Cancer patients and survivors should not really practice yoga immediately after surgery; this is to allow time for the scar tissues to heal.  For those undergoing chemotherapy and radiotherapy, clinical research has shown that practising yoga regularly can alleviate side effects of treatment like fatigue, anxiety and depression.  We suggest that you consult your physician if you have any questions about how yoga will affect your medical condition.  If you’re waiting for your doctor’s approval before beginning, start with the “guided mediation” chapters.  This will get you focused on your breath which is a crucial part of the yoga practice.

Yoga is not only about how bendy you are.  It’s about focusing your awareness inwards, using the physical postures as a moving meditation to focus on your breath.  With a consistent yoga practice, in time, you will feel a shift in your flexibility edges. Yoga is about making more space in your body, one step at a time and is suitable for everyone, including complete beginners.   Cancer patients and survivors with no previous experience can still do yoga and reap its benefits.

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Cancer patients with other solid tumours like uterine cancer, prostate cancer, lymphoma, melanoma, vulvar cancer and ovarian cancer who had surgical interventions would also sometimes experience leg lymphedema.  According to NHS England, secondary lymphedema affects around 50% of patients with vulvar cancer, 30% of patients with penile cancer and 20 – 50% of melanoma receiving treatment in the lymph nodes in the groin can also get lymphedema (1).  Unfortunately, compared to breast cancer-related lymphedema, there are relatively few studies who have investigated these patient groups on what treatment or management strategy might work best for them. Irrespective of the cancer type, leg lymphedema is a result of the damage or block to the lower extremity lymph system of the cancer patient.  Inevitably, this will create an accumulation of lymph fluid in soft body tissues, causing swelling, pain or discomfort which negatively impacts on quality of life.  If left untreated, lymphedema can cause long-term physical and psychological  harm for cancer patients.One of the favourite yoga poses which I often prescribe for cancer patients affected by leg lymphedema is supported shoulder stand.  The beauty of this pose is that is can be easily performed by almost everyone, regardless of level of physical fitness or flexibility.  Sometimes, shoulder stands are called the Queen of all yoga postures, and many benefits have been associated with this posture.  For cancer patients affected by leg lymphedema, this yoga pose is particularly helpful in the case of swollen feet where the flow of the lymphatic fluid accumulated in the feet will move towards the body, with the help of gravity.

Needed Props: A solid wall!

Instructions:
1. Bring your hips as close to a wall as much as possible.
2. Lie down on the floor, resting your back and shoulders comfortably onto the floor
3. Inhale, straightening both legs up to the sky with the support of the wall and relaxing both hands to side of the floor, palms up, facing the sky
4. Keep breathing deeply. Hold here for five to ten minutes. If you start experiencing pins and needles in your feet during inversions, you can bend your knees slightly
5. On your last exhale, roll over onto your right shoulder and rest there for five breaths.
6. Inhale; with the support of your right hand, push yourself up to a seated position

Key Benefits:
1. Reduce swelling in the leg or feet caused by lymphedema
2. Decreasing varicose veins
3. Induces relaxation by reducing your heart rate
4. Regulating hormone production by gently massaging the thyroid glands and strengthening of the immune system.

Reference: NHS England - Patient Information on Lymphedema 

Breast cancer–related lymphedema is one of the most common side effects experienced by breast cancer patients and survivors.  To date, one of the largest population-based prospective study of 631 Pennsylvanian breast cancer survivors showed that the 5-year cumulative incidence of breast cancer related lymphedema was as high as 42% (1).  Lymphedema refers to swelling that commonly occurs in your arms following breast cancer treatments, like the removal of your lymph nodes.  When lymph nodes are removed, it results in a blockage in the lymphatic system creating a stagnation and accumulation of lymph fluid.  The accumulation of lymphatic fluid leads to swelling, which can be painful.For patients with severe lymphedema, lymphatic reconstruction and excisional surgeries are the two surgical options available for breast cancer patients and survivors.  However, for those experience milder symptoms, clinical trials have demonstrated that yoga can help alleviate and manage the swelling, pain, tired or heavy arms caused by lymphedema.  For example, a small randomised control trial piloted in 2014 showed that breast cancer patients with lymphedema who participated in a 8-week yoga intervention program experienced reduction pain and swelling (2).  Other studies have also shown that breast cancer patients with lymphedema had also shown an improvement in the range of movement and pain reduction after 3 months of practicing yoga regularly (3).As an experienced yoga instructor, there are many yoga poses I can think of which might potentially help with managing lymphedema dependent on the site (arm/leg), severity, co-morbidity and physical fitness of the breast cancer patient/survivor.  For breast cancer patients and survivors with arm lymphedema, one of my favourite pose is prescribing the modified extended Side Angle Yoga Pose, which allow the practitioner to adjust the position of the height and extension of her arm.  This pose is demonstrated in my yoga exercise book -   Yoga for Breast Cancer Survivors and Patients – by the fabulous secondary breast cancer survivor Jo Taylor who was brave enough to model for us!

