Just Diagnosed

Once a diagnosis is made, the breast surgeon will sit down with the patient and discuss the diagnosis, what is known at that point, what additional information needs to be gathered, and most importantly start working with the patient to formulate a comprehensive treatment plan. This information will include the type of cancer and a clinical stage. It will also usually include the grade of the cancer and several marker results (ER, PR, Her2) although these may come back a couple of days after the initial diagnosis. Local treatment option should be covered including breast conservation (i.e. lumpectomy) and mastectomy. Basics of radiation therapy and the role this may play may be included. Other testing such as an "in breast" staging MRI and genetic testing may be discussed in pertinent cases where they will impact care. Moving from clinical staging to pathologic staging should be covered including the role of nodal staging. This may be achieved via ultrasound guided axillary node fine needle aspiration (FNA) if a suspicious node is seen on axillary ultrasound or via sentinel node biopsy. The basics of systemic therapy including cytotoxic chemotherapy, hormonal therapy, and biologic therapy may be covered as well as how staging and genomic profiling may impact systemic therapy recommendations. The final piece of the puzzle is to put together a plan and timeline including the order of anticipated therapies can be covered. If appropriate, the concept of neoadjuvant therapy can be presented as well.

Comprehensive breast cancer care today is multidisciplinary/multimodality each of which is covered by a different subspecialty. The role of the breast surgeon is the local regional specialist - performing the biopsy to make the intial diagnosis, mapping and biopsying lymph nodes as part of the staging process, and providing the major local therapy via breast conservation or a mastectomy. A medical oncologist plays the predominant role in systemic therapy (treatment of cancer cells away from the breast). The radiation oncologist's role is local/regional similar to the breast surgeon adding radiation to lumpectomy in breast conservation or when indicated after mastectomy. The breast surgeon will generally help the patient assemble this team of experts to recommend and provide the necessary comprehensive care. This team may also include a plastic surgeon for reconstruction after mastectomy.

It is important that a patient understands and is able to participate in the decisions regarding their care. The breast surgeon will make medical/technical recommendations but often there may be other impacting factors for an individual patient. Peace of mind is always huge. Similarly, it is important that the patient is comfortable with the choices they are making, that they have all the information/answers they need (particularly in the areas above), and with the doctors with whom they will be working. Once a diagnosis is made, the breast surgeon will sit down with the patient and discuss the diagnosis, what is known at that point, what additional information needs to be gathered, and most importantly start working with the patient to formulate a comprehensive treatment plan. This information will include the type of cancer and a clinical stage. It will also usually include the grade of the cancer and several marker results (ER, PR, Her2) although these may come back a couple of days after the initial diagnosis. Local treatment option should be covered including breast conservation (i.e. lumpectomy) and mastectomy. Basics of radiation therapy and the role this may play may be included. Other testing such as an "in breast" staging MRI and genetic testing may be discussed in pertinent cases where they will impact care. Moving from clinical staging to pathologic staging should be covered including the role of nodal staging. This may be achieved via ultrasound guided axillary node fine needle aspiration (FNA) if a suspicious node is seen on axillary ultrasound or via sentinel node biopsy. The basics of systemic therapy including cytotoxic chemotherapy, hormonal therapy, and biologic therapy may be covered as well as how staging and genomic profiling may impact systemic therapy recommendations. The final piece of the puzzle is to put together a plan and timeline including the order of anticipated therapies can be covered. If appropriate, the concept of neoadjuvant therapy can be presented as well.

Comprehensive breast cancer care today is multidisciplinary/multimodality each of which is covered by a different subspecialty. The role of the breast surgeon is the local regional specialist - performing the biopsy to make the intial diagnosis, mapping and biopsying lymph nodes as part of the staging process, and providing the major local therapy via breast conservation or a mastectomy. A medical oncologist plays the predominant role in systemic therapy (treatment of cancer cells away from the breast). The radiation oncologist's role is local/regional similar to the breast surgeon adding radiation to lumpectomy in breast conservation or when indicated after mastectomy. The breast surgeon will generally help the patient assemble this team of experts to recommend and provide the necessary comprehensive care. This team may also include a plastic surgeon for reconstruction after mastectomy.

It is important that a patient understands and is able to participate in the decisions regarding their care. The breast surgeon will make medical/technical recommendations but often there may be other impacting factors for an individual patient. Peace of mind is always huge. Similarly, it is important that the patient is comfortable with the choices they are making, that they have all the information/answers they need (particularly in the areas above), and with the doctors with whom they will be working.

