Just Get Me Through This! - Revised and Updated. Deborah A. Cohen
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my life had changed forever, but I was not yet quite sure how. All I knew was that I felt as if I had been smacked in the face by a tidal wave. Somehow, I would have to pick myself up and put myself back together again.
A NOTE FROM THE ONCOLOGIST
Every cell in your body has a specific function. Brain cells transport neurological messages, stomach cells help digest and absorb food, and breast duct cells make milk. Occasionally, however, a change in the chromosome pattern in the DNA of a cell occurs—a “mutation.” This can be caused by an inherited defect, external factors such as radiation or environmental toxins, or a combination of the two. Usually, a mutation has no effect at all on the cell—it continues to do its job as “programmed.” Sometimes, the mutation is lethal to the cell, so the cell just dies and is washed out of your body (no big deal, we make billions of new cells every day).
Less often, the mutation leads to the transformation of the cell in such a way that it no longer performs its function (e.g., producing milk, telling your hand to move, absorbing your lunch), but rather reprograms itself to simply replicate or “clone” itself. A group of these cells is a tumor. A “benign” tumor does not invade or damage other parts of the body, while a “malignant” tumor will be fueled by and destroy surrounding tissue. In sum, a malignant breast tumor is composed of breast cells that have replicated themselves out of control, overtaking and destroying healthy cells and tissue in their wake.
If you are reading this book as someone with “early-stage” cancer, you are lucky that most likely, all the cancerous cells have remained grouped together in the original tumor site in the breast—that is, your cancer has remained “local.” Survival rates are very high for localized, early-stage cancer, and often you are “cured” by surgery alone. All the additional treatment you may undergo is “preventative” or “adjuvant,” just extra “insurance” in case microscopic cancerous cells have broken away from your tumor and moved to other parts of your body. When original “clonal” cells migrate from the breast organ to another place in your body and begin forming tumors, that is called a “metastasis.” When you hear of cancer “metastasizing,” it means that the cancer has spread to other organs—in the case of breast cancer, most commonly the lungs, bones, or liver—and is invading the healthy tissue of those organs.
There Are Many Roads Leading to “Suspicious.”
If you’re reading this book, unfortunately you may have realized that there are many roads which can lead your doctor to mutter something about “suspicious———” (fill in the blank). It could be several alternatives: a “lump” you found yourself, either intentionally or accidentally; a “thickening” that your doctor found upon examination; or a mammogram where something caught the doctor’s attention. Whatever the pathway there, the next step is typically a biopsy. You must understand the role of the biopsy, and what information you can glean from it before considering your surgical options, if that is the appropriate route. Remember, early-stage cancer is very treatable, with extremely high survival rates. In a strange sort of way, think of yourself as lucky that your doctor was suspicious. It may have saved your life.
A NOTE FROM THE SURGEONS
For those of you just beginning the breast cancer journey, you need to be clear about exactly what a biopsy can and can not tell you. While there are variations on each, there are essentially four types of biopsies, which are increasingly invasive, but also increasingly exacting in terms of diagnosis. However, other than a complete surgical biopsy which removes the entire mass, biopsy results are not 100% definitive. Biopsy types are:
1. Fine needle aspiration (FNA). Conducted in the surgeon’s office, this involves inserting a needle into a mass that can be felt and removing representative cells. This is not felt to be a definitive diagnosis, but is still fairly accurate.
2. Core biopsy. Conducted in the radiologist’s office, this uses a sonogram to identify the mass and then a wide bore needle to remove a core of tissue. Definitive surgical decisions can be made on the basis of a core biopsy diagnosis because it provides a bigger sample than FNA.
3. Stereotactic core biopsy. Conducted in the radiologist’s office, this uses a mammogram to detect calcifications or architectural distortions that are not able to be felt. This also takes a core of tissue and uses a special table placing the patient facedown. Definitive surgical decisions can be made on the basis of a stereotactic core biopsy.
4. Excisional (open) biopsy. Conducted in the operating room using local anesthesia and intravenous sedation, this involves removal of a mass or calcifications that are not technically amenable to either core biopsy or stereotactic biopsy (deep or close to the chest wall, directly behind the nipple, or in patients who cannot be positioned for stereotactic biopsy due to arthritis or other illness).
Regardless of which type of biopsy you had, if there is any debate about the interpretation of the results, consider going to a more extensive procedure. A little sacrifice now of time, pain, and even tissue may save you a lot later.
Getting Your Lab Report . . . like Remembering Where You Were When JFK Was Shot.
Just accept that you will never forget the moment your doctor received the results of your lab test, and had to break the news to you. Just as every American adult has a vivid snapshot branded in their memory of exactly where they were and what they were doing when they heard the news that John F. Kennedy was shot, so will you have an indelible imprint of where you were and how you were told that you have cancer. Just as JFK’s assassination became a significant moment in American history, your news will become a part of your heritage, your strength, who you are. No matter how much you want to rewind the clock and erase it, you can’t. Cancer is now part of your history.
A Dose of Quiet Time Is the Best Medicine for the Ordeal Ahead.
No matter what your point of origin, be it your family physician, your gynecologist, a breast specialist, or even a dermatologist, if you are reading this book, all roads have led you to this shocking crossroads. Like me, you now have cancer as a relevant term in your life—for the rest of it! However, as you will see throughout this book, this news is not a destination, or an end, but the beginning of a new journey—a journey that will redefine who you are and what you want from life, a journey that has obstacles, but also high points, and a journey that many others will share with you and help you endure. However, in the immediate aftermath of receiving your diagnosis, allow yourself some moments alone to just sit and let it sink in as much as it can. Maybe you already have by the time you’re reading this. But if you haven’t, get away to places that make you feel good. If you like art, go to a gallery or museum. If you like the outdoors, go for a hike or walk in the nearest park. Don’t necessarily do anything yet. Look at the surroundings you’ve chosen, and realize how little you actually see on a daily basis, until news like this makes you wake up to the details of the world around you. Realize how lucky you are just to be sitting there. These moments alone will allow you to get your head clear enough to understand what is happening to you, determine who you need to share your news with, in what order, how, and when. And if you haven’t already, use some of this time to make lists of all the questions you want to ask your doctor and all the people who can possibly help you and might know something about your new disease.
A Three-Phase Plan for Letting the News Sink in.
The news that you have breast cancer cannot be comprehended in a single dose. It’s something that may happen in phases over several days—easing into your consciousness, and understanding that, “Yes, they are talking about me.” And while you will come to understand that fact, it will actually take months, perhaps years, to fully comprehend the implications of that little piece of news. So, after that initial life-changing phone call from your doctor, here’s