A Journey Through the Diagnoses of Breast Cancer
It can be devastating to be diagnosed with breast cancer. Understand the journey of a woman newly diagnosed with cancer to the day she walks out of the hospital and back home can help better assist these women through their journey. All women are different and their needs will depend on their individuality. One thing to remember is you are not alone in your journey. Know Jesus has His arms wrapped around you.
A woman can be thrown into a world of new terms, new experiences and a new kind of fear. The diagnosis does not just belong to the patient alone; it also belongs to the spouse, the children and other family members. The most important thing a women needs to know is they are not alone in this process. Education is your greatest tools and for everyone involved in this process. There are many women out there who want to help you through this journey. The most valuable website you can go to is the Susan G. Komen for the cure is a web site that is a must for anyone who is facing breast cancer and anyone you know who is facing breast cancer. The information on this site is designed to help women to understand the journey and the information can be trusted because it comes from professional who deal with breast cancer on a daily basis. The site can be found at http://ww5.komen.org/. (Komen, 2009).
The family members are also included in this journey that you are on after being diagnosed with breast cancer. A woman dedicates her life to her family and she is aware that they are not going to know how to respond to this diagnosis any more than she does. The family is use to turning to you for answers and this is one time you do not have the answers. There are many sources that are out there that can help prepare the family for the diagnosis of breast cancer. There are books that have been written for children and husbands have written books on how to help their wives through this diagnosis and the journey that is about to embark on. It is normal for the family members to be angry, sad, bewildered and confessed. Everyone is in a stage of shock at this time. That includes you the patient.
It is normal for the woman to have a whole range of emotions when she has been diagnosed with breast cancer. Emotions such as denial or guilt, there are helplessness and anxiety and always fear. It helps if their journey begins with Jesus and His strength and His constant healing power. Hebrew 6:19-20 19 reminds us that our hope has an anchor of the soul which is in Jesus Christ. (Holy Bible). It is also helpful to have a network of family and friends, along with co-survivors, health care providers and Christian counseling can help you through this most trying and difficult time in your life. There can be a positive side of breast cancer and it doesn’t have to be the worse experience in your life. It is possible to feel a renewed appreciation for life and your relationship with Jesus Christ, especially when it is all over.
This journey is a journey into the unknown. No one knows how to respond, or what to do to help, let alone how to be encouraging and supportive. All anyone can do is be understanding; not only with the woman but also with the family members. Children may become disruptive or defiant; husbands may pull away and be unresponsive. These are not signs of them being uncaring or unloving; it is a sign of stress and not knowing how to respond. You may find yourself not responding, or listening easily confused and lost. This is all normal and to be expected. Good coping tools are needed to help get through this stressful time. Psalm 139 is a wonderful reminder that the LORD knows all about you and you can trust on His hands to guide and hold you fast. This is not a time to be taking on anything new and complex.
One of the first determinations is what stage the cancer is before treatments can be considered. This is called pathological staging. This helps to determine what additional tests may be helpful to find out if the disease has spread outside the breast. Staging provides information about the extent of the disease and helps to decide the plan of treatment. The stages are:
Stage 0 carcinoma in situ. This means that the carcinoma is contained within the duct and there is no invasion of the surrounding tissue. The tumor measures no more than 2 cm or ¾ of an inch. (Mayo, 2010).
Stage I cancers are localized to one part of the body and is invasive. The tumor measures less that 2 cm or ¾ of an inch. It is possible to not find a tumor in the breast but find cancer cells in the lymph nodes under the arm. (Mayo, 2010).
Stage II cancers are locally advanced. This is also invasive where the tumor measures less than 2 cm or ¾ of an inch and has spread to the lymph nodes under the arm. It is possible that no tumor is found in the breast, but breast cancer cells are found in lymph nodes under the arm. It is also possible for a tumor to be between 2 and 5 cm or about ¾ to 2 inches. It may or may not have spread to the lymph nodes under the arm. It is possible for the tumor to be larger than 5 cm or 2 inches but has not spread to the lymph nodes. (Mayo, 2010).
Stage III cancers are locally advanced and spread to different degrees. In stage III breast cancer, a tumor has spread to tissues near the breast like the skin and chest muscles and may have spread to lymph nodes within the breast or under the arm. (Mayo, 2010).
