KAMILLA LINDER. GENTLE CANCER GUIDE FOR PATIENTS AND THEIR CLOSE ONES. (A glimpse into a soon-to-be-published book)
FOREWORD
"What if this book is sad? Or full of terrifying details?"
If those thoughts crossed your mind, I completely understand. It's quite a task to write a light book about oncology.
But that is exactly what I decided: I will create a guide-book about cancer that will be as much about life as possible, and about how we can stay alive and true to ourselves even in the most difficult moments.
That’s why I wrote it three times: first, as notes during my treatment; then, after a year of consulting other oncology patients, I reorganized those initial notes, spent a month reviewing them, restructuring the ideas, and peeling away the unnecessary parts.
And I am writing this book for the third time now, a year after my last surgery, having volunteered as an oncology consultant for a year and a half, with a calm and loving heart.
So, welcome.
If you are a patient or a loved one—I’m deeply sorry you need this book, but I can assure you that you will find a great deal of useful information here. It’s been vetted through hundreds of hours of consultations and feedback from readers in over fifty countries.
What makes this book different from other books about cancer?
It’s a navigator. An instruction manual. A guidebook full of advice on what to ask doctors, how to ground yourself if you are the patient—and how to offer support and what’s important to know about the specifics of the oncology experience if you are a loved one looking to help.
Often, severe experience and stress rob us of the ability to see the bigger picture. Seemingly elementary decisions and actions that would be obvious in a calm state become obscured revelations.
I structured this book to help you regain choices—how to act, what to do—and to make it easier to feel the ground beneath your feet again. I’ve included all the self-balancing practices, strategic tactics for managing affairs under pressure, life hacks, and observations I used for years before my diagnosis, and which I’ve gathered thanks to other oncology patients and my own experience.
In all my professional pursuits, I’ve always been interested in focus, strategy, and resilience—and my goal and mission are to increase, as much as I can, confidence and stability in others, even in situations as difficult as cancer.
If you are simply navigating life cautiously or are a friend who wants to support a friend, I am happy to have you. The more of us who are well-informed on this difficult topic in advance, the easier it is to cope with oncology in life.
You can read the book starting from any page and skip between chapters. I had collected and tested many of the self-support techniques included here for many years before my diagnosis, and they’ve supported my fighting spirit and zest for life for more than a decade.
Important Caveat 1: The book is structured around breast cancer, but many of these practices will be useful for other types of oncology.
Important Caveat 2: My work is most helpful for Stages I-II; for patients with terminal stages, I’ve added the maximum I can include without having gone through that experience personally—but please, if you’ve opened this book in connection with terminal cases, supplement it with specialized support for that specific situation.
…Now, let's approach the situation from a technical side. If we remove the demonization of cancer often generously fed to us by cinema, an oncology diagnosis of Stage I-II is largely similar to any other difficult life episode:
a) It involves intense physical and psychological stress.
b) If the diagnosis is curable, then, like any other life episode, this time passes, and life continues, bringing new, unpredictable events and meetings.
That is, as with many challenging situations in life, the main task is to go through this experience as gently as possible and with minimal losses.
TRAUMA OR EXPERIENCE?
At the very beginning of my treatment, Irina, my psychotherapist, told me something crucial:
"What we go through with a sufficient amount of resource becomes an experience. What we go through without resources becomes trauma."
This formula applies to any moment in life: if we have enough support, energy, and backing, many of tough things you simply pass through and leave behind. If there is no support, then "the last straw breaks the camel's back," as the famous proverb says.
My diagnosis did not become a trauma for me; it doesn't haunt me at night or ruin my life. It became an experience—difficult, but as useful as many others.
I created this book so that as many people as possible could find the maximum strength, resource, and humor within themselves to navigate oncology, if it comes, precisely as an experience. With dignity and as comfortably as possible.
And then, as happens with any experience, to step into another one, and another one, and continue living as fully as possible for many more years.
Who I Am
My name is Kamilla Linder, and in all my professions (philologist, teacher, business tracker, coordinator, growth coach, and musician), I love creating systems, strategizing, and fostering growth and development—whether in people or in the projects I undertake.