I agree! That was a great answer, Martine! And, Yes, IT IS super important NOT to ACT on any medical procedure until all the options are on the table. Within the last month, I had my sister discussing a situation with me about a friend's recent breast cancer dx. She was still considering a bilateral mastectomy. I suggested my sister might try to see if she could have her friend delay that surgery. There was no stopping her. Fast forward a few weeks and circumstances tipped the scale. The plastic surgeon did not see a problem but did indicate she **might** encounter an issue with a one step implant (no tissue expanders) due to the scar tissue from the lumpectomy.

BREATHE, BREATHE and BREATHE some more......

Also, helpful to talk to a patient volunteer who can discuss the less clinical and more practical side of the decision making process. Of course, as a patient volunteer, I can only share what worked for me. And, I can help decipher the options provided by the medical team.

Just another thing to consider.... If you have been diagnosed with a serious illness, you might need time to absorb what the doctor has explained to you. For most of us, it is difficult to distill all of the information from a doctor even if the diagnosis is not serious.
Some good tips:
1. As your doctor for information on your diagnosis. He/she might have pamphlets for you to read. Ask for credible websites you can research yourself.
2. If you have not gotten all of your questions answered in the appointment with the doctor when you were given the diagnosis, make another appointment or possibly call him/her on the phone. Most doctors are not paid for phone calls so you might be better off seeing this doctor in person for a number of reasons.
3. Before that appointment, create a list of questions.
4. Get a notebook for these questions. You can do research on your diagnosis on credible websites only (websites ending in .edu, .gov or .org--medical academies, disease organizations, medical school websites, government websites) Bring that notebook with you to your appointment with the doctor and write down the answers to your questions.
5. Enlist an advocate. It's hard enough to deal with a new diagnosis much less remembering every detail of information. Your advocate can act as your second set of ears and eyes. She/he can even take notes for you in your doctor's appointment.
6. Gather copies of your medical records from the doctors you've seen that pertain to your current diagnosis. Make copies so you have a packet for each medical professional you see. This will also include your list of medications, dosages, allergies to medications, over-the-counter medications, herbs and supplements. If you see a new doctor or more than one specialist, you will need to present a complete picture to each professional. You cannot count on doctors and their offices to send copies of your medical records to other doctors. You cannot be sure that your doctors will talk to one another about your case. You must help facilitate this communication process. Ask your advocate to help you with this.
7. Get a second opinion from another specialist about your diagnosis and treatment plan, preferably a specialist affiliated with a highly respected medical school. This is not to doubt the first doctor's diagnosis, but to gather further information about your diagnosis, possible treatment plans,and more. You might find out there are alternative treatments you have not thought about. This is very important.
8. Create a support system. You will need a support system but if you have a spouse/partner and/or children, they will need support as well. For example, if you cannot drive your children to their after-school activities, who will? You can ask your advocate to help you with this.
9.Create a medical journal. Going through a serious illness requires a steep learning curve on your part and you will be learning new language and how to navigate a new world. Taking notes on new doctors, terminology, possible treatments, new research, possible medications and more, can help keep you organized, but more importantly, help you feel more in control of your medical care.
10. Get familiar with your health insurance plan. Find out what is covered by your plan and what isn't. Being prepared is so much easier now rather than later.
11. Research proposed treatment plans and weigh the benefits and risks of a treatment plan. Ask questions. Get educated on your disease. You'll be able to ask more effective questions but you'll also feel more empowered.