Stage IV also called metastatic breast cancer. This cancer has often metastasized, or spread to other organs or throughout the body, such as the lungs, liver, bones or brain. (Mayo, 2010).
The determination of the type of medical treatment options also will consider if the cancer is invasive or noninvasive. Noninvasive (or in situ) means that the breast cancer has remained in the cells of their place of origin and that it has not spread to the breast tissue around the duct or lobule. (Mayo, 2009)
The most common is ductal carcinoma in situ or DCIS this is a stage 0 cancer. Invasive breast cancer is considered to be infiltrating or spreading outside the membrane that lines the duct or lobule and has invaded the surrounding tissues. (Mayo, 2009)
The staging can be Stage, I, II, III or IV because the cancer cells have traveled to other parts of the body, such as the lymph nodes and is considered invasive. It is important to know if the cancer cells are fueled by hormones. The estrogen and progesterone hormones can help breast cancer tumors to continue to grow and this has to be stopped to prevent more growth. The doctor may tell them one of three categories of the hormones and this is important to the treatment plan. The hormones levels can be reported as the estrogen receptor (ER) is positive, the progesterone receptor (PR) is positive, or Hormone receptor (HR) is negative which means this type of cancer doesn’t have hormone receptors, so it doesn’t need hormones to help it grow. When there is either an ER positive or Pr positive breast cancer, hormone blocking medications is going to be necessary to stop the cancer from growing. It may require taking a medication such as tamoxifen. (Mayo, 2009)
There are five different types of treatment for patients with breast cancer. Most treatments require surgery to remove the tumor. It is common for tissue from the lymph nodes under the arm to be removed to look under the microscope to see if they contain cancer cells. There are some surgeries to remove the cancer but not removing the breast itself it can either be a lumpectomy that just removes the lump or tumor and a small amount of normal tissue around it. The partial mastectomy is to remove the part of the breast that has cancer and some of the normal tissues around it. A total mastectomy removes the whole breast that has cancer and some of the lymph nodes under the arm. A modified radical mastectomy removes the whole breast that has cancer, many lymph nodes under the arm, the lining over the chest muscles and sometimes part of the chest wall muscles. A radical mastectomy removes the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy. Even though a mastectomy has been performed it may be necessary to also receive radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that might be left. (National, 2008).
Doctors need to know the amount of cancer and where it is in the body to make sure a person gets the best possible treatment. It is always shocking to hear and discuss the diagnosis and the next step that must be planned because there are usually no symptoms to this point. Taking a notebook so you support person can take notes on questions, any lab test, and the next step of the process is very helpful. It helps for evaluating what is being recommended by the doctor. It is okay to be emotional and not to remember what the doctor is saying that is why you need to take someone to be their ears for them. (Hirshaut, 1992).
This cannot be stressed enough to have a family member or even a close friend to accompany you. Take a notebook and have some prewritten questions ready to ask the doctor. You cannot expect to remember all the questions you need to know. Write them down as well as the answers to these questions. The person going along should be prepared to do the talking for you if you become overcome and unable to talk. This happens to the strongest of us and it will happen to you. There are going to be flood of tears that just start flowing without you even knowing why. It is okay and it does not make you look like a weak person. Your are in shock and it is understandable.
This is a definitely a lot of information. This is one of those times when it is overwhelming and confusing for you. I would like to share with when I was faced with how much of the breast I was going to lose. I was devastated and was in a state of shock that I had to loose any of my breasts. I found I could not face this questions and I did not know what the right answer was. I had to turn to God and allow Him to guide the surgeon and make the right decision for me. It was important for me to be able to say yes, or no, I agree or not. I gained strength from Isaiah 40: 28-31 who told me that the everlasting God the LORD, the Creator of the ends of the earth, does not faint nor does He become weary, and He understands everything. (Holy Bible). I got encouragement that He would give me the power not to faint and He would increase my strength during this time.
Going to the hospital for a pre admission testing will be needed before going into surgery. Routine blood test and an electrocardiogram, and chest x-ray will be ordered before you go in for surgery this will happen about a week before surgery is scheduled. This is when the consent form will be signed. The hospital staff should tell you the risk of the surgery and the anesthetic, any IV medication you might have to be on. This is also the time you can find out if your doctor has scheduled you for a sentinel lymph node biopsy, which is explained later.