I successfully and happily went through breast cancer in 2024 in California, and as a fiercely competitive person, in the very first week after my diagnosis, I mentally addressed the tumor inside and told it, "I will live you, digest you, recreate you, and sell you."
No sooner said than done. From that day on, I navigated my illness as the future main character of my own book. And now, of course, I am publishing it with a touch of wicked satisfaction—it’s gratifying when your unpleasant story ultimately becomes a source of support and inspiration for others.
What kind of cancer did I have? I am a rare case of genetic predisposition. Surprisingly, only 10% of all patients are genetically predisposed to oncology. In 90% of cases, this diagnosis comes without warning. In 9 out of 10 cases, it's unexpected. That’s why mental equilibrium is so vital—the oncology experience, especially when uninvited, severely knocks you off balance for a very long time. And this, in fact, is the main problem, because the more fear, exhaustion, and helplessness inside, the higher the chance of choosing a suboptimal decision on the path of action.
I had been quietly preparing for my oncology experience my whole life; with a family history of five breast cancer diagnoses in previous four generations, my chances of avoiding this experience were initially very low. I read articles and blogs, discussed the topic with family and friends, took various genetic tests by age 30, found my mutated gene (PALB2), established a "healthy baseline" of screenings (mammogram + MRI), and at 33, during a new check-up, a two-millimeter shadow was detected in my images. The rest is this book.
Despite knowing it would happen, I was regularly scared during that time. But thanks to the support of all my friends and everything I already knew about mental balancing, effective planning, and a strategic approach, by age 33 I put together the best medical team and finished my treatment in nine months.
Now, in 2025, I am writing this text in an absolutely different life—a life that is happy and peaceful. It's a sunny Wednesday morning, the beginning of July 2025, birds are singing outside the window, and half of an exciting summer is still ahead. Today, I need to review questions for a future job interview, sort out items bought for my future dog, and tidy the kitchen. My main problem today seems to be that I didn't manage to return a gorgeous cocktail dress that doesn't fit my new chest (I am warning you now, a lot will be said about the chest in this book).
This was a small, mundane testimony that life after diagnosis exists and it can be wonderful.
And if my stories help you arrive at this next stop more composed and calm, then my task will be fulfilled.
The Two Roads of Every Day: Emotions and Actions
I love the saying that every day we walk two paths simultaneously—and how gracefully we move through life is primarily related to the balance in traversing both roads at once.
The Road of Actions is all our daily tasks and obligations: brushing teeth, work, walking the dog, all our errands and meetings.
The Road of Emotions is how we feel and how we react.
And these two trajectories can be completely different throughout the day.
We can be doing one thing but feeling completely otherwise. Decorating a celebratory pie with cream roses and feeling awful while doing it—or vice versa, lying on the couch all day doing nothing and feeling fabulous. I imagine you have your own examples of doing one thing but thinking and feeling another.
In normal life, we rarely specifically note where we are on the emotional road at any given moment. This movement is often unobvious and unnoticed by us.
But when bad news arrives—and it doesn't really matter if it's oncology or something else—the success of the entire enterprise depends first and foremost on how strong our equilibrium is in both dimensions.
Most of us are thrown off balance by news of cancer for a long time. Emotions become overwhelming, and most of them are the various fire alarms built into us, screaming deafeningly through fear and anxiety, announcing the premonition of danger.
These signaling systems always come at a very high cost. In biological terms, elevated cortisol leads to fatigue, impaired memory, and concentration. In everyday language, constant worry mercilessly devours resources, disrupts focus, and hinders sleep.
Therefore, how we negotiate with ourselves every day on the level of emotions, in the case of oncology and any difficult period, is vitally important for all the choices and decisions we will make on the level of actions.
This book will be about practical advice and practices to maintain maximum equilibrium in emotions and take the most effective steps in actions.
Let’s go.
PART 1. THE EARLY DAYS
I AM A FRIEND OR RELATIVE. WHAT IS HAPPENING?
