The Five Stages of Cancer

We are all familiar with the five stages of grief that begins with denial and ends with acceptance. Like most of the truly difficult moments in life, it is a long emotional transformation. Mourning can come as a result of divorce, job-loss, illness. Even the end of a dream can trigger those feelings of sadness. Most of us have experienced these steps as a response to the ongoing Covid pandemic: at first, we thought it was an exaggerated ailment, inconvenient like the flu, but as statistics and experience proved that the threat is real, we have moved to what we now call the “new normal.”

Having cancer means going through a similar process.

It begins with a life-changing diagnosis. Sometimes, being able to attach a label to the troubling physical symptoms can be a relief, but most often it is shocking, unleashing a tidal wave of anxiety. Suddenly, you are aware of your own mortality as you are given a stage and survival statistics. You begin to wonder how much of your life remains. This is a frightening place to be.

But most cancer patients are quickly plunged into treatment, the second stage, which may or may not also involve surgery. Depending on the type and frequency of chemotherapy or radiation, the focus here is on managing side effects, which can be debilitating at times. If all goes well, it works, and the end result is remission or no evidence of disease.

Lots of folks remain here for years, or sometimes forever, having defeated the beast and reclaimed their lives. They are the lucky ones.

Unfortunately, for many, the cancer returns. This is the chronic stage. Here, treatment becomes a way of life, with medical appointments occupying much of your social calendar. Although not impossible, at this point, there is little hope for a cure as the goal is to simply manage the disease, to keep those nasty little malignant cells from finding their way to other parts of the body.

But cancer is crafty. Sometimes, it figures out a way around the medicine designed to contain it, developing a resistance as it begins to grow, metastasizing. Most oncologists call this progression. At this point, they throw whatever is available in their medical arsenal to contain the damage, with stability as the ultimate goal.

And when all of the available options fail, hospice is recommended. Here the emotional, spiritual, and physical needs are addressed as the patient is gently cared for in the transition from this life into the next.

The idea of stages has been weighing heavily on my mind. In the four years since diagnosis I have been through so many therapeutic measures, I often wonder how many remain. It is kind of like eating at your favorite restaurant every day for a year. Eventually, you will have tried everything on the menu. Then what? It‘s a scary question with ambiguous answers.

And the past month has meant big changes for me as my gyno oncologist has decided to change to a surgery-only practice, and I have moved my care into the hands of a new doctor, one who is incredibly skilled and kind, but with whom I have no history. Those connections are vital. But I have high hopes that this will be a good change on many levels. I‘m already seeing some impressive differences.

So yesterday, I had my second visit with her, this time to review the results of my recent PET scan to determine if I am to continue with my current treatment. I was optimistic, hopeful that this newest combination would be the magic formula to keep me stable.

The news was disappointing. I was at the chronic stage, but now I have progression. Cancer has spread to my lungs and is dancing around my liver. The tumor in the presacral space has doubled in size and become highly active. Two of my lymph nodes are positive. I think they call this a kick-in-the-gut moment. As irrational as it may be, I can't help but feel like a failure, disappointed in my body's inability to overcome this thing.

I was brave. I listened attentively to the treatment plan I am to begin as soon as insurance agrees to pay for it. I nodded in understanding and thanked everyone for their efforts to save me. But when I got to my car I cried, and then I called a friend and cried some more. It is easy to revert back to that denial stage at such moments, to speculate on medical errors or to rationalize that you have enough strength to continue the fight. The survival instinct is strong. I also think it is human nature to want to be optimistic, even when circumstances prove otherwise.

And I am.

When you have cancer, you become a quick study in medical terminology and procedures. You spend your free time researching and wondering. But you also spend it praying, reserving some quiet time with The Almighty, in whose hands your future rests. Faith grows in this uncertain soil. But let's face it: none of us get out of this life alive, in spite of what we might think. We all have that return ticket home with an undisclosed date and time stamped on it. God is the conductor of this train.

Until then, I will embrace each moment, live with a sense of urgency, seek new adventures, do what brings me joy. I will spend time with those who mean so much to me and remember to laugh at the absurdity of life. I will try to be productive, to consistently work on this new novel I recently started. And I will pray that I will be able to accept whatever comes along because it is there that peace dwells.