Surgery for breast cancer usually means they will be in the hospital only a couple of days depending on the surgeon. Most hospitals have a limited number of people who can be in the surgical waiting room. If they do not tell you make this one of your questions and you can find out about this at the time of your pre admission to the hospital.
The day of the surgery they will be instructed not to eat or drink anything after midnight of the night before the surgery is scheduled. Being positive as they say good bye to their family helps both cope with the ride to the hospital. You should leave your jewelry at home. Glasses, contact lenses, hearing aids and even dental bridges can be giving to their family member to keep while they are in surgery.
Before going to surgery you may have to go to the radiation lab for a sentinel lymph node biopsy. This is a surgery that takes out lymph node tissue to look for cancer. This is especially used if you have a diagnosis of DCIS. A sentinel node biopsy is used to see if a known breast cancer has spread from the original cancer site. This is useful if cancer is found in the sentinel lymph node at the time of surgery, more surgery will be needed to remove additional lymph nodes. The sentinel lymph node is the first node in a group of nodes in the body where cancer cells may move to after they have left the original cancer site and started to spread. For example, the sentinel node (SN) for breast cancer is normally one of the lymph nodes under the arm. (Bear. 2004).
Your doctor or the radiologist injects a blue dye or special tracer substance or both into the area around the original cancer site. The dye or tracer moves to the first lymph node (sentinel node) that drains close to the cancer site. The dye or tracer makes a map pattern of lymphatic fluid. The map can show where the cancer is likely to spread and which lymph node is most likely to have cancer cells. Then during your surgery your doctor can see the dye or tracer with a special device like a gagger counter. The lymph node can be taken out, cut into very thin slices, and looked at under a microscope at the time of surgery. If a sentinel node is positive for cancer cells, additional surgery is done to remove more lymph nodes. Your family member can be with you during this part of the journey. This part of the journey will take anywhere from an hour to two or three hours. They will keep x-raying you until they make sure the dye has identified one of the sentinel nodes. This can be very tiring for you but just hang in there it will all be over soon enough.
Once this has been accomplished you will be on your way once again. Before surgery they will be hooked up to an IV, blood pressure cuff, electrocardiograph machine and a thrombosis stocking that will prevent clotting through compression will be placed on their legs. This is a time of lots of frenzied activity. It might feel like you are just a piece of furniture being tossed and turned. You need to know this is just part of the procedure and they should just relax and allow the nurses to do their job and know they are in the hand of a loving Savior.
The surgeon will talk to the family after the surgery so they should be around the waiting room for his visit. Again that notebook would be helpful for them because they also have a heavy burden to bear at this time. They are also in a state of shock. You are in the capable hands of many skilled people; your love ones are now on their own and left to face the issues. Things they may consider are if you are going to come back to them, or what will they do without you, even how they will handle the holidays. Make sure your loved ones are not alone. Make sure that one other person is one that will be most comfortable with that would not demand too much of their time and energy. Some one that would make sure they had something to eat and drink and to help support them and someone they can talk with IF they did need to talk. I also wrote a note and sent some little special snacks and gum in a brown paper bag that was not to be opened until I was wheeled to the surgery. It was my way of letting them know that I understood the pain they were going through.
There is no real way to prepare you for when you come out of surgery. You will spend some time in recovery and you may or may not be aware of being there. So the next stage of this journey I will take you thru is when you are aware of the smiling faces of your loved ones. Once you are in your hospital room you are still groggy. The nurses will assist you to the bathroom because of you will be wobbly on your feet. Just a word of warning you will see blue dye in the toilet when you stand up is you have had a sentinel lymph node biopsy. You have the IV’s in and maybe even an oxygen tub to breathe from and you are heavily bandaged. You probably will not be in any great pain if so there is medication that is ordered for you as you need it.