I usually offer the following formula to family and friends to help them understand what a newly diagnosed person is going through and what types of support they need:
Oncology diagnosis is like an uninsured apartment burning down.
Treatment is like going through a war.
Physical condition is like having a severely broken leg.
Why these analogies?
Like dry wood in a fire, everything that was previously in the life coordinates system burns down at once. All future plans vanish, a ton of problems and tasks emerge that need solving here and now, while everyday life doesn't stop: children still need to be transported to kindergarten every morning, cats and dogs fed and walked, and parents visited and taken care of.
War, because it is a near-death experience. Even if the diagnosis is relatively mild, we patients are flung much closer to the sensation of extreme danger and death; we undergo very severe treatment trials, and the patient may have post-traumatic stress disorder for some time after treatment ends.
Physical condition, because often during surgeries and therapies, there is very little strength, movement is restricted, you can walk little, and lift almost nothing.
And in all three cases, actions mean more than mere comfort. All these three examples from "healthy life" require action and help. Below, I will discuss the types of actions and assistance depending on which part of the journey the patient is on.
However, it’s important to remember that witness trauma also exists. In psychology, this is the feeling of painful helplessness when you cannot stop the suffering your loved one is enduring. There will be a separate chapter on this later,but until we get there, I will remind you here and there that your responsibilities, especially during difficult times, include not only caring for others but also for yourself—to be the best support and the best superhero for the one for whom you opened this book.
The lists regarding support, resources, and advice for patients apply to you too, because the firmer you stand on the ground, the easier it is to walk on it.
So, what happens at the beginning of the road?
CHALLENGES AND TASKS OF THE EARLY DAYS:
The most unpleasant time is the period of uncertainty between a suspected diagnosis and the biopsy results.
The hardest part, if a diagnosis comes, is the ton of new information that needs to be understood and absorbed very quickly, plus a lot of new tasks on the calendar.
The most important things for the patient are:
Maintaining emotional balance (remember the road of emotions)
Recording all information (see chapters below about organizing)
Sustaining their resources and allowing themselves to breathe
Giving themselves time to consider and verify any decision
Taking daily steps to solve current problems—and be sure to celebrate them
Remembering that every event passes, and life will continue—the question is, what will that future be, and how do they want to see themselves in it?
Accepting support and help.
The words about support here are intentional—for many of us, due to upbringing and social pressure, accepting help feels difficult.
This is a global phenomenon for decent people—I have met patients embarrassed to accept help from Latin America, the USA, Europe, Russia, Ukraine, and Eastern Europe. In many cultures, we are taught to cope independently, not to impose on others, and not to accept offers on the first try.
But when speaking with patients, I often offer a different perspective: when someone offers us help, we are helping them feel better in their compassion for our situation. And thus, there is less pain in life for both of us—the person who helped us feels better because their offer of assistance was accepted, and we gained more support during a truly difficult time.
ACTIONS: HOW TO SUPPORT?
In short: support with actions and resources. Comfort is important, but actions, especially early on, are vital.
It is normal to feel confused when a loved one is diagnosed with cancer. It is a serious diagnosis with difficult treatment. But in reality, as I said above, cancer is much like any other complicated life episode. And each of us has experience helping friends in such circumstances.
How did you care for a friend with a severe broken leg? How did you help a friend in their eighth month of pregnancy? How did you all chip in to help someone's relative? All that experience counts and can be perfectly applied here.
Just in case, I’ll provide a numbered list of ideas below:
Money. Oncology treatment is expensive, and any financial support incredibly eases life. Paying for consultations, procedures, medications, or even just a little help with transportation—all of it counts.
Conversations. It matters to us when you write. Even if we don't always reply. Conversations help us feel less alone. It’s especially valuable when you share pleasant memories or cheer us up.
Food. Sometimes during treatment, there's no strength to cook; sometimes you forget to eat between doctors and procedures. Every soup and every plate of warm food is care. You can cook, order, or send delivery. Frozen portions of quality food can be a lifesaver at any moment. My friend Anna ordered me an entire package of various ready-made meals from a restaurant; I went and picked it up, and it was help for a whole week!
