There's no sugarcoating it - The journey of battling cancer is a rocky one: it will challenge a person's physical, mental and emotional state. Not only that, it affects the people around them as well.

Then, it is a cause of celebration when a person's body is able to overcome cancer. In this article, we will explore things you should know about life after breast cancer treatment (whether this is something that impacts you directly or a loved one).

Breast cancer

Breast cancer is defined as a condition "in which the cells in the breast grow out of control" (Centres for Disease Control and Prevention [CDC], 2022). The breast is made up of three main parts: lobules, ducts, and connective tissue. Breast cancer can begin in differing parts of the breast.

Usually, it would begin in the ducts or lobules. Then, they may spread outside the breast area via blood vessels and lymph vessels. If breast cancer has spread to other parts of the body, it is described to have metastasized.

These are the two common types of breast cancer:

Invasive ductal carcinoma. This is a type of cancer that begins in the ducts, before growing into other parts of the breast tissue. Invasive cancer cells can spread and metastasize throughout the body.

Invasive lobular carcinoma. In this case, this is a type of cancer that begins in the lobules. Later, they can spread to the breast tissues and also to other parts of the body.

Aside from these, there are other types of breast cancer which are less common: Paget's disease, medullary, mucinous, and inflammatory breast cancer.

Challenges as a breast cancer survivor

After being diagnosed with breast cancer, treatment options would have been discussed. Over time, choices would have been made - weighing the pros and cons of each treatment option. A breast cancer patient would have undergone one or more of the following:

Local treatments (specific to the tumour)

Systemic treatments (used to reach cancer cells throughout the body - examples such as chemotherapy, hormone therapy, drug therapy and immunotherapy)

Common treatment approaches (based on stage or inflammation)

No matter which treatment option was chosen, it is a win after you have had your final treatment and a clear diagnosis. However, it is unlikely to return to a normal life. Instead, after a life-changing illness, some things will remain different and not as before.

In this list, these are some of the challenges you may discover as a breast cancer survivor.

Challenge #1: Sorrowful emotions

You may find it difficult to be motivated despite your recovery. It may seem like a struggle to get up in the mornings or find pleasure or comfort in the things that you used to like, such as hobbies.

Guilt may also become a part of the emotions as you may feel that you should be happier or ready to move on. There may also be fear and anxiety in returning to everyday living activities, such as work, study or play.

Nonetheless, experiencing these emotions is common in people who have had cancer. Therefore, you can make an appointment with healthcare personnel in order to address your mental health needs in this transitional phase.

Challenge #2: Fatigue

Enduring treatment for cancer over an extensive period of time will cause tiredness. In most people, the fatigue can be felt for months after the treatment, or even up to 2 years in some cases. Cancer-related fatigue may not easily go away despite having rest.

Fatigue may impede a person's function in the following ways:

Struggling to carry out simple tasks

Experiencing a lack of strength

Difficulty in remembering and concentrating

Slowing down in thinking and speaking

Feeling dizzy or lightheaded

Inability to sleep well

As such, it is important to find ways to cope with fatigue, be it strategising the tasks required for the day or getting additional help.

Challenge #3: Physical changes

Treatment of breast cancer may result in drastic physical changes to one's body. Firstly, there could be breast and arm changes. This is likely due to surgery and radiotherapy.

Some of these changes may entail:

The appearance of the breast (removal of a breast or a tumour)

Sensation of pain

Movement and strength coordination

Swelling of the arm, hand or breast

Not only that, there may be significant weight gain. This may challenge a person's pursuit of a healthy weight.

In addition, a person's hair may not grow back in the same manner after chemotherapy. The hair may be thicker, thinner, curlier, or appear in a differing colour. Not having the same look as before may impact a person's self-image and confidence.

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Challenge #4: Increased risk of other diseases due to treatment

Treatments that have been carried out for breast cancer may result in other side effects, such as an increased risk for certain health conditions.

For instance, the intake of chemotherapy drugs or radiotherapy on the left breast may affect the heart. This risk factor is mainly due to pre-existing heart disease, such as high blood pressure. People who are at risk should inform the doctor in advance before beginning the treatment.

Aside from that, radiotherapy may affect a person's lungs. Experiencing breathlessness can happen up to a few months or years after treatment. Generally, this should not be a common issue as radiotherapy is planned and not given sporadically.

Some people are also at greater risk of bone thinning (osteoporosis) after undergoing breast cancer treatment. Some treatments may reduce the amount of estrogen in the body, which helps to keep bones healthy. Some of these may put a person at greater risk of bone thinning, such as chemotherapy, hormonal therapy, and ovarian ablation. Otherwise, it is not uncommon to experience joint and muscle pain.

Another side effect of treatment is nerve damage. It may not be extensive, but it can cause disruptions to the nerves that carry messages between the brain, spinal cord, and the rest of the body. This may lead to the occurrence of pins and needles, numbness, and pain.

Meanwhile, some therapy treatments for breast cancer may slightly increase a person's risk of developing diabetes. Usually, most people would not get diabetes after undergoing cancer treatment. The effects of the treatment should also outweigh the risk. However, you can always talk to the doctor about this.

Challenge #5: Early menopause

Some treatments may affect the function of ovaries. As such, this may incur early menopause, which may be temporary or permanent. Menopausal symptoms may include mood swings, hot flushes, aches and pains, dry skin, and the need to pass urine more often and more. Early menopause may also affect a woman's health as it may increase the risk of osteoporosis and heart disease.

Challenge #6: Sex and fertility

Last but not least, having had breast cancer can affect your sex life. You may lose interest in sex or feel unattractive. You may also have lost your sexual drive. This can continue even after the treatment is over.

A person's fertility may also be affected as a result of treatment. This would affect your ability to have children. This can be difficult news especially if you or your partner have been trying to get pregnant. It is vital to have these conversations with your partner and you may also ask for a referral to a fertility specialist.

Overcoming the challenges

Life after cancer is not easy to assimilate into for most cancer survivors. There may be fears of cancer recurrence, and a new outlook on the relationships around you. There will be less medical attention after being declared cancer-free which may cause you anxiety.

Here are some ways to overcome the challenges:

Taking time to go back to normal. This may mean noticing that others have taken over some tasks for you, which may not be returned to you. Take the time to give and take in terms of responsibilities and opinions.

Taking care of your mental health. Although staying positive might be cited as an important attitude to prevent cancer recurrence, it is not the case. Encouraging good thoughts is able to help you relax and be at peace, but it is not possible to feel happy all the time. It is better to engage in your feelings and find ways to sort them out.

Learning to live with uncertainty. Anything abnormal, such as a lingering ache or pain, may feel like a sign of recurrence. You may also wonder when it may come back, and what to do if it does. This feeling is likely to be present during follow-up visits, anniversary events, birthdays or learning that someone has passed on due to cancer. In this case, it is best to remain informed and be aware of your fears.

However, find peace in the present moment and focus on wellness, controlling what you can in order to find things less fearful. You are not able to control cancer recurrence, but you can take steps to live with uncertainty.

Finding support. Emotional support may be found in trusted family members and friends, or even support groups. These are meant to be safe places where you can express your feelings. For some, you may prefer a counsellor who works with cancer survivors. Some may also find strength in faith and spiritual practices.

In conclusion, challenges are still present even after you have had your last treatment for cancer. However, you can be prepared and find ways to overcome the hurdles together with trusted persons.