Upcoming Webinar- 5/19/2026- with Dr. Sarah Persing

Reconstructing Confidence: Dr. Sarah Persing on Breast Reconstruction for Men with Breast Cancer

Male breast cancer remains widely misunderstood and under-discussed, leaving many patients without clear guidance on what comes after treatment. While survival outcomes have improved with earlier detection and better therapies, the physical and emotional aftermath of surgery can be profound—particularly for men who undergo mastectomy and experience visible changes to the chest. On March 19 at 11:00am EST, the Male Breast Cancer Global Alliance (MBCGA) will host a Spring Webinar featuring Dr. Sarah Persing, a plastic and oncoplastic breast surgeon and Associate Professor of Surgery at Tufts University School of Medicine, to address one of the most overlooked aspects of male breast cancer care: breast reconstruction.

Why Reconstruction Matters for Men

For many men, breast reconstruction is not initially presented as part of the treatment conversation. Reconstruction is often perceived as a “women’s issue,” despite the reality that men can experience significant chest wall deformity, scarring, asymmetry, and functional concerns after breast cancer surgery. These physical changes can impact posture, comfort in clothing, and body image—factors that carry psychological weight during recovery and survivorship.

Modern reconstructive approaches recognize that restoration is not cosmetic vanity; it is part of comprehensive healing. Reconstruction can help restore chest contour, address tissue deficits, improve symmetry, and, in select cases, incorporate techniques that preserve or reconstruct the nipple-areolar complex when oncologically appropriate. For male patients, even subtle contouring can significantly influence confidence and the willingness to re-engage socially and physically after treatment.

Dr. Persing’s Expertise in Oncoplastic Reconstruction

Dr. Persing brings a rare blend of expertise in plastic surgery, microsurgery, and oncoplastic breast surgery, with a clinical focus on breast cancer and reconstructive techniques. Her work bridges cancer control with aesthetic and functional restoration—an approach that reframes reconstruction as an integrated part of cancer surgery rather than an afterthought.

In the upcoming webinar, Dr. Persing is expected to discuss how reconstructive planning can begin at the time of cancer surgery, not months later. This “oncoplastic” model coordinates tumor removal with reconstructive strategy to optimize outcomes while maintaining oncologic safety. For men, this may include careful management of skin flaps, contour refinement of the chest wall, and microsurgical options in more complex cases where tissue deficits are significant.

Current Approaches to Breast Reconstruction for Men

Reconstruction for men differs from traditional breast reconstruction in women. Rather than restoring breast volume, the goal is to re-establish a natural male chest contour. Options may include:

·        Local tissue rearrangement to smooth contour irregularities

·        Fat grafting to correct depressions or asymmetry

·        Scar revision and chest wall contouring

·        Nipple-areolar reconstruction or preservation when oncologically appropriate

·        Microsurgical techniques in cases involving extensive tissue loss or prior radiation

Radiation therapy and lymph node surgery can complicate healing, making individualized planning essential. Dr. Persing’s experience in microsurgery and oncoplastic techniques positions her to address these challenges while minimizing functional limitations and long-term discomfort.

A Patient-Centered Conversation

Beyond surgical technique, the webinar will emphasize the importance of shared decision-making. Men are often not informed that reconstruction is an option, and many do not realize that even modest reconstructive interventions can improve comfort, posture, and self-image. Education empowers patients to ask better questions, set realistic expectations, and advocate for comprehensive survivorship care.

Dr. Persing’s presentation is designed to equip patients, caregivers, and clinicians with practical knowledge: when to consider reconstruction, what questions to ask a surgical team, how timing interacts with chemotherapy or radiation, and what recovery realistically looks like.

Why This Webinar Matters

As male breast cancer awareness grows, so must the sophistication of post-treatment care. Reconstruction is not about aesthetics alone—it is about restoring wholeness after a life-altering diagnosis. The March 19 webinar offers an opportunity to bring clarity to an often-overlooked topic and to normalize reconstruction as part of standard care for men with breast cancer.

By spotlighting reconstructive options through the lens of an experienced oncoplastic surgeon, MBCGA continues its mission to close care gaps, challenge outdated assumptions, and elevate survivorship standards for men worldwide.

PART 2:

Beyond Survival: Why Education on Breast Reconstruction for Men Matters Now More Than Ever

By Cheri Ambrose, Founder & CEO, Male Breast Cancer Global Alliance (MBCGA)

Every time we host an educational forum, I am reminded why the work of the Male Breast Cancer Global Alliance exists. But some conversations land differently. Dr. Sarah Persing’s presentation on breast reconstruction for men was one of those moments—where science, dignity, and long-overdue inclusion intersected in a way that felt both affirming and urgent.