In my perfect world scenario, no woman who is newly diagnosed should be making her health care decisions without backup. Backup may be a friend, a family member, a nurse advocate, a social worker, etc. With that in mind, here are a few suggestions:
1. If nothing else, make sure that you have someone with you at critical doctors' appointments. This person should be able to ask questions, take notes, etc. Ideally, they'll be someone who is good at explaining things, so that if you have questions later, you can check in with them.
2. In addition to having a back-up person, consider using some technology. Take a digital recorder, or use the recording tool on your cell phone.
3. Set aside some time to process your emotional reactions. If you need an evening (or several), to cry, to say that it's not fair, to freak out, please give yourself that time.
4. Use resources to generate questions if you're feeling overwhelmed. Sites like this one can be a great place to get some direction on the things you may need to ask. The social worker or nurse advocate at your cancer facility should also be able to help with that.
5. This may make me sound like a broken record, but I also think it can be valuable to get additional support, particularly during the most intense period of decision-making.
I know that this is a huge topic, so I'd welcome any follow-up questions.
In my perfect world scenario, no woman who is newly diagnosed should be making her health care decisions without backup. Backup may be a friend, a family member, a nurse advocate, a social worker, etc. With that in mind, here are a few suggestions:
1. If nothing else, make sure that you have someone with you at critical doctors' appointments. This person should be able to ask questions, take notes, etc. Ideally, they'll be someone who is good at explaining things, so that if you have questions later, you can check in with them.
2. In addition to having a back-up person, consider using some technology. Take a digital recorder, or use the recording tool on your cell phone.
3. Set aside some time to process your emotional reactions. If you need an evening (or several), to cry, to say that it's not fair, to freak out, please give yourself that time.
4. Use resources to generate questions if you're feeling overwhelmed. Sites like this one can be a great place to get some direction on the things you may need to ask. The social worker or nurse advocate at your cancer facility should also be able to help with that.
5. This may make me sound like a broken record, but I also think it can be valuable to get additional support, particularly during the most intense period of decision-making.
I know that this is a huge topic, so I'd welcome any follow-up questions.

Just as our kids are all different, so too are the ways in which we need to approach them. Ten years ago resources were hard to find, and I can clearly recall sitting on the floor at Barnes & Noble crying because I had no clue what to say to my 3 1/2 year old son. However...I came up with something that he could really understand and opened the door to all our future communication.

There are two things that I advise clients.

First, help your children, no matter what age, find reliable resources. It is all but impossible for a child to has his or her parent if she is going to die...and yet with cancer, that is what most children worry about above all else. Frankly, some of us don't want to confront that question ourselves. But giving kids other places to turn - a school counselor (who you've pre-informed!), your doctor or nurses, a family member or friend who offers to help, another child who has gone through this, AND the access to age-appropriate, reliable web sources, can help empower them to find answers to the questions that are keeping them up at night.

Second, answer every question directly, and carefully! I know others differ in their opinions, but I personally believe that kids deserve answers. This is happening to them too! And when you go from one voice mail a day to 30, they know something is up (btw, either send your calls to a cell phone or set your answering machine so that incoming messages cannot be heard as they are being left, especially if you have young kids!). At the same time, I personally, was cautious to be careful with my answers. My son DID ask if I was going to die...and I didn't know. As important as it was to reassure him, I also could not make a promise I couldn't keep -- and leave he and dad with that baggage. My mom actually came through with the answer to that question: "We have a whole team of people working very hard to make sure that doesn't happen." (Thanks, Mom!)

Hi,
I do not have children but in my work with breast cancer patients the feedback that I have heard from them is that Gilda's Club has a wonderful program called Noogie Land. They have great programs for children with cancer and programs with children who have a parent or sibling with cancer. There are also many books addressing this problem that you can read with your children depending on their age. One thing a patient reported to me is that she did not tell her daughters in the begining but the children knew something was wrong and ended hearing second hand and it was not a good situation. I guess it a person personal decision but I do think that kids are smart and if they sense that something is going on and not know what it is their imagination might cause fear and upset. Many hospitals have social workers or therapists that might help figure out the best way to deal with this tough situation.

First, you need to slow down by using deep breathing techniques, buy some meditation tapes and get a journal to keep track of your feelings and what you are going through.
That being said, there are number if factors that will determine what your treatment options are, for example:
What stage _____ are you; What grade _____ are you? Have you had your biopsy yet and, if so, did you have clear margins, were any lymph nodes involved, etc. If you need a list of questions to ask your oncologist, please e-mail me and I will send you a list.
I am a two time cancer survivor and a Certified Professional Cancer Coach, just like Elyn. I also work with cancer patients with the goal to get them through this journey and come out the other side thriving and surviving.
Susan Mayer-McHugh
susan@helpyouhealcoaching.com


This is such a complex question, and there is no one answer. An excellent resource is http://ww5.komen.org/. The first link on the top of the page is "Understanding Breast Cancer." There are several choices in the drop-down menu, including Questions to Ask Your Doctor. That is divided into sections every step of the way.

Ask your doctor if there is a "Breast Cancer Navigator" or a "Peer Navigator Program" at your hospital, or call the local cancer center. You can also Google "Peer Navigator Program" to find one near you. There are women there who can help guide you through each step and provide resources to help you sift through the decisions you will face.

