Conquering Breast Cancer - a Survivor's Guide

I was diagnosed with breast cancer 9 years ago at the age of 45. Even though I braced myself for the news after knowing I had a lump in my breast, it was a bit unreal as I was told the diagnosis. I cried a little at first. Then I decided that I was not going to let this diagnosis get me down and interfere with my future plans. I was determined to fight it and be an inspiration to those who might follow me down that path.

If you have been recently diagnosed with this disease, I know that it is overwhelming. There is shock and fear and the search for the right answers about your treatment. What you do in the early days of diagnosis is very important, both for your physical and psychological health. Following is some important information and some tips to help you get through those first days and weeks after the diagnosis.

Getting a Handle on Your Emotions and Taking the First Step

After you have been diagnosed, it is very normal to feel a host of emotions. You will be upset. You will cry at times, and will worry a lot of about your future and your family. It is important to know that today breast cancer is highly treatable, particularly if it is caught early. Even those individuals I know who had the most aggressive form of cancer, that had spread to other parts of their body, have been treated and still alive after almost 10 years. These individuals have done so well because they sought the best treatment available.

Therefore, your first order of business is to make appointments to visit at least two breast surgeons, and make an appointment to see them within the month of your diagnosis. Do not rush into any surgery. I have heard of cases where a general surgeon has told the patient that he needed to operate immediately, maybe within a matter of days. The need for immediate surgery is very rare. Don't forget that your tumor has most lilkely grown over a number of years, so that waiting to see one or two other surgeons for a second opinion is wiser than rushing into surgery. Most breast surgeons will see you very quickly once you have told their office that you have a confirmed malignancy.

Even if your cancer is relatively small, it is preferable to see a breast surgeon over a general surgeon, and it always pays to get a second opinion. The reason to see a breast surgeon rather than a general surgeon is that while many general surgeons do a lot of surgeries on the breast and may be very good, a breast surgeon usually has far more experience in operating on the breast, will usually be more up-to-date on treatment options, and will be able to refer you to the most appropriate oncologists for treatment after surgery, or what they call adjuvent treatment. In addition, you might have a better overall outcome to the look of your breast with a breast sugeon.

Once you have made your appointments, prepare for your visit. You can search the internet for information on breast cancer treatment to get an overview of the treatment options your surgeon might discuss. The best sites for this information include the American Cancer Society, www.cancer.org, and the National Cancer Institute, www.cis.nci.nih.gov. Familiarize yourself with the inforamtion on breast cancer, so that when your surgeon begins discussing treatment options, you are somewhat familiar with the terms and treatments available. Also, make sure you bring a notebook to the office and take someone with you. It is good for your spouse, significant other, child or friend to hear the surgeon in case you miss something your surgeon has told you.

After the surgeon has examined you, he or she will be giving you a lot of information about the course of treatment, wheter it be lumpectomy or mastectomy, and the chances of yourl needing just chemotherapy or radiation or both. Remember also that most breast surgeons today perform lumpectomies rather than mastectomies, except in cases when the tumor is very large, or in the case of certain types of tumors. However, having a lumpectomy usually means having radiation to the breast to ensure that any stray cancer cells are destroyed.

Your Surgery

After you visit the first surgeon, and then get a second opinion, you will most likely be able to choose who you would like to do the surgery. You should feel comfortable and confident about your surgeon. Once the surgery date is set, you will most likely feel anxious and will probably want to get it over with. Whether you are having a lumpectomy or mastectomy, the surgeon will tell you that he will also be checking your underarm lymph nodes for any signs of cancer spread. This involves a small cut under the arm on the side of the lump. If your tumor is relatively small (2 cm. or less, or 1 inch or less), many surgeons today do a sentinel node biopsy. This means that you will have only 1 or 2 nodes removed, rather than the 20 or so that used to be removed several years ago. If the cancer is not found in a frozen section of the 1 or 2 nodes, in 99% of the time, cancer will not have spread to any other lymph nodes or to the rest of the body. This type of treatment is a great breakthrough since you will be spared the possibility of lymphadema. Lymphadema is a condition that causes perodic swelling of the arm on the side where the lymph nodes were removed. The more nodes removed, the greater the chance for lymphadema, since the lymph fluid needs a place to drain. However, even if you need to have more than 1 or 2 lymph nodes removed, proper excercises done soon after surgery can help you avoid lymphadema. Make sure you ask your surgeon about these exercises if he or she does not discuss them first.

If you have a lumpectomy, it is usually ambulatory surgery, and you will be released home the same day. Recovery is relatively quick. I was back at work in about 5 days. A mastectomy requires at least a 24 hour stay. Be sure to ask your surgeon about the details of your surgery and recovery time.

Your Treatment

Once you have had your surgery, your tumor, the surrounding tissue and the lymph nodes will be carefully analyzed. The results of this analysis will provide the basis for your further treatment. At this point, the surgeon will either refer you directly to a radiation oncologist, if you have had a very small tumor that is non-aggressive. Usually, the protocol for anything that is a centimeter or more (1/2 inch or more), regardless of the level of aggressiveness, is to refer you to a medical oncologist for a discussion of chemotherapy treatment. There are many different chemotherapy protocols, and a specific protocol will be recommended to you based on the pathology of your tumor and your lymph node status. While chemotherapy is generally not pleasant, there have been tremendous strides in medications for nausea. There are also medications that boost the red blood cells and white blood cells that drop in numbers when you are on chemotherapy.

I worked all through the time of my chemotherapy. I also worked through my radiation treatments. After the first few days of mild nausea, I was able to put in full days at work. If you can work while on chemo, it is a great way to maintain a sense of normalcy in your life. My husband and I made sure we got out to dinner, and did other enjoyable things. I actually found that while I was on chemotherapy, the things I enjoyed doing seemed to be even more enjoyable. It was as if I was given a new lease on life, and I recognized more of the beauty of life. This is not an isolated feeling. I know of many other women on chemo that felt the same way.

If you are having radiation only, there are usually 28 to 35 treatments. These entail a minute or two under a linear accelerator (a powerful x-ray type machine) five days a week. The discomfort of radiation is localized to the breast and can be treated with certain creams that your radiation oncologist will recommend. Sometimes women find they are more tired when on radiation. This is common, but will go away as soon as your treatments end.

Through either chemo or radiation, get plenty of rest and eat well. Good nutrition is an essential part of your healing and will allow the good cells in your body to come back faster after treatment.

If you are at all uncomfortable about your treatment recommendations, don't hesitate to get a second opinion. I changed oncologists after two chemo cycles because I felt I was receiving too much chemo and did not know how I would get through the next six cycles. I found an equally conpetent oncologist, who reduced one chemo drug and increased another. By doing this, I still received the full benefit of my chemotherapy, yet was able to tolerate it much better.

After you finish chemotherapy and / or radiation, your oncologist will probably discuss your taking a chemo-preventive medication such as tamoxifen, or more recent medications such as arimadex. If taken for five years, these medications have been shown to reduce the risk of cancer recurrence.

Be Courageous

Undergoing cancer treatment is not a walk in the park. However, if you educate yourself, have a forward-looking attitude, and be discerning in choosing your health care team, you will have confidence in a positive outcome, and feel like a prize fighter who has just won the fight. Looking back 9 years, my cancer experience is like a dream to me. I was fortunate to have wonderful doctors, and family and friends who rallied around me. I was determined not to curtail the things I enjoyed while undergoing treatment. So, have courage and fortitude, and remember that there are millions of survivors out there who have walked your walk.