For too long, men with breast cancer have been excluded from conversations about reconstruction. Not intentionally, perhaps—but systemically. The language, the protocols, even the assumptions around post-surgical care have been built on a model that does not fully recognize male patients as needing the same comprehensive, whole-person recovery pathway. Dr. Persing’s presentation made something very clear: reconstruction is not cosmetic—it is restorative. It is about helping people feel whole again after cancer takes something away.

Education on this topic is tantamount in today’s cancer world because survivorship has evolved. We are no longer only measuring success by survival statistics. We are measuring it by quality of life, by how people return to their lives, relationships, work, and sense of self. Chest wall deformity, scarring, asymmetry, and physical discomfort may seem “minor” on a medical chart, but to a survivor, these are daily reminders of trauma. When we normalize reconstruction as part of the continuum of care for men, we validate their experience and restore agency to their healing journey.

What struck me most was how far reconstructive procedures have evolved. We are no longer in an era of one-size-fits-all surgery. Today’s oncoplastic and microsurgical approaches integrate cancer control with restoration of form and function. Techniques like contour refinement, fat grafting, scar revision, and chest wall reconstruction reflect decades of innovation—born from listening to patients and responding with better science. This evolution mirrors what we have seen in male breast cancer treatment itself: improved diagnostics, more tailored therapies, more nuanced understanding of male-specific disease patterns, and growing awareness among clinicians.

As an advocate and as someone who has witnessed countless men navigate breast cancer in silence, I see education as the bridge between medical progress and real-world impact. Knowledge dismantles stigma. It opens doors for conversations that men may be afraid to start. It equips caregivers to support more effectively. And it gives clinicians permission to broaden their standard of care beyond tumor removal to true restoration.

The aftermath of this presentation is not just information—it is momentum. Momentum toward inclusive care models. Momentum toward better-informed patients. Momentum toward a cancer care culture that recognizes men as deserving of the same post-treatment options, compassion, and dignity historically afforded to women.

At MBCGA, our mission has always been to close gaps in awareness, research, and care. This conversation about breast reconstruction for men is one of those gaps finally being filled. The more we educate, the more we normalize these options, and the more we invite men into these conversations early in their care, the closer we move toward a future where no patient is overlooked simply because of gender.

This is what progress looks like: not just treating cancer—but treating the whole person who survives it.

 

Gadolinium, Imaging, and Male Breast Cancer Survivorship

 What Patients Should Know about CONTRAST

By the Male Breast Cancer Global Alliance (MBCGA)

Why This Matters for Men with Breast Cancer

If you are a man who has been diagnosed with breast cancer—or you are living in survivorship—you may undergo multiple imaging studies over the course of your care. MRI scans, sometimes enhanced with contrast agents that contain gadolinium, are important tools used by clinicians to detect tumors, assess treatment response, and monitor for recurrence. These technologies save lives. At the same time, a growing number of patients and clinicians are asking informed questions about long-term contrast exposure, especially when scans are repeated over months or years.

This article is not meant to discourage appropriate imaging or undermine the role of radiology in cancer care. Instead, it is designed to help male breast cancer patients make informed decisions, understand emerging conversations about gadolinium retention in the body, recognize symptoms that may warrant discussion with a clinician, and advocate for thoughtful, individualized imaging strategies as part of survivorship care.

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What Is Gadolinium and Why Is It Used?

Gadolinium-based contrast agents (GBCAs) are injected during certain MRI scans to improve the visibility of tissues, blood vessels, and areas of concern. In oncology, contrast-enhanced MRI can be helpful for:

·        Tumor characterization

·        Monitoring treatment response

·        Surveillance for recurrence

·        Evaluating suspicious findings when other imaging is inconclusive

For most patients, GBCAs are considered safe and are widely used in clinical practice. Modern protocols include kidney screening and agent selection to reduce known risks. However, research over the last decade has shown that small amounts of gadolinium can be retained in the body after contrast-enhanced MRIs, even in people with normal kidney function. The long-term clinical significance of this retention is still being studied.

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Why This Is Relevant for Male Breast Cancer Patients

Male breast cancer is often diagnosed later than female breast cancer due to lower awareness and delayed screening. As a result, men may undergo intensive imaging during diagnosis, treatment planning, and follow-up. Survivors may continue surveillance imaging for years.

Repeated exposure does not automatically translate into harm. However, cumulative exposure raises reasonable questions about long-term safety, especially for individuals who later develop unexplained symptoms that overlap with neurological, musculoskeletal, dermatologic, or systemic complaints. For survivors already managing the effects of surgery, chemotherapy, radiation, endocrine therapy, or targeted treatments, new symptoms can be confusing and stressful.

The goal is not to create fear—but to support informed consent, transparent dialogue with your care team, and thoughtful use of imaging tools when they are clinically necessary.