As you go to your upcoming medical and testing visits, it's helpful to take a list of questions, a notebook to write answers, as well as a supportive friend, spouse or family member with you as a second set of ears.

There are many excellent cancer facilities and many wonderful doctors. The key is to find the right one for you, for your cancer. I have written several blogs on this topic. If you would like to read them, please visit http://elynjacobs.blogspot.com
I have linked to two specifically:
http://elynjacobs.blogspot.com/2011/05/empowerment-is-key-to-successful.html
http://elynjacobs.blogspot.com/2011/05/cancer-find-right-team.html Here are some practical tips that should help:
- Appoint someone as your advocate to provide support, go to appointments with you, take notes, etc.
- Develop a support network (i.e. prayer groups, etc. ) and prepare family and friends
- Get copies of your electronic records from you physician and hospital to make sure they are correct. This will reduce risk of mistakes.
- Understand your insurance coverage - medications covered, deductibles, etc.
- Make sure to follow-up to get the information you need. Don't be shy.
- Try to have blood work and labs done at same facility. Have these tests done on a regular basis so you may look for trends.
- Have the hospital/clinic give you the results of tests and diagnostics digitally (i.e. compact disc) if possible.
- Check with social services to see if you are eligible for assistance.
- Make sure your living will, power of attorney, medical surrogate power of attorney, and names on bank accounts are up to date.
- Be calm and know that you are in charge of your decisions.

If there is just one piece of advice I can give you, it is to always have an advocate with you at appointments...a spouse, friend, relative or a coach. When faced with a cancer dianosis even the most brilliant and medically knowledgable person can become overwhelmed with the information given.
Today cancer patients have many options. It is critical that you find the best treatment plan and team for you and your cancer. I have written a few blogs on this and if you can, please view:
http://elynjacobs.blogspot.com/2011/05/empowerment-is-key-to-successful.html
http://elynjacobs.blogspot.com/2011/05/cancer-find-right-team.html The first thing that needs to happen is a series of tests and analyses, and potentially biopsy and surgery to learn more about the breast cancer. Breast cancer is different for everyone, and as much information as possible must be gathered in order to determine treatment options. These tests likely will take a week or two to perform and analyze the results. In the meantime, do whatever works for you to relax and not worry, whether that is pampering yourself, taking a trip, exercising, shopping, etc.

When you receive the results of the tests, make sure that you have copies of all your medical records (mammograms, test results and pathology slides, etc.) so you can have them for future consultations and appointments. You can get this information at any time, all you need to do is ask for it.

It is also recommended that you get a second opinion, or even a third or fourth, to help you feel more comfortable with your options. This will also help you to begin selecting your medical team. You will get a feel for the physicians that are the best fit for you and that will listen and spend time with you.

After you evaluate the test results and discuss your options with your medical team, the next step will be to decide on your treatment plan. The good news is that there will more than likely be quite a few options to choose from. There will be a lot of information to understand. The medical team and your personal support team will be helpful during this process. Make sure to ask a lot of questions.

These are all great answers. Two things to add.
Many patients focus on statistics, they want to know what the stats are for recurrence and survival. Statistics DO NOT APPLY to individuals, they do not predict when you will die. This is important for everyone to understand, so, if possible, help your friend to ignore those stats. We will all die someday, but you need to remember that you are an individual with your own unique situation. There are countless thrivers out there who were told to go home and get their affairs in order. Instead, they chose to live another 10, 20 or 30 years. That being said, take control of your cancer and keep a positive attiude...it goes a long, long way in terms of living a long, cancer-free life.

Next, when a loved one is diagnosed, everyone wants to help, to visit and comfort. Often times, this is a burden on the patient. She may be tired, and VERY tired of retelling her story. Offer to man the phones, save her the stress. Offer to pick up her kids from school, offer to clean her house...be useful, not a burden.

Also, for anyone newly diagnosed, I encourage you to read my blog: Empowerment is the Key to a Successful Journey:
http://elynjacobs.blogspot.com/2011/05/empowerment-is-key-to-successful.html These are all great answers. Two things to add.
Many patients focus on statistics, they want to know what the stats are for recurrence and survival. Statistics DO NOT APPLY to individuals, they do not predict when you will die. This is important for everyone to understand, so, if possible, help your friend to ignore those stats. We will all die someday, but you need to remember that you are an individual with your own unique situation. There are countless thrivers out there who were told to go home and get their affairs in order. Instead, they chose to live another 10, 20 or 30 years. That being said, take control of your cancer and keep a positive attiude...it goes a long, long way in terms of living a long, cancer-free life.

