You had your last dose of chemotherapy, or your last radiation treatment. The surgical scars are beginning to heal. As your energy and confidence return, you’ll be able to explore the many options for moving forward from the cancer experience, to a new life.
A diagnosis of cancer impacts your self-esteem, your body image, your sexuality—even your outlook on survival. You probably realize that life will never be the same after such an experience. This will leave you with a sense of loss. Take time to grieve the loss. This grieving process is an important first step toward the healing of the mind.
As you try to come to terms with your diagnosis and try to deal with the impact of your treatment, you are likely to have episodes of anxiety and depression. It is important for you to be able to distinguish depression that you can cope with on your own, from depression that requires professional help.
As is the case for most women undergoing cancer treatment, there will be times when you are sad—times when you are “feeling blue”. This is called reactive depression—in other words, you are having an appropriate reaction to your situation. This level of depression is normal, and most women can cope with it, with help from family, friends, or support groups.
One way to help manage anxiety and depression is to plan pleasant activities such as going out with friends or seeing a movie for those times when you normally feel depressed.
Another approach is exercise and sports. Physical activity stimulates the body to produce certain chemicals called endorphins that help restore a sense of well being. Try to get out of your mind and into your body, so to speak.
If you haven’t already, consider joining a support group. You should have no trouble finding one that matches your lifestyle and your particular needs. You will find a list of resources for referral to support groups at the end of the book.
There are specific times during the course of treatment and recovery when bouts of anxiety and depression are more likely to occur. Most women experience their highest level of anxiety when they come home from the hospital after surgery, because coming home means leaving most of the medical team behind and resuming normal activities.
Another time women may feel anxious or depressed is when their chemotherapy or radiation treatments end. There may be a feeling of panic at the thought that you are not being treated any more. This post-treatment anxiety is quite natural, and will gradually diminish as you regain confidence.
Some women notice that they are particularly anxious on the anniversary dates of their diagnosis or surgery. These are the so-called anniversary reactions. In addition, many women also may have “check up anxiety” just before their scheduled follow-up visit to the physician.
There is a form of depression that is unlikely to improve on its own. Usually it includes continuous feelings of sadness, feelings of worthlessness or guilt, excessive fear of the future, and lack of interest in intimacy or sex. This is called clinical depression and requires intervention by a trained professional.
Clinical depression can be treated. It may involve counseling, medications, and perhaps physical exercise and stress reduction techniques. Your physician will be able to refer you to the appropriate specialist.
And remember, you should never feel embarrassed to seek professional help. It is not a sign of weakness—no more so than going to a surgeon for a lumpectomy. Most cases of depression are short, and usually respond to counseling, with or without the use of some of the very effective medications available today.
If you experience several of these symptoms, you should discuss your situation with your physician. If you have thoughts about suicide, call your physician or nurse immediately.
You may have a clinical depression if you:
• Are continuously sad for weeks
• Withdraw from friends and relatives
• Feel worthless
• Fear the future excessively
• Speak or move slowly
• Feel tired all the time
• Can’t make decisions
• Are angry all the time
• Lost interest in intimacy and sex
Even after the most complete treatment, there’s always a chance that cancer will recur. Most recurrences happen two or three years after surgery. The longer you go without a recurrence, the greater are your chances of remaining free of disease. But you can never say that the cancer has been completely cured.
Because of this possibility, you need regular follow-up visits with a healthcare professional. It could be your family physician, your oncologist, or your breast surgeon. What’s important is to have a single person in charge of the follow-up care. Usually you’ll be seen as often as every few weeks immediately after treatment, and perhaps only every six months later on. There is no “right” schedule. Eventually, you will probably be down to a single annual visit.
What does follow-up involve? Most physicians suggest a physical examination to look for signs of local recurrence—new lumps within the breast after lumpectomy, or tiny hard nodules in the surgical scar after mastectomy.
In addition, mammography will be scheduled on a regular basis, and you may have a number of blood tests that will assess the function of your liver, bone marrow, and other organs, and a chest X-ray. Other tests such as CEA (a protein found in the blood of patients with cancer) and bone scans are not used routinely.
Currently, many experts feel that there is little to be gained by performing multiple tests on patients that are asymptomatic—that is patients who have no symptoms. Such tests may detect a recurrence a few months earlier, but earlier diagnosis will not change the outcome of whatever treatment you might need. So you can expect to have fewer and fewer tests as the years pass after your initial treatment.
Breast Self Examination (BSE)
BSE is particularly important for women at higher risk of breast cancer—and that includes you and your first degree relatives. You need to become familiar with the new look and feel of your breasts, so that you can report any changes promptly.
Clinical Breast Examination (CBE)
CBE will be part of your regular check ups. The physician will probably spend additional time examining the scar and areas where enlarged lymph nodes may be found—under the arms, and around the collar bones.
Every woman who has had breast cancer should have a mammogram once a year, regardless of age. If you had a lumpectomy, the films may be more difficult to interpret, so make sure that previous mammograms are available for comparison. If you had a mastectomy, you should have mammograms of the other breast.
For women with especially dense breasts, or women who present unusual diagnostic challenges, MRI is an effective option. In fact, the American Cancer Society now recommends that all women at high risk of breast cancer (which includes women who already had breast cancer before) should have screening with MRI every year.
Care of the Surgical Arm
After a mastectomy and particularly if you also had a lymph node dissection, your arm may feel numb and tingly due to nerve damage during surgery. Later, you may feel shooting pains due to nerve re-growth. There is not much that you can do to reverse numbness due to nerve damage. Some of it may improve as the nerves heal over the years.
Your healthcare professional will tell you which exercises are appropriate to help your arm regain its mobility and strength. It is very important to follow the exercise schedule faithfully so you can recover your full range of motion.
Lymphedema is swelling of the arm due to scarring of the lymph ducts after surgery or radiation. It is important that you always follow your medical team’s recommendations about how to avoid injury to the arm to reduce the chances of developing lymphedema.