Additionally, there is a free hospital service called Mealtrain, where you can organize shifts for food delivery among friends: http://mealtrain.com
Cleaning. The effectiveness of cleaning drops catastrophically in oncology — so much so that in America, there are volunteer cleaners for oncology patients. You can pay for and send a cleaner; if that's uncomfortable, you can come yourself and wipe surfaces, vacuum, help with sorting/laundry, or clear out the refrigerator. You can bring food and host a great dinner while watching a funny movie — this becomes superhero support and a reprieve from the heavy routine.
Caring for Pets, Children, Parents. Walk the dog, feed the cat, clean the parrot's cage, take a sneezing hamster to the vet, help with children's logistics — school, activities, clubs, check if elderly parents need support (a trip to the pharmacy or grocery store sometimes is a huge help). Relieving all these tasks helps immensely.
Finding Useful Contacts and Help with Documents. Oncology is an exhausting marathon of collecting contacts and filling out paperwork, and the patient may not have the mental capacity for it. Therefore, if you can find the contact for a necessary doctor, lawyer, tax consultant, check on insurance and available charity programs, fill out applications for organizations, or double-check documents for insurance payments. This is a very valuable assistance.
Medication Delivery and Packing for the Hospital. You can offer to pick up medications from the pharmacy or bring something for the hospital. My friend Sasha greatly helped me by picking up a necessary bag of useful items from the patient community and bringing it to the hospital after my surgery.
Walks and Outings. Any change of scenery helps significantly to re-adjust, and even a small change of background can lift the mood and distract from the treatment routine. Take your friend for a walk, to a park, a cafe, a museum, a movie; if health permits, go boating or take a small weekend trip.
Transportation and Taxis. This is a particularly valuable form of help: during my treatment, I had over eighty doctor visits. For several surgeries, I had to arrive at the hospital at 5:30 AM, and after the operations, I couldn't drive for a couple of weeks, so the grocery question hung in uncertainty. Or, for instance, two days after surgery, I needed to go back to the hospital for a check-up, and I didn't have the strength to use public transport.
What you can do: offer a ride or gift money for a taxi. Here I thank my friend Ilya, who gave me $100 for Uber, allowing me not only to get to the hospital but also to take one trip to the ocean shore to breathe the air after my surgery.
Gifts and Quality Time Together. A certificate for a massage or spa, a beautiful gift, cosmetics, a museum membership, a cozy blanket. A Cirque du Soleil show, a concert, the theater. Flowers (my study group sent me a beautiful surprise bouquet after my toughest surgery). Clothing — for example, cashmere is very welcome after a mastectomy while the skin can be painfully sensitive while healing for several weeks.
Simple joys remind you that life goes on and is waiting for your return. Or you can organize a cozy evening at home with favorite movies. I rewatched Woody Allen throughout my illness; it was very funny and tender.
You can easily add many more excellent ideas here; expand the list to your liking.
IS ALL THIS GOING TO LAST LONG?
If the biopsy is positive, then yes.
Here are the rough timelines for breast cancer, using an average case:
The biopsy is valid for 30–60 days (but this period needs to be double-checked); during this time, people often look for good doctors and get second or third opinions (this is mandatory).
Active treatment (surgery, radiation, chemotherapy) takes from three and a half months to a year and a half, plus hormonal preventative therapy for five to ten years.
Important: The duration of active treatment is not always set in stone. One doctor might suggest one method, while another might look at the case from a slightly different angle. One surgeon might propose one operation, while another might suggest doing it differently.
Everything heavily depends on each specific case and the treating physician — which is why it’s so important to gather and cross-reference opinions, methods, and approaches. Oncology is a young branch of medicine, and new methods, approaches, and discoveries regularly appear, and not everyone knows about these discoveries because time is limited; you’re either working with patients or non-stop reading new research.
My case: The first two medical teams gave me a treatment plan for six and a half years. With the third medical team, we finished in nine months. The first two surgical teams were unaware that nerve-ending grafting during mastectomy already existed, allowing breast sensitivity to return as quickly as possible after surgery. The third surgical team I found myself had already performed hundreds and hundreds of such operations in recent years. But because this technology is so new, few people have heard of it.