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What Is Known About Gadolinium Retention

Research has documented that trace amounts of gadolinium can remain in tissues after MRI contrast administration. This has been observed in areas such as the brain, bones, and soft tissues. Scientists are actively studying:

·        How long gadolinium may persist in the body

·        Whether certain people retain more than others

·        How different contrast agents compare

·        Whether cumulative exposure has clinical relevance

Regulatory agencies and professional radiology societies have updated guidelines over time to reflect these findings. In current practice, contrast use is increasingly individualized, with attention to kidney function, imaging necessity, and alternative imaging strategies when appropriate.

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Reported Symptom Patterns: What Patients Have Described

Some patients across cancer and non-cancer populations have reported persistent symptoms following contrast-enhanced MRI. These reports are part of an evolving conversation and do not establish direct cause-and-effect in every case. Symptoms described in patient registries and clinical observations include concerns involving:

·        Skin and connective tissue changes

·        Neurological or cognitive complaints

·        Musculoskeletal discomfort

·        Fatigue and exercise intolerance

·        Cardiorespiratory sensations

·        Renal or urinary changes

·        Gastrointestinal or swallowing discomfort

·        Eye, hair, or metabolic shifts

·        Immune or inflammatory patterns

Many of these symptoms also occur commonly in cancer survivors due to treatment effects, aging, hormonal therapies, nerve injury, vascular changes, or chronic inflammation. This overlap is why careful clinical evaluation is essential before attributing symptoms to any single factor.

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Immediate Reactions vs. Long-Term Concerns

Acute Reactions

Some individuals experience short-term allergic-type reactions to contrast agents at the time of imaging. These reactions are uncommon and are typically managed safely in imaging centers with standard protocols.

 

Long-Term, Non-Specific Symptoms

Longer-term symptoms, when reported, are more difficult to interpret because they may appear weeks or months later and overlap with cancer-related side effects. This is where survivorship care becomes especially important: tracking symptom timelines, documenting imaging history, and coordinating across specialties.

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Special Consideration: Kidney Health

A rare but serious condition called nephrogenic systemic fibrosis (NSF) has been linked to gadolinium exposure in patients with advanced kidney disease. Today, kidney screening and safer contrast selection have made NSF extremely uncommon in routine oncology imaging. This progress demonstrates how evidence-based protocols can meaningfully improve patient safety.

For male breast cancer patients, particularly older survivors or those with comorbid conditions such as diabetes or hypertension, kidney health remains an important part of imaging decision-making.

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What Male Breast Cancer Survivors Can Do

1. Ask Informed Questions

You have the right to understand why contrast is being used and whether it is essential for your specific scan. Consider asking:

·        Is contrast necessary for this MRI?

·        Are there alternative imaging options?

·        Which contrast agent is being used and why?

·        How does my kidney function factor into this decision?

2. Keep a Personal Imaging Record

Maintaining a simple log of past imaging studies (dates, type of scan, whether contrast was used) can support informed discussions with your care team over time.

 

3. Track New or Persistent Symptoms

If you experience new neurological, musculoskeletal, skin, or systemic symptoms after imaging, document timing and progression. This helps clinicians assess patterns and determine appropriate next steps.

 

4. Build a Trusted Care Team

Male breast cancer survivors benefit from multidisciplinary care that may include oncology, primary care, cardiology, neurology, endocrinology, rehabilitation, and integrative specialists. Complex symptoms often require collaborative evaluation.

 

5. Balance Vigilance with Perspective

Imaging remains a cornerstone of cancer care and surveillance. The goal is not avoidance, but thoughtful use—ensuring each scan serves a clear clinical purpose.

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Why MBCGA Is Sharing This Information

The Male Breast Cancer Global Alliance assembled this educational overview to support transparency, patient empowerment, and survivorship awareness. Men with breast cancer are often underrepresented in research and education. Providing balanced, clinically grounded information helps survivors participate more actively in their care, ask better questions, and reduce uncertainty around unexplained symptoms.

This conversation is not about rejecting MRI technology or contrast agents. It is about advancing informed consent, continued safety research, and patient-centered imaging practices that evolve with emerging evidence.

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A Supportive Closing for Survivors

Living beyond male breast cancer involves navigating uncertainty, long-term monitoring, and the cumulative effects of treatment. Imaging is part of that journey—and so is your right to understand how it fits into your overall health picture. If something does not feel right, speak up. If you have concerns, ask questions. Your experience matters, and your voice contributes to improving care for the next generation of men facing breast cancer.