Next, when a loved one is diagnosed, everyone wants to help, to visit and comfort. Often times, this is a burden on the patient. She may be tired, and VERY tired of retelling her story. Offer to man the phones, save her the stress. Offer to pick up her kids from school, offer to clean her house...be useful, not a burden.

Also, for anyone newly diagnosed, I encourage you to read my blog: Empowerment is the Key to a Successful Journey:
http://elynjacobs.blogspot.com/2011/05/empowerment-is-key-to-successful.html

Breathe, that's the first thing. Remember, your cancer has likely been growing for quite some time, so it is important not to rush when making decisions as to treatment.
Tanya is right, you must bring along an advocate, it is far too much to expect to process all that is said to you. Be sure to bring along a list of questions and do not leave if these questions are not answered. Be prepared to fire a doctor if you do not feel comfortable with his recommendations or personality. Please, get a second opinon, if nothing else, hearing the same information twice may make it easier to digest the treatment plan. Remember, it's your body, your life and there is life after cancer; find the team that is best for you and your cancer. I'd like to share with you a blog I posted:
http://elynjacobs.blogspot.com/2011/05/cancer-find-right-team.html" target=_blank>http://elynjacobs.blogspot.com/2011/05/cancer-find-right-team.html
To view another great post on this topic, please view:
http://bit.ly/mu0LVB Breathe, that's the first thing. Remember, your cancer has likely been growing for quite some time, so it is important not to rush when making decisions as to treatment.
Tanya is right, you must bring along an advocate, it is far too much to expect to process all that is said to you. Be sure to bring along a list of questions and do not leave if these questions are not answered. Be prepared to fire a doctor if you do not feel comfortable with his recommendations or personality. Please, get a second opinon, if nothing else, hearing the same information twice may make it easier to digest the treatment plan. Remember, it's your body, your life and there is life after cancer; find the team that is best for you and your cancer. I'd like to share with you a blog I posted:
http://elynjacobs.blogspot.com/2011/05/cancer-find-right-team.html" target=_blank>http://elynjacobs.blogspot.com/2011/05/cancer-find-right-team.html
To view another great post on this topic, please view:
http://bit.ly/mu0LVB

If a biopsy has been completed and the diagnosis is breast cancer, data collected from tests and surgery will help to determine the stage, treatment options, and prognosis.

One of the first steps is for the pathologist to assign a grade to the cancer based on examining a tissue sample. The grade measures the speed of growth of the cancer.
The DNA Ploidy and Ki-67 Antigen tests may also be used to measure speed of growth. The grade of the cancer helps to determine the treatment options and prognosis.

Determining the stage of the cancer also helps to determine the treatment options (staging tests are not required depending on size of cancer and symptoms):
- Tests may include:
- Diagnostic mammogram in both breasts - to get a more thorough view, pin point location, measure size, and search for other abnormal areas
- A complete blood count to determine overall health and if cancer has spread to the organs
- MRI - to help measure size of tumor and to see if cancer has spread to other parts of the body
- CT scan - to see if cancer has spread to other organs
- PET scan - to see if cancer has spread to other parts of the body
- Chest x-ray - to see if cancer has spread to the lungs
- Bone scan - to see if the cancer has spread to the bones

In order to accurately determine the stage of the cancer, many times surgery is required. During breast surgery, the following data may be collected to help determine the stage: size of the tumor(s), presence of cancer cells in the axillary lymph nodes under the arm, and the presence of cancer cells in other parts of the body.

Determining the hormone receptor status and Her2 status will determine how the cancer will respond to hormonal therapy and other targeted treatments.
- Her 2/neu - used to determine Her2 status. Helps to determine treatment options. If there are increased levels of Her2 protein, patients may respond well to the medication Herceptin.
-Estrogen Receptor/Progesterone Receptor - used to determine hormone receptor status. Helps to determine treatment options. Patients who have high percentages and intensity of estrogen and progesterone positive cells, may respond well to anti-hormone therapy.

There are also more specific tests for patients whose cancer meet specific criteria. A couple of examples are:
- Oncotype DX - for early stage, node negative, ER+ cancers to predict chemotherapy benefits and recurrence.
- MammaPrint (Agendia) - for lymph node negative breast cancer patients under 61 years of age with tumors of less than 5 cm. May assist in determining risk for possible metastasis of cancer.
If a biopsy has been completed and the diagnosis is breast cancer, data collected from tests and surgery will help to determine the stage, treatment options, and prognosis.