One of the silly little things that happened to me late at night after the surgery I laughed but was shocked at the same time. I had been helped up to go to the bathroom and once I returned to my bed I noticed this huge belly staring at me. Now no one needed to tell me I was slim, trim, little thing but I had no idea where that belly came from. Was it gas or because of the medication I really was not sure and had no intention of asking anyone about it. I giggled and fell asleep. Then it dawned on me that belly had always been there but because I had large breasts I never saw it. So a word of warning to you who were well endowed the breast did hid a multiple of indulges you are not aware of.
The emotions experienced once you are in you hospital room can range from a quiet acceptance the surgery is over, or resentment, or denial, or even anger. This brings a combination of sadness and relief. This journey of the mind can be very painful if there is no one to talk to and explore the emotions that are swirling around. Don’t be surprised about this just accept it and try to move on to the next step. And that is going home. Get a good night sleep because it will be an exhausting day going home.
It is helpful to take two or three pillows along with you, especially if you have a long way to travel to get home. You can leave the pillows in the car or have your family member bring them when you are ready to leave. Pillows help to secure the chest area from bouncing when the car turns or hits those bumps.
Once you get home your family won’t really know what to say or what to do to help you. Here is where you have to talk to them and let them know where you are in this journey. Share your experience in the hospital listen to your families experience in the hospital and those who stayed home. This should be a time when the family comes together. You and your family have e experience a horrendous few months; yet here you all sit with smiles on your face and hope in your heart and most of all the knowledge that you all made a journey hand in hand with Jesus. You are all a little broken and a lot bruised but as the years go by you and your family will look back on this journey knowing it was our Lord Jesus Christ who got you through this journey. You will look back on these past few months and say wow this was the year I received my greatest growth toward Him. You and your family has gained an eternal trust in Jesus that He will guide you, sustain you, nourish you, and strengthen all of you, and most of all loved and healed all of you.
The period after surgery after coming home from the hospital is the time you may feel the most depression and anxiety. Even though you know how blessed you have been you can still fell emotions you do not understand.
Don’t hide these emotions talk them out knowing there really isn’t a solution or anything that needs to be done. Just get out these emotions so they can be gone otherwise they can fester and will burst when you least expect it. You need to take time to be kind to yourself. You are going to feel exhausted for weeks after such a major surgery don’t fight it just except it. Take the time to do quiet things that mean something to you like read a good book or spend time with the Lord. You need to remember you have made it through a huge journey and have had to rely on Jesus and family all the way. The journey does not stop here because there will probably be radiation or chemotherapy maybe a reconstruction downs the road. Friends and even family may expect you to start where you were before the diagnosis of cancer. They need to understand that you have to ease back into life and so do they. Children and other family members need to know they can still hug you but that they have to be gentle. They also need to know that there will be real tears but it is okay it is just part of the journey.
You will leave the hospital with a heavy bandage that covers the surgery site. There will be two drains under the arm or at the side that is to remove the fluid and blood. They look like plastic hand grenades. The nurses will tell you how to measure and empty the drains while you are at home. These drains will be removed around 1-2 weeks after surgery. Some women may experience numbness, pinching, or a pulling feeling beneath the arm closest to the affected breast from damage to nerves under the arm. (Benedet. 2003).
The first time you see the incision will probable when the doctor removes the bandages. This can be very shocking and there is no real way to prepare you. You can take peeks from under the bandages; but there is no way of preparing you. It does help if before you leave the hospital if you ask the doctor what to expect and maybe he can help prepare you. When the drain tubs are removed it will burn and hurt for a matter of seconds. Just remember to breath and relax and it will be over before you know it.
It is not uncommon for women who have had mastectomies to feel anger, depression, anxiety and a fear of the known. There may be issues about self-esteem; there can be a psychological trauma of losing a breast. The cancer might be gone but so is the breast and that is a loss. It is not uncommon for there to be anger toward God for allowing this to happen. There are many issues that have to be addressed and good way of addressing these issues is through writing in a journal the fears, dreads, what it means to be without a breast. Then deal with them one by one. (Aldredge.1984).