 

Epilogue

BE INFORMED, NOT AFRAID; Doing Your Homework as a Cancer Patient

By Cheri Ambrose, Founder, Male Breast Cancer Global Alliance

One of the most important lessons I’ve learned through advocacy is that empowerment begins with information. As patients and caregivers, we are asked to trust complex systems of care, powerful technologies, and treatment decisions that can feel overwhelming in the moment. Imaging, medications, and therapies are essential tools in modern cancer care—and they save lives every day. At the same time, each tool has a profile of benefits, limitations, and potential side effects that deserve thoughtful consideration and open conversation.

Gadolinium-based contrast agents, used in some MRI scans, are one example of a technology that is both valuable and worthy of informed discussion. For many patients, contrast-enhanced imaging plays a critical role in diagnosis, treatment planning, and follow-up. Yet, as with many aspects of cancer care, individuals may respond differently, and some patients report symptoms or sensitivities that deserve to be taken seriously. This is not about rejecting medical imaging—it is about understanding what you are receiving, why it is being recommended, and what questions to ask if something does not feel right afterward.

Doing your homework as a patient does not mean becoming fearful or distrustful. It means participating in your care with curiosity and confidence. Ask your care team why a test is needed. Ask whether alternatives exist. Ask how your personal health history—especially kidney health, allergies, and prior reactions—factors into the decision. Keep a simple record of the treatments and imaging you receive. If you notice new or persistent symptoms after any procedure or therapy, document them and bring them into the conversation. Your lived experience is part of your medical story.

It is also important to rely on credible, balanced sources of information. Not everything online is accurate, and extreme narratives can create unnecessary anxiety. Patients and survivors deserve access to trustworthy education that respects both the value of medical technology and the importance of patient safety. Some reliable places to learn more include:

·        Your oncology and radiology care team – the first and most important resource

·        Major cancer organizations (e.g., American Cancer Society, National Cancer Institute)

·        Professional radiology societies (e.g., Radiological Society of North America – RSNA)

·        Patient advocacy organizations focused on education and survivorship

·        Peer-reviewed medical literature when discussed with your clinician

At the Male Breast Cancer Global Alliance, we believe that informed patients are stronger patients. Knowledge helps reduce fear, improve communication with clinicians, and support better long-term outcomes. You deserve transparency. You deserve to understand your options. And you deserve to be an active participant in the decisions that shape your care and survivorship.

 

MBC Educational Series

Feeling the Burn: Neuropathy in Cancer Patients and the Overlooked Burden in Male Breast Cancer

Written by: Lennard M. Goetze, Ed.D  |  Phil Hoekstra, Ph.D

This article is an original work prepared for publication exclusively for the Male Breast Cancer Global Alliance. No copyrighted sources were reproduced or paraphrased. All content is intended for educational purposes.

Neuropathy is one of the most common and distressing complications faced by people undergoing cancer treatment—and one of the least adequately addressed in routine survivorship care. Characterized by numbness, tingling, burning pain, electric-shock sensations, temperature sensitivity, and loss of balance, neuropathy can profoundly disrupt mobility, sleep, work, and quality of life. While chemotherapy-induced peripheral neuropathy (CIPN) is widely recognized in oncology, the experience of neuropathy in male breast cancer (MBC) patients remains underrepresented in clinical discourse, research priorities, and survivorship resources.

Men diagnosed with breast cancer often enter care pathways designed primarily around female patients. As a result, side effects such as neuropathy may be under-screened, under-discussed, and under-treated in male survivors—despite the same exposure to neurotoxic chemotherapies, radiation, and adjunctive therapies. Advocacy groups in male breast cancer care have increasingly called attention to this gap, noting that lingering neuropathy becomes a silent burden that outlasts remission and shapes long-term recovery.

 

Why Does Neuropathy Happen in Cancer Care?

Neuropathy in cancer patients arises from multiple converging mechanisms:

1) Chemotherapy Neurotoxicity
Certain chemotherapeutic agents—such as taxanes, platinum compounds, and vinca alkaloids—directly damage peripheral nerves. These drugs interfere with axonal transport, mitochondrial function, and myelin integrity, leading to sensory loss and neuropathic pain that often begins in the toes and fingertips before ascending proximally. Because nerves regenerate slowly, symptoms may persist long after treatment ends.

2) Radiation-Induced Nerve Injury
Radiation can cause fibrosis and microvascular compromise around nerve bundles. While breast cancer radiation targets the chest wall and axillary region, downstream effects on autonomic regulation and microcirculation can alter distal nerve health, contributing to sensory disturbances and cold intolerance in the extremities.

3) Microcirculatory Injury
Cancer therapies can damage small blood vessels that nourish nerves. Reduced perfusion deprives peripheral nerves of oxygen and nutrients, compounding neurotoxicity. The feet—being the most distal tissues—often reveal these deficits first.

4) Inflammation and Immune Dysregulation
Targeted therapies and immunotherapies can trigger inflammatory cascades that affect small fibers and autonomic nerves. In susceptible individuals, this results in burning pain, hypersensitivity, and temperature dysregulation.

