What is Breast Cancer?
Cancer occurs when cells start to multiply uncontrollably, often forming tumours. In breast cancer, uncontrolled cell growth begins in the breast and forms a tumour. These cancerous cells may eventually spread to the rest of the body if left untreated. It is important to note that not all breast tumours are cancerous. Nevertheless, it is best to get it checked immediately to make sure it is not a potential health risk.
One in 19 women in Malaysia is at risk of getting breast cancer, although men are also at risk of contracting the same cancer. Breast cancer affects approximately one million women worldwide and is also the second leading cause of cancer-related deaths, behind lung cancer.
Dealing with Your Breast Cancer Diagnosis
Dealing with the news will be a very confusing, frightening experience. You may be going through a lot of uncertainty, panic and fear as your doctor presents your diagnosis. You might even find relief to have an answer to a condition that has affected you for some time.
Take some time to come to terms with your diagnosis; you may not be able to absorb all the information of the diagnosis. Give yourself sufficient time to process everything, at your own pace. As the reality of it sets in, you will need to start taking steps that will help you stay informed of your cancer progression, and how to effectively manage your overall well being.
Research is your best friend to understanding how this cancer affects you and those around you. You and your family can find out about current treatment methods, the associated side effects, and what to expect as your cancer changes through treatment. If you have not spoken to your doctor about your diagnosis in detail, research can help you prepare questions that you want to ask them regarding your condition.
Breast cancer affects people differently, and how it affects you depends on many variables, from its stage to symptoms you will face, to how it affects your body. Knowing how it affects you can help you stay informed of how the medical team will treat you, and what to expect in the event something comes up. Consult your medical care team to clarify questions about your condition and how to treat and manage it. If there are aspects you do not fully understand, ask for a simpler explanation.
There may also be instances where your doctor does not give you a full picture of your diagnosis. It helps to be informed so that, if you feel your doctor’s initial diagnosis seems dismissive or if they refuse to elaborate on your condition, you can immediately seek a second opinion that will accurately diagnose your complications and determine what it actually is.
Equally important is to get relevant and medically accurate information from trusted sources. In this age of connectivity, false information can be rapidly circulated by the public. Look for resources from known cancer research charities or organisations. If something seems off to you, have it fact-checked or consult your medical team on the matter. Some organisations that you can get reliable information from including the Malaysian Breast Cancer Foundation, the UK-based Cancer Research UK, and charity organisations such as Breast Cancer Now.
Questions to Ask your Doctor
Before you see your doctor again, you may want some time to think about what you would like to ask regarding your diagnosis. Consider the following list of questions:
- What type of breast cancer do I have?
- Where is the cancer located?
- What stage is my cancer?
- Are there other tests that need to be done?
- Has my cancer started to spread to the rest of my body?
- What are my options for treating the cancer?
- What will my treatment be like?
- What kind of side effects will I face?
- Is surgery an option for me?
- How will the treatment affect my daily activities/work?
- What symptoms or side effects should I inform you about immediately?
- Am I limited to what I can or cannot do?
- What kind of follow-up will I need after successful treatment?
This is not an exhaustive list but may help suggest other questions you might want to ask. There may be some questions that are too early to ask, but you can consider them at a later point in your treatment.
Communicate with Family and Friends
If you have not informed your family of this development, you might be feeling anxious about how you will break the news to them. What will they say? How will they respond?
Disclosure of your condition is a very personal matter. Who you decide to tell is up to you, based on your relationship with them or even how you perceive their reaction to the news will be. You could start with some basic information on your diagnosis and treatment options, and let the conversation flow from there. Answer questions to the best of your knowledge. You may choose to withhold some information or refrain from answering others because you are not sure yourself. Provide some booklets on breast cancer if you think it will help.
Having someone who knows of your diagnosis before you disclose it to others can be reassuring, as you have someone you can rely on for support when you bring up the news with others. They can even act as a mediator if need be. While you cannot predict or control how they react to the news, the important thing is to focus on getting your overall health back on track.
Having a strong support system is key to recovering and managing your condition. By building closer bonds with your family and close friends, you may find the strength to keep moving forward even as the cancer advances. If you were not close with some of them, you may eventually find meaningful closure. If you are very close with others, it will reinforce the love and care they have for you, and vice versa.
Their participation in your wellbeing is important as a source of strong familial love and support, as well as being able to help you research breast cancer and learn its intricacies and what to expect from your situation. They can also help point out credible sources and learn about myths surrounding breast cancer. Having someone when you see the doctor can provide outside perspectives to how your condition is progressing. They may recognize a new symptom that has developed or point out changes that you may not have noticed. They may even have other questions to pose to your doctor on your treatment plan. In doing so, and by staying alert to your condition, they can help you manage your symptoms and encourage you on your journey.