One of the first steps is for the pathologist to assign a grade to the cancer based on examining a tissue sample. The grade measures the speed of growth of the cancer.
The DNA Ploidy and Ki-67 Antigen tests may also be used to measure speed of growth. The grade of the cancer helps to determine the treatment options and prognosis.

Determining the stage of the cancer also helps to determine the treatment options (staging tests are not required depending on size of cancer and symptoms):
- Tests may include:
- Diagnostic mammogram in both breasts - to get a more thorough view, pin point location, measure size, and search for other abnormal areas
- A complete blood count to determine overall health and if cancer has spread to the organs
- MRI - to help measure size of tumor and to see if cancer has spread to other parts of the body
- CT scan - to see if cancer has spread to other organs
- PET scan - to see if cancer has spread to other parts of the body
- Chest x-ray - to see if cancer has spread to the lungs
- Bone scan - to see if the cancer has spread to the bones

In order to accurately determine the stage of the cancer, many times surgery is required. During breast surgery, the following data may be collected to help determine the stage: size of the tumor(s), presence of cancer cells in the axillary lymph nodes under the arm, and the presence of cancer cells in other parts of the body.

Determining the hormone receptor status and Her2 status will determine how the cancer will respond to hormonal therapy and other targeted treatments.
- Her 2/neu - used to determine Her2 status. Helps to determine treatment options. If there are increased levels of Her2 protein, patients may respond well to the medication Herceptin.
-Estrogen Receptor/Progesterone Receptor - used to determine hormone receptor status. Helps to determine treatment options. Patients who have high percentages and intensity of estrogen and progesterone positive cells, may respond well to anti-hormone therapy.

There are also more specific tests for patients whose cancer meet specific criteria. A couple of examples are:
- Oncotype DX - for early stage, node negative, ER+ cancers to predict chemotherapy benefits and recurrence.
- MammaPrint (Agendia) - for lymph node negative breast cancer patients under 61 years of age with tumors of less than 5 cm. May assist in determining risk for possible metastasis of cancer.

Some of the important information you and your medical team will need to find out to determine your treatment options are:
-whether the cancer is non-invasive or invasive
-whether lymph nodes are involved and if so, how many?
-size of the tumor
-tumor grade
-hormone receptor status
-HER2/neu oncogene overexpression
-margins of resection Some of the important information you and your medical team will need to find out to determine your treatment options are:
-whether the cancer is non-invasive or invasive
-whether lymph nodes are involved and if so, how many?
-size of the tumor
-tumor grade
-hormone receptor status
-HER2/neu oncogene overexpression
-margins of resection

It is important to meet and develop relationships with others who understand what you are going through. There are quite a few resources for this.

Support Groups: contact your local hospitals, clinics, churches, etc. to find local groups. You may also reach out to organizations such as the American Cancer Society or Komen Foundation. They maintain lists of support groups. Of course you can also search google (i.e. breast cancer support groups). Sometimes it may take some time to find a support group where you feel comfortable. If you would like to potentially start your own support group, the American Self-Help Clearinghouse (http://www.cmhc.com/selfhelp/) has information, models, and advice.

Cancer Hotlines: if you need emotional support from someone trained to help, a couple of options are Share (http://www.sharecancersupport.org/) and Network of Strength (www.networkofstrength.org)

Online chat rooms and discussion boards: There are numerous chat rooms and discussion boards including http://TalkAboutHealth.com, http://breastcancer.org and http://www.bcsupport.org/. It is important to meet and develop relationships with others who understand what you are going through. There are quite a few resources for this.

Support Groups: contact your local hospitals, clinics, churches, etc. to find local groups. You may also reach out to organizations such as the American Cancer Society or Komen Foundation. They maintain lists of support groups. Of course you can also search google (i.e. breast cancer support groups). Sometimes it may take some time to find a support group where you feel comfortable. If you would like to potentially start your own support group, the American Self-Help Clearinghouse (http://www.cmhc.com/selfhelp/) has information, models, and advice.

Cancer Hotlines: if you need emotional support from someone trained to help, a couple of options are Share (http://www.sharecancersupport.org/) and Network of Strength (www.networkofstrength.org)

Online chat rooms and discussion boards: There are numerous chat rooms and discussion boards including http://TalkAboutHealth.com, http://breastcancer.org and http://www.bcsupport.org/.