5) Compounding Risk Factors
Pre-existing diabetes, vitamin deficiencies, thyroid dysfunction, alcohol exposure, and occupational neurotoxin exposure can amplify neuropathic vulnerability—factors that may be overlooked in male breast cancer care pathways.

Why Male Breast Cancer Patients Are at Particular Risk

Male breast cancer patients frequently report feeling “out of place” in oncology settings, which can discourage proactive reporting of side effects. Neuropathy may be normalized as “expected discomfort” rather than recognized as a treatable condition. Additionally, men may delay reporting sensory changes until functional impairment—falls, gait instability, or sleep disruption—becomes unavoidable. This delay narrows the window for early intervention.

Furthermore, MBC survivors may lack access to gender-specific survivorship education and peer support where neuropathy management strategies are shared. The result is an unmet clinical demand: to screen, detect, identify, and treat neuropathy earlier and more systematically in men with breast cancer.

Screening and Detection: Moving Beyond Symptom Checklists

Traditional neuropathy screening relies heavily on patient-reported symptoms and bedside exams. While essential, these approaches can miss early physiologic changes. Modern survivorship care benefits from combining subjective reporting with functional and imaging-based tools:

·        Quantitative sensory testing to track vibration and thermal thresholds

·        Nerve conduction studies to evaluate large-fiber involvement

·        Thermal imaging to visualize microcirculatory and autonomic changes associated with neuropathic stress patterns in the feet and hands

·        Gait and balance assessments to identify functional risk

Thermal imaging, in particular, offers a non-invasive way to detect asymmetric temperature patterns and distal perfusion changes that often accompany neuropathic dysfunction. While not a standalone diagnostic, it complements neurologic testing by revealing functional changes that may precede overt nerve conduction abnormalities.

Standard Solutions for Managing Cancer-Related Neuropathy

There is no single cure for CIPN, but a multimodal management strategy can significantly reduce suffering:

Pharmacologic Options

·        Neuropathic pain agents (e.g., duloxetine)

·        Topical analgesics for focal pain

·        Careful medication review to avoid neurotoxic overlaps

Rehabilitation and Physical Therapy

·        Balance training and proprioceptive exercises

·        Gait stabilization and fall-prevention programs

·        Strength training to reduce compensatory injury

Lifestyle and Supportive Interventions

·        Foot protection and proper footwear to prevent unnoticed injury

·        Nutritional assessment (B vitamins, metabolic support)

·        Sleep and pain hygiene strategies

Adjunctive Non-Invasive Modalities

·        Neuromodulation techniques

·        Image-guided monitoring of extremity health to track response to interventions

·        Education on daily foot checks to catch early skin or sensory changes

Neuropathy and Dermatomal Mapping

Peripheral neuropathy and radiculopathy often produce burning, tingling, or electric pain in specific distributions. Thermography can visualize these patterns along dermatomes—the “wiring diagram” of the skin mapped to spinal nerve roots. Dr. Hoekstra describes how thermal gradients trace neuropathic pathways, helping localize nerve impingement in the spine or peripheral nerves in the limbs. When combined with autonomic challenge testing, clinicians can differentiate acute inflammatory phases (often warmer) from chronic ischemic or denervated phases (often cooler).

 

This capability is especially valuable in pain management and personal injury contexts, where objective documentation of nerve-related dysfunction supports diagnosis, treatment planning, and medico-legal clarity.

The Case for Proactive Neuropathy Care in MBC Survivorship

For male breast cancer survivors, neuropathy is not merely a side effect—it is a quality-of-life determinant. Persistent numbness or burning pain undermines confidence in walking, returning to work, and re-engaging in daily life. When neuropathy is under-identified, survivors feel unseen; when it is proactively addressed, recovery becomes tangible.

Elevating neuropathy screening within male breast cancer survivorship reframes care from survival alone to functional restoration. By integrating early detection tools, imaging-informed surveillance, and multidisciplinary treatment pathways, clinicians can move from reactive pain management to proactive nerve protection. In doing so, the cancer community honors a simple truth voiced by patients themselves: relief from neuropathy is not optional—it is essential to healing.

 

 

Part 2 —

A Diagnostic Perspective on Neuropathy in Cancer Care

By: Robert L. Bard, MD, DABR, FAIUM, FASLMS

From a diagnostic imaging perspective, neuropathy in cancer patients is not a mysterious side effect—it is a predictable consequence of how modern oncology therapies interact with nerve biology, microcirculation, and tissue metabolism. Peripheral nerves are uniquely vulnerable structures. They rely on uninterrupted blood supply, intact mitochondrial function, and stable axonal transport to maintain sensory and motor signaling over long distances. Cancer treatments disrupt each of these systems in different ways, which explains why neuropathy often emerges first in the feet and hands.