Speaking to your children, especially if they are still very young, can seem a little daunting. When talking about your condition, do not speak down to them; despite their age, children can be surprisingly mature on the subject of many topics. Be honest with your diagnosis and what it means; tell them it is not their fault (some children tend to assume it is their fault when a parent falls ill), and that you are still the same person they know. Answer their questions with these in mind. If you refuse to talk to them about it, you may risk alienating them or eroding trust.
Your cancer treatment can affect your overall performance in daily activities. It is alright to seek help when you find it difficult to do things you could normally do before the cancer. Seek help when you need it, and have honest discussions with family and friends about how you feel. Do not keep your emotions to yourself, or you may only end up hurting yourself and those closest around you. Just as they are being patient and doing all they can to help, be patient with them too. Resolve tensions amicably through candid, polite discussions on what you are all going through.
Disclosure and Your Work
Outside of your family, you may feel afraid about how to approach the subject with your colleagues or your manager, or even your friends outside of your close circle. You may worry that your diagnosis may change their perceptions of what you can or cannot do. There is a fear that you will be alienated from your peers and colleagues for being less capable due to your cancer.
The important thing to remember is that while you cannot control how they react to your condition, you can control how you respond to them, or how you feel about it. Not everyone may have empathy for your condition, and some may outright choose not to acknowledge the situation. Reassure your colleagues and employers that you can still contribute to your work as best as you can, and are open to accommodate changes that can help you continue working.
If need be, speak to your immediate supervisor and work out something beneficial for you and your company via its policies on employee benefits. Some companies may offer medical benefits that can help cover the costs of your treatment, while ensuring you can return to work once your cancer is treated. As a precaution, look up ways to protect yourself and your rights; leaving your job should be the last resort, or if the condition has advanced and prevents you from working.
Discuss with your family for suggestions as well; they may offer insights that you may not have thought about.
Treatment and Care Options in Malaysia
The type of treatment you will receive will depend on factors such as the size and location of the tumour in the breast, the results of lab tests done on the cancer cells, and the stage, or extent, of the disease.
The term ‘local’ refers to treating the tumour without affecting the rest of the body. Local treatments include surgery and radiotherapy.
Surgery may be needed depending on the severity of your cancer. If only the tumour is to be removed, this requires a lumpectomy, also known as breast-conserving surgery or wide local excision. This procedure removes the tumour and a small amount of surrounding healthy tissue as well. It is recommended for those whose tumours are small, although in some cases radiotherapy (or other treatments) will be needed to shrink the tumour in order to remove it via lumpectomy. For advanced cases, however, a mastectomy – the removal of all the breast tissue – may be required. If there is an increased risk of cancer in the other breast, a double mastectomy (the removal of both breasts) may be done.
You should always discuss the consequences of surgery with your medical team and your family before deciding to pursue it. Consider the side effects, the chances of recovery, and how it will impact you in the long run.
Radiotherapy is another form of local treatment that involves using high-powered beams of energy, such as X-rays and protons, to kill cancer cells in the breast, chest and lymph nodes. This can be done via external beam radiation using a machine, or by placing radioactive material inside your body (brachytherapy), usually in or around the tumour. Radiotherapy is generally conducted before or after surgery, depending on your condition. It may also be used together with chemotherapy to complement your treatment. It may also be used to help treat advanced stages of breast cancer. As with surgery, it pays to know more about radiation therapy through research and by consulting your medical team, who will advise you on what will be done and how it will affect you. Some of the side effects include fatigue, a sunburn-like rash where the radiation was applied, as well as soreness and swelling in the breast area.
Systemic therapy involves treatments that affect cancer cells throughout the entire body. They include chemotherapy (or simply chemo), hormone therapy, and immunotherapy.
Chemotherapy uses medications to destroy fast-growing cancer cells in your body. Its application in your treatment plan will vary depending on your cancer. It may be used before surgery to shrink a tumour prior to surgery or radiotherapy, or it may be used after surgery to destroy cancer cells that remain in your body after surgery or radiotherapy. It may also be considered to control the cancer and decrease any symptoms it causes.
Hormone therapy involves preventing certain hormones (estrogen and progesterone) that can attach to cancer cells and promote their growth. This will require taking medications that will do either one of the following:
- Stops production of a specific hormone(s)
- Block hormone receptors
- Substitute chemically similar agents for the active hormone(s)
Because of how it affects your hormones, side effects may include hot flashes, vaginal dryness, weight gain and/or night sweats.
Immunotherapy is somewhat similar to chemotherapy, but it entails using medicines to stimulate the immune system to recognize and destroy cancer cells more effectively. Your immune system may not be protecting you from cancer because the cancer cells produce proteins that “blind” the immune system cells. Because cancer cells start forming from normal, healthy cells, the immune system does not immediately recognize them as a threat. Immunotherapy, therefore, assists your immune system to be able to target the cancer cells and eliminate them. It may be administered along with chemotherapy to treat advanced cancer.
A cancer diagnosis can be unnerving and your loved one has care needs that are unique. Engaging a caregiver for your loved one not only encourages better recovery; it also helps build strong emotional support for your loved one.
