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Has the Cancer Come Back

Posted 8/25/2016

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This is really it: the crux of the whole experience. Is the cancer back? Does that back pain or persistent cough or stomach cramps mean something terrible or is it another "normal" ache or pain?  Having had cancer turns us all into hypochondriacs, and we become very (? too much?) aware of our bodies. If you don't already know it, here is the most important and, usually, comforting thing to remember: Live by the "Two Week Rule". With the obvious exception of things like you think you may be having a heart attack, our doctors generally suggest that we wait for two weeks before calling with a worry. Most things are long gone before two weeks. If the ache or pain or whatever persists for two weeks, go ahead and call--but remind yourself that most things are not cancer!

Here is something else to remember. Most of us have something, at some point, that does last for more than two weeks or something that is so scary that we just can't wait. So, we call and that likely leads to a  doctor visit and maybe x-rays or scans or a biopsy--and very often it turns out not to be cancer or anything to worry about at all. This is terrible while it is happening, but can be helpful later as you will then be able to remind yourself of the time that your worry was for naught, and that reminder will likely dial down your anxiety about the next thing. And here is a promise: as time passes, likely quite a lot of time, these worries will be fewer. There will come a day when your sore shoulder makes you think "Oh, I overdid it at the gym yesterday" rather than "OMG, the cancer is back."

A few years after my first breast cancer, I noticed an enlarged lymph node above my collar bone (these are known as supraclavicular lymph nodes). With some anxiety, actually with a huge amount of anxiety, I pointed it out to my husband. The expression on his face as he palpated it (remember: he is an oncologist) was not comforting. However, he said something like: "Let's wait two weeks and see if it is still there." Because I am pretty expert at denial, I was mostly able to do that and went ahead with my Sunday. However, the next morning at work, my phone rang. It was my surgeon who said that she had seen my husband in the hall, and he apparently had mentioned it to her. She wanted to see me right away.

Because I can also be quite stubborn, I told her that I wasn't ready to admit it could be a problem, and promised to call her in a week if it were still there. Blessedly, it was gone within a few days. And you can be sure that my husband and I had a conversation about "what happened to waiting two weeks?" and "why did you tell her?". Clearly he told her because he was anxious, so this was another reminder that one of our jobs can be to manage others' anxiety in addition to our own.

If your lymph node or cough or painful shoulder persists for more than two weeks, you do need to make that phone call. Some people prefer to call their PCP because that seems less scary. Others prefer to go directly to their oncologist because, after all, that is really what they are thinking about. Your choice here, but my suggestion would be to call whichever doctor you feel more comfortable with and whom you can reach more easily.

If your doctor feels that more exploration is needed and orders a scan or an MRI, that brings even more anxiety. A really important thing is to make a plan with your doctor before having the test. Will you wait for a scheduled appointment to hear the results or will s/he call you? Some people want to know as soon as possible and others really don't want to hear until they are sitting with the doctor. What you don't want is uncertainty re how the news will be shared. You don't want to be trapped in a cycle of worry: Is she not calling because it is good news or because it is bad news? Or Why isn't she calling?

Throughout this difficult process, remember that often the news is good. And that, if it isn't, there will be a plan. And, if you can sustain a Buddhist kind of attitude, it is what it is. 


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