Chemotherapeutic agents are designed to target rapidly dividing cells, but many also interfere with microtubule dynamics and mitochondrial integrity within neurons. This impairs axonal transport—the cellular “highway” that delivers nutrients and signaling molecules along nerve fibers. When transport fails, distal segments of long nerves become metabolically deprived, producing the classic stocking-and-glove distribution of numbness, burning pain, and temperature sensitivity. In parallel, treatment-related injury to the small vessels that nourish nerves reduces oxygen delivery, compounding neural stress in the most distal tissues.

Radiation therapy introduces a different pathway to neuropathy. By inducing endothelial injury and fibrotic change within irradiated fields and adjacent neurovascular bundles, radiation alters vascular regulation and autonomic signaling. Even when radiation is localized to the chest wall or axilla in breast cancer care, downstream effects on autonomic tone can influence distal circulation and nerve health. Over time, this dysregulation manifests as altered temperature control, color changes, edema, and sensory disturbances in the extremities.

Imaging provides a unique window into these processes because neuropathy is not solely a neural problem—it is a neurovascular and metabolic disorder with structural and functional signatures. High-resolution ultrasound can visualize peripheral nerves, revealing enlargement, altered echotexture, and perineural edema associated with inflammatory or compressive neuropathies. Doppler ultrasound adds physiologic context by assessing regional blood flow, highlighting areas of microcirculatory compromise that parallel sensory symptoms. When nerve irritation coexists with ischemic stress, imaging helps distinguish primary neural pathology from secondary vascular contributors—an important distinction for targeted intervention.

Functional imaging modalities further extend diagnostic insight. Thermal imaging, for example, visualizes patterns of cutaneous temperature regulation that reflect autonomic control of microcirculation. In neuropathic states, asymmetry, distal cooling, or focal hotspots often parallel patient-reported burning or numbness. While not a standalone diagnostic tool, thermal imaging complements neurologic testing by revealing functional dysregulation that may precede structural nerve changes detectable by conduction studies. This functional perspective is particularly valuable in early survivorship, when symptoms are evolving and intervention windows are still open.

Imaging also supports longitudinal care. Neuropathy in cancer patients is dynamic: symptoms may worsen during therapy, plateau, or slowly recover afterward. Serial imaging—tracking nerve morphology, regional perfusion, and functional temperature patterns—provides objective markers of change over time. These markers inform clinical decisions about dose modification, rehabilitation strategies, protective footwear, and referral timing to neurology or pain management. In male breast cancer survivorship, where neuropathy may be underreported, objective imaging evidence helps validate patient experience and accelerates appropriate care pathways.

From a broader diagnostic standpoint, neuropathy rarely exists in isolation. Imaging frequently reveals concurrent contributors such as spinal degenerative changes, entrapment neuropathies, or vascular insufficiency that magnify treatment-related nerve injury. By integrating peripheral nerve imaging with regional vascular assessment, clinicians can address layered pathology rather than treating neuropathy as a single-cause phenomenon. This integrative approach aligns with precision survivorship—tailoring interventions to the dominant drivers of nerve dysfunction in each patient.

Ultimately, the value of imaging in cancer-related neuropathy lies in its ability to translate subjective symptoms into objective, trackable physiology. When patients say their feet burn, go numb, or feel “disconnected,” imaging provides clinicians with a map of where neurovascular stress is occurring and how it changes with time and therapy. This diagnostic clarity reframes neuropathy from an inevitable side effect to a monitorable condition—one that can be detected earlier, managed more precisely, and mitigated before it becomes a permanent barrier to recovery and quality of life.

 

References

1.     Argyriou, A. A., Bruna, J., Marmiroli, P., & Cavaletti, G. (2012). Chemotherapy-induced peripheral neurotoxicity (CIPN): An update. Critical Reviews in Oncology/Hematology, 82(1), 51–77. https://doi.org/10.1016/j.critrevonc.2011.04.012

2.     Cavaletti, G., & Marmiroli, P. (2010). Chemotherapy-induced peripheral neurotoxicity. Nature Reviews Neurology, 6(12), 657–666. https://doi.org/10.1038/nrneurol.2010.160

3.     Hershman, D. L., et al. (2014). Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO clinical practice guideline. Journal of Clinical Oncology, 32(18), 1941–1967. https://doi.org/10.1200/JCO.2013.54.0914

4.     National Cancer Institute. (2024). Peripheral neuropathy (PDQ®)–Health professional version. https://www.cancer.gov/about-cancer/treatment/side-effects/nerve-problems/peripheral-neuropathy-pdq