Therefore, before every major decision, gathering information from all possible sources is crucial.
The most important task is to remember that this is a marathon, not a sprint. And you need to approach this marathon with corresponding patience, self-care (this advice applies to all participants—patients and their loved ones), and, as much as possible, with humor, because when you find a reason to laugh, the situation is no longer controlling you.
AND NOW — A SMALL BREAK FOR STORIES ABOUT CALIFORNIA
Many times while writing this book, I wanted to ask, "How are you doing, my reader?" — because there's a lot of information, oncology is tough, and it's unclear what the future will hold when treatment ends.
I cannot get an answer from you, reader, but what I can definitely do is tell you about how life continues afterward.
Near the University of Berkeley, amidst peaceful, sun-drenched streets with two- and three-story houses, there is a place called the Greek Theatre. It is truly an amphitheater standing in a semicircle, seating approximately 700 people, a modern construction, of course, with a stage. There is no roof over the amphitheater, and during the dry months (the majority in Northern California), concerts of various musical genres are held here. The acoustics of the place are stunning,and in the evenings, large, bright stars shine overhead.
The first time I went to this place was the day after I was given my diagnosis.
The concert was amazing; the experimental Icelandic band Sigur Rós played on stage with a symphony orchestra. Around me was the scent of Berkeley summer — dry grass, autumn flowers, and a faint hint of cannabis. I felt a profound internal contrast between what I saw outside versus what was happening inside me. I had cancer, and I didn't know what would happen with my life next. I knew nothing at all —neither where I would live when the time in my current apartment ended in two weeks, nor how I would cope, nor what my future would be. The amphitheater was packed, and there was absolute silence as the musicians played — and absolute silence with twinkling stars in the sky above us. I was wearing a new, stunning dress, and I was surprised and joyful at how many people had come to listen to a band I had loved for many years.
Two years later, last week, I saw that another one of my favorite musicians was playing in the same amphitheater. What did I remember about that first night? The stars, the smell of grass, the symphony orchestra, and the warm air. And of course, I went to buy a ticket.
WHAT IS THE PATIENT'S MAIN PRIORITY IN THE EARLY DAYS?
(Spoiler: Champagne)
The short answer, which is given to all patients in America: to maximally take care of yourself and your condition, to find time for rest, entertainment, good food, and absolutely — walks in beautiful places. Delegate tasks as much as possible to everyone you trust. Go to performances, put on pleasant music at home, try to sleep as much as your body needs. If possible, remove all irritants in the home, and take maximal care of your health.
Funnily enough, much of oncology is similar to pregnancy in terms of self-focus, although it's a story with the opposite sign. But, as in pregnancy, self-care here becomes the main task.
Why is this so?
Because every decision we make depends on how composed we are internally. And how composed we are internally depends on whether we are well-rested, fed, calm, financially secure, and whether we have a support ring of people to lean on. By Maslow's hierarchy of needs, these would be all the base levels.
Conversely, it is extremely difficult to make life-altering decisions when you are unrested, hungry, tired, nerves are frayed, attention is shot, and you have so many problems and unresolved questions that you just want to hide under the couch and not come out for a week.
You probably wouldn't go to a job interview in that state. Yet, people occasionally come to doctors in an even more frayed condition. Does this help in making decisions about the type of surgery and treatment? Do you remember everything in that state, or is there a risk of missing something important?
I think you mentally answered the same way I did.
An entrepreneur friend of mine once said: "When I get bad personal news, I first open a bottle of champagne, and then I write to my psychotherapist. But first, I absolutely open a bottle of champagne. Nowhere without the champagne."
This principle fascinated me at the time. If you keep the structure, it’s a two-step chain:
Step 1: Self-support (the bottle of champagne can be anything—a warm bath, a walk, meditation, journaling, delicious food)
Step 2: Constructive search for solutions (therapist, specialist, information resource, and so on).
