The document discusses physical therapy interventions for cancer patients after surgery, focusing on early mobilization, lung hygiene exercises, and specific rehabilitation programs for common cancer types like breast cancer, lung cancer, and gastrointestinal cancers. Post-surgery goals include preventing complications, improving range of motion, and managing symptoms like pain, breathlessness, and bone metastasis. Precautions and considerations for different surgeries are also outlined.

1. 癌症病人術後物理治療
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臺大醫院物理治療師
蕭淑芳

2. Goal of surgery
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 Debulking a tumor:表示腫瘤已無法完全切除，因此開
刀時只將較大，較易切除的腫塊拿掉
 Diagnosing a tumor(biopsy)
 Removing precancerous(癌前期) lesions
 Resecting a tumor
 Correction of life-threatening conditions caused by
cancer
 Palliation

3. Theme for postsurgery physical therapy
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 Early mobilization
 Prevention of complications: pneumonia, ileus, DVT, loss of lean
body mass
 Lung hygiene
 Splinting cough, diaphragm/deep breathing exercise, posture
education
 Gait training
 Weight bearing restriction? pain?
 ADL training

4. Management of some common cancer
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 Breast cancer
 Head and neck cancer
 Lung cancer
 Colorectal cancer
 Gastrointestinal cancer

5. Breast cancer
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 Introduction of surgery type
 Post op programs

6. 前哨淋巴切除檢驗(sentinel node dissection)
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 優點：若哨兵淋巴結沒
有癌細胞，則不做腋下
淋巴清除，則減少淋巴
水腫的問題。
 缺點：有10﹪的僞陰性
率
 建議用在腫瘤2公分以
內及原位癌的患者

7. Lumpectomy or partial mastectomy
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 removal of the breast tumor
(the "lump") and some of
the normal tissue
 Lumpectomy : Tumor size<4
cm

8. Mastectomy
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 Removal of the whole breast
 Simple/ total mastectomy
 Modified radical mastectomy
 Radical mastectomy
 Partial mastectomy
 Subcutaneous (nipple-sparing) mastectomy.

9. Simple Mastectomy
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 removes the entire
breast, skin, nipple
 No muscles are
removed from
beneath the breast

10. Modified Radical Mastectomy
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 removal of both breast
tissue and lymph nodes:
 優點：維持胸部肌肉及
手臂肌肉的張力，
 手臂腫脹的情形較施行
乳房根除術輕微
 乳房重建較易。

11. Radical Mastectomy
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 Most extensive type of mastectomy
 Removes :
 the entire breast,
 Levels I, II, and III of the
underarm lymph (B, C, and D in
illustration),
 chest wall muscles under the
breast.
 缺點：會留下很長的疤痕，胸部也
會凹陷，可能導致淋巴水腫、手臂
無力、痲痹、疼痛、肩膀活動受限
制等，

12. Post op programs
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 Progressive shoulder ROM exercise:
 Begin after removal of the drains
 http://www.breastcf.org.tw/bloom/personal.php
 Postural exercise
 Lymphedema education

13. Head and neck cancer
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 Site: Lip, tongue, floor of mouth, gum, salivary gland,
oropharynx, nasopharynx, larynx, nose and sinuses,
ear, thyroid
 Surgery type
 Radical neck dissection:
 Modified radical neck dissection
 Selective neck dissection

14. Head and neck cancer
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 Reconstruction: TMJ dysfunction
 Pectoralis flap:
 Fibular flap:
 reconstruct the mandible bone; non-weight bearing for 4-7 days
 Vascular integrity, peroneal nerve function
 Transfer skill, bed mobility
 Radical forearm flap:
 no weight bearing activity on donor site,
 ROM limited to 90 degree before drains removed

15. Head and neck cancer
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 Post op care in acute phase
 Maintain airway, Lung hygiene and tracheotomy care
 Monitor circulation
 Prevent infection
 Control pain
 Postural training
 Cervical and shoulder ROM exercise

16. Airway management and tracheostomy care
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 Aim of care
 Ensure a patent airway
 Maintain comfort
 Ensure regular breathing rhythm, depth, and pattern
 Complication
 Bleeding
 Tracheoesophageal fistula
 Infection
 Obstruction or displacement of tracheostomy tube
 PT programs
 Breathing exercise, cleaning of tracheostomy q2-3h(suction),
humidification

17. Lung cancer
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 Small cell lung cancer
 High growth rate
 Worse progonosis
 Non small cell lung cancer
 Squamous cell carcinoma
 Adenocarcinoma
 Large-cell carcinoma

18. 18
epgonline.org

19. Reduced respiratory capacity after lung surgery
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 ↓25-30%functioning lung tissue after lobectomy or
bilobetomy
 ↓40% after left pneumonectomy
 ↓60% after right pneumonectomy
 Indicators for post-op lung function
 %FEV1
 Diffusion capacity of the lung for carbon monoxide
 Maximal oxygen uptake during exercise
 Provide oxygen