5.     Staff, N. P., Grisold, A., Grisold, W., & Windebank, A. J. (2017). Chemotherapy-induced peripheral neuropathy: A current review. Annals of Neurology, 81(6), 772–781. https://doi.org/10.1002/ana.24951

6.     Giordano, S. H. (2018). Breast cancer in men. New England Journal of Medicine, 378(24), 2311–2320. https://doi.org/10.1056/NEJMra1707939

7.     Loprinzi, C. L., et al. (2020). Management of cancer treatment–related peripheral neuropathy. Journal of Clinical Oncology, 38(28), 3325–3348. https://doi.org/10.1200/JCO.20.01399

8.     Mols, F., Beijers, T., Vreugdenhil, G., & van de Poll-Franse, L. (2014). Chemotherapy-induced peripheral neuropathy and its association with quality of life among cancer survivors. Supportive Care in Cancer, 22(8), 2261–2269. https://doi.org/10.1007/s00520-014-2208-4

 

CANCER TREATMENTS & THE FEET - A SENTINEL ORGAN

How oncology therapies reshape peripheral circulation, nerve health, and tissue integrity—and why the feet serve as a diagnostic sentinel

By: Lennard M. Goetze, Ed.D  / Phil Hoekstra, Ph.D

 

Introduction

Modern cancer therapies have transformed survival outcomes, yet survivorship often carries a hidden burden: long-term compromise of peripheral circulation, nerve integrity, and tissue resilience—most visibly expressed in the feet. Chemotherapy disrupts microvascular networks and damages peripheral nerves; radiation alters vascular regulation and autonomic signaling; and targeted and immunotherapies introduce new patterns of inflammatory and ischemic stress. These physiologic disruptions commonly manifest in the lower extremities as numbness, burning pain, edema, color changes, delayed wound healing, nail pathology, and skin breakdown—symptoms that erode mobility, independence, and quality of life.

PodiatryScan reframes the feet as a sentinel region for treatment-related injury—where early shifts in perfusion, nerve function, and tissue tolerance can be detected, monitored, and managed longitudinally. Rather than waiting for survivorship complications to escalate into disability, a proactive surveillance model identifies emerging microcirculatory compromise and neuropathic stress earlier in recovery. Positioned within oncology survivorship care, PodiatryScan supports preventive foot monitoring, rehabilitation planning, protective strategies, and timely referral—elevating post-cancer care from reactive management to function-preserving, anticipatory medicine.

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1) Chemotherapy-Induced Peripheral Neuropathy (CIPN) and the Feet

CIPN is among the most prevalent and functionally limiting toxicities of cancer therapy. Agents such as taxanes, platinum compounds, vinca alkaloids, and proteasome inhibitors damage sensory axons and small fibers that innervate the feet, producing numbness, paresthesia, burning pain, and proprioceptive loss. The feet—being distal—are affected earliest and often most severely. Sensory loss increases fall risk, impairs balance, and predisposes to unnoticed trauma. Persistent neuropathy can outlast treatment by years, reshaping gait mechanics and loading patterns across the foot and ankle. Surveillance that tracks sensory thresholds, skin integrity, and functional stability helps clinicians intervene with protective footwear, balance training, and timely referrals to neurology or rehab before secondary injuries accrue.

 

2) Microvascular Injury and Ischemic Stress

Many cytotoxic agents injure endothelial cells and disrupt nitric-oxide–mediated vasodilation, diminishing capillary perfusion in distal tissues. Reduced microcirculation compromises oxygen delivery to the toes and plantar skin, delaying healing after minor cuts or pressure points. In patients with pre-existing vascular disease, diabetes, or smoking history, treatment-related microangiopathy compounds ischemic risk. The feet, as terminal vascular territories, often reveal early signs of perfusion stress—color changes, temperature asymmetry, and delayed capillary refill—making them an ideal surveillance target for circulatory compromise during survivorship.

 

3) Radiation Effects on Vascular Regulation and Autonomic Control

Radiation therapy can induce long-lasting endothelial injury, fibrosis, and autonomic dysregulation within treated fields and along neurovascular pathways. Although the feet are rarely irradiated directly, autonomic disturbances and systemic inflammatory responses can alter distal vascular tone and sweat gland function. Patients may report cold intolerance, color changes, edema, or brittle skin and nails in the lower extremities. These changes increase susceptibility to fissures, infection, and pressure injury—particularly in older adults or those with limited mobility. Monitoring distal tissue resilience becomes part of comprehensive survivorship care.

 

4) Hand–Foot Syndrome (Palmar-Plantar Erythrodysesthesia)

Certain chemotherapies and targeted agents precipitate hand–foot syndrome, characterized by erythema, pain, swelling, desquamation, and blistering on palms and soles. Plantar involvement threatens ambulation and adherence to therapy. Early identification of plantar skin stress enables dose adjustments, topical protection, and offloading strategies that preserve function and reduce treatment interruptions.

