc-nanocolloid clearance rate from the ipsilateral forearm measured by quantitative lymphoscintigraphy at 12 months. Overall, there was a statistically significant, but clinically modest, reduction in ipsilateral arm volume at 12 months follow-up compared with baseline (P = 0.005). The mean percentage reduction in arm volume from baseline at 12 months was 7.51. Moderate or marked lessening of induration in the irradiated breast, pectoral fold and/or supraclavicular fossa was recorded clinically in 8/15 evaluable patients. Twelve out of 19 evaluable patients volunteered that their arms felt softer, and six reported improvements in shoulder mobility at 12 months. No significant improvements were noted in patient self-assessments of quality of life.

CONCLUSION:

Interpretation is limited by the absence of a control group. However, measurement of limb volume by perometry is reportedly reliable, and lymphoscintigraphy is assumed to be operator-independent. Taking all data into account, there is sufficient evidence to justify a double-blind randomised controlled trial of hyperbaric oxygen in this group of patients.

____________________________________________________________________________________________

Hyperbaric oxygen therapy for late radiation-induced tissue toxicity: prospectively patient-reported outcome measures in breast cancer patients.

Teguh DN1,2, Bol Raap R3, Struikmans H4,5, Verhoef C6, Koppert LB6, Koole A3, Huang Y7, van Hulst RA3,8.

Author information
1
Hyperbaar Geneeskundig Centrum Rijswijk, Treubstraat 5a, 2288 EG, Rijswijk, The Netherlands. d.teguh@hgcrijswijk.nl.
2
Department of Surgery/Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. d.teguh@hgcrijswijk.nl.
3
Hyperbaar Geneeskundig Centrum Rijswijk, Treubstraat 5a, 2288 EG, Rijswijk, The Netherlands.
4
Department of Radiation Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
5
Radiotherapy Centre West, Medical Centre Haaglanden, The Hague, The Netherlands.
6
Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
7
University of Leuven, Leuven, The Netherlands.
8
Department of Anesthesiology/Hyperbaric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Abstract INTRODUCTION:

This study examines patient reported outcome measures of women undergoing hyperbaric oxygen treatment (HBOT) after breast-conserving therapy.

METHOD:

Included were 57 women treated with HBOT for late radiation-induced tissue toxicity (LRITT) referred in the period January 2014-December 2015. HBOT consisted of (on average) 47 sessions. In total, 80 min of 100 % O2 was administered under increased pressure of 2.4 ATA. Quality of life was assessed before and after treatment using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-BR23, and a NRS pain score.

RESULTS:

Fifty-seven women were available for evaluation before and after treatment. Before HBOT, patients had severe complaints of pain in the arm/shoulder (46 %), swollen arm/hand (14 %), difficulty to raise arm or move it sideways (45 %), pain in the area of the affected breast (67 %), swollen area of the affected breast (45 %), oversensitivity of the affected breast (54 %), and skin problems on/in the area of the affected breast (32 %); post HBOT, severe complaints were still experienced in 17, 7, 22, 15, 13, 15, and 11 % of the women, respectively. Differences were all significant. The NRS pain score improved at least 1 point (range 0-10) in 81 % of the patients (p < 0.05).

CONCLUSION:

In these breast cancer patients treated with HBOT for LRITT, the patient-reported outcomes were positive and improvements were observed. HBOT was a well-tolerated treatment for LRITT and its side-effects were both minimal and reversible.




________________________________________________________________________________________________________



3293

Hyperbaric Oxygen Therapy for Improvement of

Radiation-Induced Late Toxicity

R. Roncero,1 J. Pardo,1,2 E. Jimenez Jimenez,1 D. Morera,3 N. Aymar,1

M. Vidal,1 I. Ortiz,1 and L. Valencia1

; 1

Hospital Universitari Son Espases.

Radiation Oncology Department, Palma de Mallorca, Spain, 2

IdISPa.

Institut d'Investigacio Sanitaria de Palma, Palma de Mallorca, Spain,

3

Hospital Universitari Son Espases. Medical Physics Department, Palma

de Mallorca, Spain

Purpose/Objective(s): To assess the efficacy of hyperbaric oxygen ther-

apy (HBOT) in the management of patients with radiation-induced late

effects, in which more conservative treatments have failed.

Materials/Methods: We retrospectively reviewed the clinical records of

33 patients treated at our Department, from 2012 to 2016, who

developed late toxicity (Grade IV CTCAE4.0) and who had not

responded to conservative treatment. After hyperbaric oxygen treat-

ment, the variation, if occurred, in the degree of toxicity was recorded.

