Cording: A common post-op complication to breast cancer surgery
Have you had breast cancer surgery and experiencing sharp or pulling pain in your armpit?
If so, you may be experiencing cording, a common, side effect of lymph node removal following breast cancer surgery. Most people with breast cancer have this type of surgery to ensure that the cancer doesn’t spread to other parts of their body, and 20% of them will develop the condition called cording. Thankfully, there’s relief, and early detection is key to a full recovery.
How common is it?
Cording, also known as axillary web syndrome (AWS) is estimated to occur in 20% of patients as a post-op complication.
Making it a more common side effect from breast cancer surgery than lymphedema, infection, or build-up of fluid in the surgical area.
The two most common types of lymph node surgery are sentinel lymph node biopsy (SLNB), where two nodes are removed, and axillary lymph node dissection (ALND), where many nodes are cleared. Patients who have ALND develop cording 3-4 times more than patients who have SLNB. Another risk factor for developing cording is if the patient has a preventative surgery of the opposite breast. The incidence rate of cording with this procedure is 86%.
What Causes Cording?
In patients with breast cancer, lymph nodes are removed to ensure that the cancer hasn’t spread to other parts of the body. The removal of these nodes causes the lymphatic vessels to undergo fibrosis, or hardening, which then leads to this painful condition. More research needs to be conducted to find out what exactly the cords are made of.
Symptoms of Cording
The most common initial symptom of cording is sharp pain in the axillary (armpit), which normally occurs a few days or weeks following surgery. This pain typically occurs when the arm is stretched and raised above the shoulder level. Symptoms then progress to a tightness that runs from the axillary scar along the inside of the arm, sometimes reaching as far as the elbow or wrist. Without prompt treatment, the cord can become palpable and visible. There can be one larger cord, or many smaller, intertwined cords, which creates a thick area of hard tissue in the affected armpit.
Is Cording Scar Tissue?
No. Patients will often present to their healthcare provider with pain in the affected armpit and be misdiagnosed with having scar tissue, when it actually is the start of cording. They are two very different things, and cording will extend much further than scar tissue from the surgical site.
Treatment
Early recognition and diagnosis of cording is key. Primary care providers recognizing the symptoms of cording and then referring their patient to a physical therapist can facilitate quicker healing. Physical therapists can provide the patient with exercises and therapy techniques to relieve the pain and prevent further symptoms from developing. If the diagnosis and treatment plan are started early, a full recovery is expected within a few weeks or months.
Failure to treat cording can have a negative impact on quality of life, and can even impact future treatment plans for breast cancer.
If you or someone you know is experiencing cording, please don’t hesitate to reach out to Women in Motion Physical Therapy and wellness. Our therapists are speciality trained in women's health conditions including all oncology conditions that impact women.
We would love to connect and be a part of your treatment journey.