Needed Prop: A yoga brick

Instructions:
1. Inhale, step your feet out 4-5 feet apart, and turn your left foot at 45 degrees and right foot parallel to the mat.
2. Exhale, bending your right knee at a 90-degree angle. Ensure your right heel is in line with your right knee.
3. Inhale and place your right elbow/forearm near the top of your knee without sinking your entire body weight. Place a yoga block vertically or horizontally outside your front foot for support if required. 
4. Exhale, straighten your arms out at 45 degrees and gaze towards your left hand.
5. Breathe deeply for five breaths.
6. On your last inhale, straighten your front leg and come all the way to standing gently.
7. Exhale, turn to the other side and repeat the extended side angle pose on the leftside, gazing towards your right hand.
8. Remain here for another five deep breaths.
9. Come out of the posture by straightening the left leg and come all the way to standing, feet together, at the front of the mat. 
10. You can repeat the posture a few times for a “juicier” stretch 

Key Benefits:
1. Reduce swelling in the arm caused by lymphedema
2. Practising breath control can reduce stress and anxiety
3. Helps open up chest area and promote healing of scar tissues
4. Stretching and lengthening of intercostal muscles 

References:
‍ J Clin Oncol. 2009 Jan 20; 27(3): 390–397.
‍ BMC Complement Altern Med. 2014; 14: 214.
‍ Int J Yoga. 2016 Jul-Dec;9(2):145-55. doi

This pose is particularly good for cancer patients affected by the side effects of chemotherapy or radiotherapy:
1. Alleviating fatigue
2. Stress reduction
3. Helps in relieving chemo brain or chemo fog
4. Helps mind to relax, promoting better sleep
5. Reduce anxiety level 

Needed props: 7 bolsters, 5 blankets.  *If these props are unavailable, use pillows or sofa cushions as a replacement. 

Instructions: Head should be higher than hips, and back should be well supported. Feet should feel free without any pressure.  Place three bolsters in triangle (two on bottom, one on top) with a blanket just behind top bolster for the head. Place two bolsters under the knees and a bolster under each arm. Place two blankets on each arm bolster, with the second blanket double folded to support the hand and forearm. The body should feel completely supported and relaxed in this posture, without any stress to the lymph or chest muscles. The thighs should be open, with the feel free from the floor.4-count samavritti breath is equal inhale, equal exhale; breathing into the abdomen and back ribs on the inhale for 4-counts, breathing out moving the energy into the core on the exhale. The practitioner should on the breath count and steadily relax.

I would like to thank expert yoga teacher, Elizabeth Reumont for demonstrating this posture.  http://freeliz.com/

This pose is particularly good for breast cancer patients who have undergone mastectomy or breast reconstruction surgeries.  Lymphedema

1. Helps in relieving swelling and pain due to Lymphedema 
2. Relieves shoulder and upper back pain
3. Promotes healing of scar tissues
4. Supports recovery or regaining normal range of shoulder mobility

Needed props: A yoga belt (Or any belt/scarf)   

Instructions: Raise the left arm with the palm facing backwards and then reach the hand down between your shoulder blades. Then take your right arm out to the side, rotate it so that the palm is facing backwards and then bend your elbow and take the back of the hand behind your back and up towards the shoulder blades. The aim is for the fingertips to reach and hold, but don’t worry if your range of motion isn’t quite there yet. The second picture shows an alternative using a yoga belt using the belt, work the hands gently towards each other. As you practice your will find that the fingertips get closer together and you may eventually be able to clasp them. Note that there may be a big difference between sides.Hold for about 20 seconds (around five long breaths) and then swap sides. Breathe deeply and evenly. Always listen to your body and stop if the feeling of good stretch becomes more like pain. You can repeat 2 or 3 times on each side. I always finish this pose with a gentle massage of my upper arms.
I would like to take this opportunity to thank Jude Murray, MA, IYN Yoga Elder for demonstrating the following yoga pose. https://myhealingspace.org.uk/healing-space-teachers/