In oncology, no matter how difficult the experience, this order of action helps immensely. If you already adhere to this sequence in ordinary life, much of this book will be of particular interest to you. If not — try it; this distribution of actions can become a very good support in your daily navigation. You have many challenging days ahead, after which you may not have time to recover if you don't dedicate it beforehand.
Find time when no one bothers you. Accept self-care — including from yourself.
The more you are resourced, the easier it is to maintain equilibrium and calm (remember the road of emotions from the introduction? That's it). And the more resource, equilibrium, and calm you have, the easier it is to move forward.
P.S. Returning to the conversation about basic needs: friends, money, even the ability to get enough sleep — these points are not always available, unfortunately. Cancer comes to some during a job search. To others, when they have a small child or are going through a divorce.
Life doesn't wait for the perfect time when we are fully armed to issue the next task for solution.
When I was diagnosed with cancer, my entire family was on another continent, my apartment lease was ending in two weeks, and after that was a void, as I had planned to travel; I hadn't saved any money, and with half of my friends, we only rarely stayed in touch because we lived in different countries.
But for some reason, from the very first day, I was sure that this would be an experience of love and friendship. And that everything would be fine. And it was.
Often, despair and fear obscure the paths and solutions that are obvious when you are calm. I will tell you how my story developed further, but for now, I return to...
...THE PATIENT'S MAIN CARDS AT THE START: BIOPSY AND GENETIC TEST
When the hospital calls and says they found a shadow on a mammogram, it throws you off. You were healthy just an hour ago, and an hour later, you have a suspicion of a disease with a very bad reputation.
But at this moment, it's very important to remember: this news is always time gained.
Any moment when something is caught on the images is better than a moment in the future because this "catch" provides an opportunity for action. It's better to catch a cavity before it reaches the nerve. It's better to fix a leaky pipe before the crack expands to require a team of plumbers.
The news is unpleasant, but when you are aware, you can take actions that may improve and significantly extend your lifespan in the future—that is priceless.
And from this perspective, any additional information is an extra ace that helps you figure out the most effective next steps.
Patients have two main aces:
a) Genetic Test: Shows whether there is a breakdown at the genetic level. For example, about twelve different genes are responsible for breast cancer. If there is a mutation in a specific gene, there is an increased likelihood of oncology in a particular body area—and based on this, some people choose to remove only the tumor for breast cancer, while others choose a mastectomy.
b) Biopsy: One of the most important documents for assessing your situation. In fact, a biopsy is like the user manual for a microwave; it contains all the information upon which further actions and treatment are built. It is essential to know it when selecting your medical team and comparing what different specialists propose.
"Wait, can I really be offered different treatment methods for the same disease?"
I’ve heard this question many times from newly diagnosed patients. Yes. It is crucial to remember this: oncology is a young and rapidly developing science, and like everywhere else, it has its geniuses and mediocrities.
The technological and informational race in it is such that patients treated in the 2010s can no longer advise patients in 2025. Some doctors manage to read the latest research, and some do not.
In addition, there is bureaucracy: some doctors simply cannot deviate from the prescribed old protocol because such are the rules in a specific hospital network (I experienced this myself). Otherwise, there is a risk that the patient will sue the system in case of an error.
And there is the human factor: some doctor had a scattered nurse accidentally place the wrong medical chart (that's my story too). Another oncologist, in front of my acquaintances, called his colleague for advice because he hadn't encountered such a diagnosis before. One team I worked with disappeared for a week, and by a bad coincidence, their nurse gave me the wrong medication prescription.
Therefore, it is important to record, store across all devices, and remember as well as possible your individual metrics, medication prescriptions, and any key details.
BIOPSY: THE ROADMAP AND HOW TO READ IT
If the diagnosis is very recent, be sure to ask the patient: "Have you already deciphered your biopsy?"
Unfortunately, this is the most common situation in my practice of oncology consulting: I call a patient with a fresh diagnosis, and to the question, "Have you already deciphered the biopsy?" I hear "no."
It seems like the diagnosis is stressful enough, why delve even deeper into that information? In ordinary medicine, which treats us every day, none of us digs into the nuances of dental X-rays and colonoscopy details.