 

5) Lymphedema, Edema, and Tissue Vulnerability

Cancer-related lymphatic injury—whether from surgery, radiation, or systemic inflammation—can manifest as lower-extremity edema. Chronic swelling increases skin tension, reduces microcirculatory exchange, and raises infection risk. The feet, constrained by footwear and dependent positioning, are particularly vulnerable to maceration and fissuring. Longitudinal surveillance guides compression strategies, footwear modification, skin care, and referral to lymphedema therapy to prevent recurrent cellulitis and mobility decline.

 

6) Immunotherapy and Inflammatory Dermatoses

Checkpoint inhibitors and other immunotherapies introduce novel inflammatory toxicities affecting skin and small vessels. Acral dermatitis, vasculitic changes, and microvascular inflammation may present on the feet as painful erythema, purpura, or ulceration. Differentiating immune-mediated dermatoses from ischemic or infectious etiologies is critical to avoid mismanagement and unnecessary treatment interruptions. Structured foot surveillance supports earlier triage and targeted management.

 

7) Nail and Skin Barrier Disruption

Onycholysis, brittle nails, paronychia, xerosis, and fissuring are common during systemic therapy. On the feet, nail dystrophy alters pressure distribution in footwear, while skin barrier breakdown invites fungal and bacterial infection. Preventive foot care—routine inspection, nail management, moisturization, and footwear assessment—reduces secondary complications that disproportionately burden survivors with neuropathy or edema.

 

8) Musculoskeletal Deconditioning and Gait Changes

Pain, fatigue, and neuropathy alter loading patterns across the forefoot and heel, precipitating callus formation, plantar fasciopathy, and stress reactions. Deconditioning compounds these biomechanical shifts, increasing fall risk. Integrating podiatric assessment with rehabilitation planning preserves mobility and helps survivors return to activity safely.

 

9) Infection Risk in an Immunocompromised Host

Neutropenia and mucocutaneous barrier injury elevate the risk of tinea pedis, cellulitis, and wound infection in the feet. Minor interdigital fissures can escalate rapidly in immunocompromised patients. Proactive surveillance, patient education on daily foot checks, and rapid response pathways for early infection signs are essential.

 

10) Why the Feet Are a Sentinel in Survivorship

The feet concentrate the downstream effects of vascular, neurologic, inflammatory, and mechanical stressors introduced by cancer therapies. Because they are distal, load-bearing, and richly innervated, early dysfunction becomes clinically apparent there first. PodiatryScan operationalizes this insight through structured, longitudinal foot monitoring—integrating perfusion cues, sensory status, skin integrity, and functional mobility into survivorship workflows. The result is earlier detection, smarter referrals, targeted protection, and function-preserving care that keeps survivors mobile and independent.

 

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Clinical Takeaways

·        Screen early and often for sensory loss, perfusion stress, and skin barrier compromise in the feet during and after therapy.

·        Act preventively with footwear optimization, offloading, skin care, balance training, and timely specialty referral.

·        Coordinate care across oncology, podiatry, neurology, rehab, and wound services to prevent small problems from becoming disabling sequelae.

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References

1.       American Cancer Society. (2023). Hand–foot syndrome (palmar-plantar erythrodysesthesia).

2.       Argyriou, A. A., Bruna, J., Marmiroli, P., & Cavaletti, G. (2012). Chemotherapy-induced peripheral neurotoxicity (CIPN): An update. Critical Reviews in Oncology/Hematology, 82(1), 51–77.

3.       Cavaletti, G., & Marmiroli, P. (2010). Chemotherapy-induced peripheral neurotoxicity. Nature Reviews Neurology, 6(12), 657–666.

4.       Hershman, D. L., et al. (2014). Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers. Journal of Clinical Oncology, 32(18), 1941–1967.

5.       Lacouture, M. E., et al. (2011). Clinical practice guidelines for the prevention and treatment of EGFR inhibitor–associated dermatologic toxicities. Supportive Care in Cancer, 19(8), 1079–1095.

6.       National Cancer Institute. (2024). Peripheral neuropathy (PDQ®)–Health professional version.

7.       Rockson, S. G. (2018). Lymphedema. American Journal of Medicine, 131(3), 276–280.

8.       Siegel, R. L., Miller, K. D., & Jemal, A. (2024). Cancer statistics. CA: A Cancer Journal for Clinicians, 74(1), 17–48.

9.       Smith, E. M. L., et al. (2013). The reliability and validity of a modified Total Neuropathy Score in patients with CIPN. Journal of the Peripheral Nervous System, 18(1), 45–51.

10.     Sonis, S. T. (2013). Pathobiology of mucositis. Nature Reviews Cancer, 4(4), 277–284.