To give your loved one the best care he/she deserves, we provide a free care consultation for you and your loved one, to ensure that they get a Care Professional that best suits their needs.
Knowing is half the battle, as the saying goes. Being aware of how your cancer can change over time, and how your treatment will affect you overall, can help you make more informed decisions together with your doctors. The side effects that emerge from treatment may affect you differently than other breast cancer survivors, so be sure to communicate how you feel with the medical team. If a particular treatment causes a strong negative reaction, ensure your doctor knows about this so they can look into what might be the cause, or consider an alternate treatment method.
Changes caused by treatment can be drastic; you may find yourself anxious when you start losing hair, or when you have to decide to surgically remove a breast to treat your cancer. All these drastic changes will leave you unsettled, or make you feel like you have lost control of your body and your life. You may feel that your entire life has been disrupted by cancer and that you have lost a sense of who you are.
It is normal to feel that your body has let you down, or feeling like you need to exert control over your life to face the uncertainties of the future. Most of the effects you experience are temporary, but they may still leave you upset. Your doctors may consider palliative care to help you prevent and relieve side effects. You can also ask about complementary therapies to help remedy your ailments. Discuss how you feel about these changes with your doctors and your family so you do not feel burdened by the physical or emotional toll cancer inflicts on you.
Have someone close to you to help you weather difficult times. Having someone to support you can do wonders to easing your fears and helping you move forward.
Even after the cancer is treated, the after-effects of surgery and/or treatment methods can continue to affect you, even after leaving the hospital. You may find yourself worrying over the prospect of the cancer coming back, or whether you can regain control of your life and get it back to the way things were. These are some concerns you will have as a cancer survivor, a state known as survivorship.
Breast Cancer Support Groups in Malaysia
There are a few breast cancer support groups in Malaysia you can consider joining. The Breast Cancer Foundation is one such organisation that conducts awareness campaigns and fun activities for survivors. It is their mission to empower survivors and help them live their lives to the fullest. They also provide monetary assistance through the Breast Cancer Foundation Patient Fund and other endeavours.
The National Cancer Society of Malaysia is a not-for-profit organisation that provides education, care and support services for people affected by cancer and the general public of Malaysia. They aim to deliver holistic cancer–related services to cancer patients, caregivers and the public, including wellness programs, public awareness campaigns and support for cancer survivors. They also manage the support group PINK UNITY, which has a page on Facebook.
There is also the Breast Cancer Welfare Association Malaysia, which aims to provide the quality of life for women with breast cancer using a “Reach to Recovery” concept of psychosocial and material support, and offer public education, early detection of breast cancer and subsequent follow-up investigations and timely medical treatment. They offer individual and group psychosocial support channels to help you cope with your treatment and recovery, as well as to face the road ahead.
Living a Full Life with (and After) Cancer
Once treatment finally stops and your doctors declare that you are cancer-free, you may be feeling very elated that it is finally over. But you may find that feeling eventually fades away and you’re left feeling vulnerable and worried about what is in store for the future.
Survivorship may have a different meaning to you compared to other survivors. It could mean being cancer-free after finishing treatment or living with, through, and beyond cancer. Your experience of breast cancer determines how you experience the rest of your life and how much it has changed since your diagnosis.
Much of the fear stems from this change, where familiar things have suddenly become so foreign and unrecognizable. Your workplace may have instituted new systems to get things done, and you will need to learn how these systems work. At home, your family members may have settled into new routines that you were responsible for when you were around. Some of them may no longer be dependent on you.
The important thing is to give yourself time to adjust to these changes. Life after cancer, for many people, means having to deal with unfamiliar situations on a daily basis and making changes of your own to adapt. Coping with the new life ahead requires an understanding of what you face, thinking through solutions and being comfortable with your decisions. Communicating with your family, friends and medical team can help you through the uncertainties that come up, so do not hesitate to bring it up with them.
You might feel worried that the cancer will come back. Every little ache or pain might put you on high alert because, to you, it might be a bad sign. Always keep in touch with your doctors if you have any medical concerns that may come up; it is always good to find out the truth, and it might be nothing more than a warning sign of a cold coming up. It is perfectly fine to feel anxious, but do not ever keep these occurrences to yourself.
You may find yourself developing a new perspective of life as well. Given what you have been through, you may find the motivation to make lifestyle changes as you adapt to things. This usually involves changing your dietary habits, such as having a healthier and well-balanced diet; reducing or quitting smoking; reducing alcohol intake; and being more active. Doctors believe abiding by these lifestyle changes can be helpful in reducing the risk of recurring cancer.
It also becomes important to check yourself for possible signs of returning cancer. Be aware of changes to your breast, chest or the surrounding area, and inform your doctors accordingly. Equip yourself with this information so you know what to look for when performing a self-check.
Don’t let the challenges of survivorship bring you down. With strong support from those around you and a comprehensive medical team rooting out for you, life with or after breast cancer becomes much more bearable.
Find out more about other cancer-related resources in our Breast Cancer 101 article.
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