20. Lung cancer
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 Pre-op assessment: ADL, PFT
 Risk factor: obesity, smoking
 Review blood counts

21. Lung cancer
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 Post op care
 Symmetrical movement of the thoracic cage
 ROM of shoulder
 Breathing training: pursed lip and diaphragmatic
breathing
 Drainage of secretions/ percussion, use of
nebulizers
 Splinting cough
 Reconditioning: early ambulation, functional
independent

22. Symptoms and signs of Radiation pneumonitis
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 Dyspnea
 Non-productive cough
 Tachypnea
 Low grade fever
 Fullness in the chest
 ↑ESR
Treatment: corticosteroids,

23. Cardiovascular complications after pneumonectomy
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 Arrhytmias: 20-25%
 Atrial fibrillation, supraventricular tachycardia, artial flutter
 ↑mortality
 Myocardial infarction
 Acute heart failure
 Pulmonary emboli
 stroke

24. Possible organ displacement after right
pneumonectomy
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 Displacement of the tracheal to the right side
 Displacement of esophagus
 Mediastinal displacement to the empty pleural space
 Elevation of diaphragm and liver
 Deviation of the vertebral column

25. Superior vena cava obstruction
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 Tumor compress
 Neck swelling
 Distended veins over chest
 Swelling of one or both arms
 Dyspnea
 Hoarse voice
 Stridor
 Headache

26. 26
http://www.aboutcancer.com/svco_cuases_nejm_507.gif

27. PT intervention for SVCO
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 Elevate the patient‘s head
 Oxygen therapy
 Modified chest care skill
 Avoid compression therapy

28. Colon cancer
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 Ileostomy: after removal of colon and rectum,
externalized ileum
 Colostomy: rectum removed, distal colon attached to
abdominal
 Ileo-anal reservoir surgery

29. Somatic rehabilitation requirements after
hemilectomy
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 Hernias
 Diarrhea/constipation
 Adhesions
 Anemia
 Diet/obesity

30. Precautionary measures to prevent abdominal wall
hernia
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 Caution in lifting and carrying heavy loads
 Loads should never lifted suddenly
 Excess weight should be avoided
 Abdominal bandage

31. Example of physical therapeutic interventions for
abdominal surgery
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 Breathing exercise
 Deep breathing/ inspiratory holds
 Incentive spirometry
 Huffing/ directed cough
 Chest percussion/vibration
 Early mobilization
 Log-rolling /bracing with pillow
 Transfer/ gait training
 Progressive ambulation

32. Gastrointestinal surgery
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 Thoracoscopy
 Laparoscopy
 Esophagectomy
 Esophagus reconstruction

33. Pre/post upper abdominal and thoracic surgery
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 Pre op assessment: FEV1
 Post op increased risk of respiratory complication:50%
 Disruption of abdominal and diaphragmatic muscles
↓30%FRC for days
 Impaired mucociliary function
 PT programs
 Breathing exercise, Deep breathing, Incentive spirometry,
Huffing, Chest percussion/vibration
 Early mobilization

34. Precaution for PT programs after upper abdominal
and thoracic surgery
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 Avoid head down postural drainage:
 Suction ??
 Drips and drains
 Shoulder ROM

35. The environment and patient support/non-
intravenous equipment after GI sugery
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 IV fluid
 TPN
 Enteral nutrition: PEG (percutaneous enteral
gastrostomy), J-tube (jejonostomy), NG
 PRBC (paced red blood cell): ↑the O2 carrying
capacity of blood
 FFP(fresh frozen plasma): ↑blood volume
Stop PT
 JP (Jackson-Pratt) drain
 Sump drain
 Foley

36. Breathlessness management
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 Breathing exercise
 Positions
 High side lying
 Sitting upright in a chair with feet, back, and arm support
 Forward lean sitting with arm resting on pillows on a table

37. Bone metastasis
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 Location of metastatic bone disease
 Vertebrae 69%
 Pelvis 40%
 Femur 25%
 Ribs 25%
 Humerus 20%

38. Pain characteristics that may indicate fracture
or impending fracture
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 Pain with weightbearing
 Pain in the groin
 Pain with hip external rotation and abduction
 Pain with deep breathing
 Pain in a ban around the chest wall
 Increased pain with supine
 Increased pain with valsava

39. Goal of Surgery for pathological fracture
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 Excision of tumor
 Cure
 Stabilization of bone
 Prevention sequela from bed rest
 Palliation

40. Reference
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 Physical therapy in acute care : a clinician's guide .
Edited by Daniel Malone Thorofare, NJ : Slack, 2006.
 Rehabilitation in cancer care. edited by Jane Rankin
Chichester, UK ; Ames, Iowa : Wiley-Blackwell, 2008.