It can take a few weeks to a few months to recover from a mastectomy, and longer if they have had reconstruction. It all depends on what you have had done. It’s important to take the time you need to heal. The physical problems associated with recovery from a mastectomy are lymphedema (swelling of the lymph channels), seroma (a collection of serum in the body, producing a tumor-like mass), delayed wound healing for any number of reasons including infection, impaired shoulder motion, muscle atrophy (a wasting away or weakening) and delayed from the usual daily activities usually from 1-4 months. The pain, weakness and numbness, tingling and stiffness can last from 3-6 months or longer. (Nail, 1984). This is an individual time period you need encouragement to reassure that this all takes time. It may help you to know that most of your undying fears and anxiety come from the fear the cancer will return.
Family and friends need to be prepared to step in and be a good listener at any stage that you may need good listening skills. It takes time for a woman to adjust to the loss of a breast. Talking to other women who have had mastectomies, to their partners, and family can help deal with these feelings. It needs to be remembered that a mastectomy threatens some women’s interpretation of body image, partly because of the breast’s symbolic and physical association with being a woman. Studies have shown that most women in the beginning of the process are more afraid of the cancer than on body image. Studies also shows that self-image worsen after 6 months to a year after the mastectomy. (Bredin, 1999).
There is no getting away from the fact that there is a difference; a sense of incompleteness in the way your body looks and feels. It is important for you to know that the Scripture is full of encouraging Words that you are loved by God and that you are important in His world. 2 Corinthians 9:8 is a reminder that God is able to make all grace abound toward them; that they will always have sufficiency in all things because of Him. (Holy Bible) John 14:27 is the most powerful verse to give hope and peace with the message to not let their heart be troubled, neither let it be afraid. (Holy Bible). It is my earnest prayer that I may take my experience to help you and others who are facing the journey of breast cancer.
Once your surgeon has released you to an oncologist, and radiation or chemotherapy is over, and the oncologist releases you, is an important time in this journey. Yet there is a shock that is involved in being on your own. You have had doctors and nurses surround you and you have been reassured that everything is happening the way it is supposed to be happening and now they are gone. Those questions you have had has all been answered and you have been reassured that the cancer will not return.
You even have been given a list of things to look for. You still may be anxious and undergo feelings of abandonment. You still have a primary care doctor if you have questions and you are still not alone. There are avenues that are still open for you. Your cancer society chapter can help you get in touch with other women who have gone through exactly what you have gone through. We all belong to an exclusive club and we belong to a sisterhood. We all care what you are going through just like you are getting to the place where you want to share and help other women to survive this thing called breast cancer.
The journey of breast cancer is an individual journey but you do not have to be alone on this journey. I mentioned in the beginning that there can be a positive side of breast cancer and it doesn’t have to be the worse experience in your life. It is possible to feel a renewed appreciation for life and your relationship with Jesus Christ, your family especially when it is all over. You can look back and say you did it. You walked through one of the hardest times in your life. You faced the possibility of death and lived to see another day. You are loved not only by your family and friends but especially by the Lord; He has been there for you will continue to be there every step of the way. It is so good to know that you are such an important lady that so many people are and will be praying for you and your recovery. Yes, there will be sadness, tears and fear and I cannot say when the sadness over losing your breast and having cancer will leave; but I do know that you are not alone and every step you have taken is a mark that is left for others to follow. It is my prayer that God blesses you and your journey through this process.
Reference
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Mayo clinic staff, M. c. (2010, Jan 9). Brest cancer staging. Retrieved Feb 10, 2010, from Mayo Clinic: http://www.mayoclinic.com/health/breast-cancer-staging/BR00022/
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Nail,L/ Jones,L/ Giuffre, M/Johnson,J. (1984). Sensations After Mastectomy. American Journal of Nursing, 84(9), 1121-1124 Retrieved from CINAHL Plus with Full Text database.
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MLA Style Citation:
Holstein, Joanne “A Journey Through the Diagnoses of Breast Cancer:.” Becker Bible Studies Library Apr 2009.< https://guidedbiblestudies.com/?p=2238,>.
APA Style Citation:
Holstein, Joanne (2009, April) “A Journey Through the Diagnoses of Breast Cancer:.” Becker Bible Studies Library. Retrieved from https://guidedbiblestudies.com/?p=2238,.
Chicago Style Citation:
Holstein, Joanne (2009) “A Journey Through the Diagnoses of Breast Cancer:.” Becker Bible Studies Library (April), https://guidedbiblestudies.com/?p=2238, (accessed).