The average age of the patients was 61 +/- 12 years and the mean dose

delivered during the radiotherapy treatment was 52 +/-12Gy with

standard fractionation. The toxicities presented were: enteritis/proctitis

(33%), bone necrosis and sacroileitis (30%), skin injury (9%), Cystitis

(6%) and others [neurocognitive impairment, dysphagia and xeros-

tomy] (9%). The patients received an average of 61 sessions of HBOT.

In order to its evaluation, responses were classified into three groups

according the CTCAE4.0 scoring: Major Response: Improvement of

toxicity from Grade IV to Grade I or 0 (without toxicity, or minor

toxicity not requiring medical treatment), Minor Response: Improve-

ment from Grade IV to Grade III/II (permanent toxicity controlled with

medical treatment) and No Response. The statistical study was carried

out by using SPSS_22.

Results: Ninety-one per cent of the patients (30) completed the treat-

ment sessions with hyperbaric chamber scheduled (2 patients didn�t

start the treatment and 1 patient stopped after 4 sessions). Statistical

significant toxicity improvement (p<0.05) was observed after the hy-

perbaric oxygen treatment. 60% of the patients presented a Major

Response, and 18% presented a Minor Response. 9% (3) of our patients

were no responders. Major responses were founded in patients with

bone and gastro-intestinal toxicities. No relationship was founded be-

tween the degree of response and the age, or the time relapsed since

radiation treatment to the indication of the HBOT. Table 1 presents the

patients outcomes according the toxicity.

Conclusion: In our patients, there is a significant improvement in late

radiation toxicity after HBOT, with the best responses being observed in

gastro-intestinal and bone toxicity.

Author Disclosure: R. Roncero: None. J. Pardo: None. E. Jimenez

Jimenez: None. D. Morera: None. N. Aymar: None. M. Vidal: None.


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Sep 19, 2019 01:10PM Ingerp wrote:

You've probably heard of cording? I had it show up several times after rads, including a year after I was finished. It seemed to always be related to when I increased my weightlifting at the gym. I called my BS the first time and was told I could go to PT or it leave it alone and it would resolve on its own. I just ignored it every time and it did indeed go away after a few weeks.

Re: range of motion--yoga *really* helps with that, particularly the armpit/shoulder area. If you can't commit to a full class, a couple of down dogs every day will really open up that area.

Dx 3/11/2016, DCIS, Left, 6cm+, Stage 0, Grade 3, ER-/PR- Surgery 3/23/2016 Lumpectomy Surgery 4/20/2016 Lumpectomy: Left Radiation Therapy 5/18/2016 Whole-breast: Breast Dx 3/2/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2+ (FISH) Surgery 3/13/2018 Lumpectomy: Right; Lymph node removal: Sentinel Targeted Therapy 5/18/2018 Herceptin (trastuzumab) Chemotherapy 5/18/2018 Taxol (paclitaxel) Radiation Therapy 8/20/2018 Whole-breast: Breast
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Oct 8, 2019 06:24PM euphonious wrote:

Checking back in after my Physical Therapy appointment (took a while to get synced with the work schedule). They said that I have mild lymphadema even without node removal, from the radiation. I have it on my chest wall and on my back. So, I'll be going to the lymphadema PT for a few weeks and getting some compression garmets, and then we'll see. I can see a lymphadema specialist if I want. It's mild, so I don't know if I want to commit to that or not. I'll have to think about it.

Dx 1/22/2019, DCIS, Right, 1cm, Stage 0, Grade 2, ER+/PR+ Surgery 3/1/2019 Lumpectomy: Right Radiation Therapy 4/2/2019 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Oct 9, 2019 02:04AM Lexica wrote:

I had some clinical lymphedema while going through radiation and I think I got over it fairly quickly with the compression garments and physical therapy. If it's not too difficult for you to do I would highly recommend it

Diagnosed at 34. 2 years of Ibrance via PALLAS trial (ends 4/2019) Dx 7/2017, IDC, Left, Stage IIIC, Grade 2, ER+/PR+, HER2- (IHC) Surgery 12/15/2017 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right Dx 12/27/2017, DCIS/IDC, Left, 6cm+, Stage IIIA, Grade 3, 5/11 nodes, ER+/PR+, HER2- (IHC) Radiation Therapy 1/16/2018 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Aromasin (exemestane) Chemotherapy AC + T (Taxol)

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