But in oncology, it’s the opposite. The details of your story will be useful many times to:
Understand the severity of the problem and minimize fear (many of us, thanks to cinema, think cancer immediately means chemotherapy—it doesn't).
Review and choose a treatment plan if there are options.
Get a second and third medical opinion (this is mandatory in oncology).
Find good doctors if the first ones encountered are not suitable (a breast cancer biopsy is valid for 30–60 days, and if the stages are early, many patients change doctors and still manage to start treatment in time).
Get help if you are in a region with developed non-profit support.
Get advice from other patients, compare treatment trajectories, and calmly ignore details that do not apply to your case.
Sometimes, let’s be honest, doctors and nurses mix up medical files and forget nuances—I kept all the deciphered information about my case in a note on my phone, synced across all my devices, and praised myself for it many times.
So, how do you decipher it?
I'll show you my example. Here is how my early breast cancer was described:
PALB2 ILC IA (G1 (T1N1M1), ER+, PR-, HER2-), cT1bN0M0 > pT1aN0Mx
It looks a bit like a cat walked across the keyboard, but in reality, this chain of symbols contains a huge amount of useful information. Let’s go in order:
PALB2: My mutated gene. It increases the risk of breast and ovarian cancer, but is not a diagnosis in itself.
ILC (Invasive Lobular Carcinoma): A type of cancer that grows not as a lump, but as a "web," penetrating between healthy tissues. That's why it is not visible on mammogram and cannot be felt by hand — it can only be caught on an MRI. This makes up about 20% of breast cancer cases.
IA: Stage I cancer, subtype A (each stage can have subtypes A and B). Subtype A means the tumor is very small and has not spread to the lymph nodes.
G1 (T1N1M1): This is the Nottingham grade, an aggressiveness score. It has three levels:
G1 – Low aggressiveness (slow growth, cells resemble healthy ones).
G2 – Medium (altered cells, divide faster).
G3 – High (strong mutations, rapid growth). The higher the level, the more critical the urgency and intensity of treatment.
ER+, PR-, HER2-: These are the cancer cell receptors; the type of post-operative treatment is chosen based on these indicators.
ER+: The tumor is estrogen-responsive. This means hormonal therapy is needed to block this pathway for future tumor development.
PR-: The progesterone receptor is absent, meaning this hormone does not affect the tumor.
HER2-: The tumor is not dependent on the HER2 protein (in case of a positive response, there would be separate targeted treatment).
What does this mean in practice? 80% of breast cancers are estrogen-dependent, like mine. Most often, this means 5–10 years of hormonal therapy after surgery.
cT1bN0M0 > pT1aN0Mx: This is a separate classification for the presence of metastases and affected lymph nodes with two indicators (c - what the biopsy showed, and p - what the tissues removed during surgery showed. Accordingly, before the operation, I had T1bN0M0, and after the operation, the diagnosis was clarified to T1aN0Mx). What does this mean?
T1a – The tumor is smaller than previously estimated.
N0 – Lymph nodes are not affected.
Mx – No information about metastases (this is normal if there are no suspicions).
…Thus, if we make a general summary and translate it into human language, my biopsy would be deciphered as: "We found a very stealthy cancer, we don't know exactly how much there is, but what we see is very small, non-aggressive, grows slowly, hasn't spread anywhere yet, and falls under the most common treatment type; all therapy protocols for it already exist."
Not that having cancer in your body is good news. But bad news, as I learned many times that autumn, comes in different degrees of severity— and the faster you figure out the details, the better.
How is the decision about chemotherapy made?
This depends on the Ki-67 index.
Far from all cancers, especially early and small ones, as seen in the example of my biopsy, are severe and require chemotherapy, like in a Hollywood movie.
Ki-67 shows the percentage of cells in the division phase — meaning, that the aggressiveness we discussed above does not mean speed. These are two different parameters. And if the Ki-67 is low, no one prescribes chemotherapy.
Ki-67 below 10%: Tumor grows slowly, chemotherapy is not required.
Ki-67 10–20%: Gray area, the decision depends on other factors.
Ki-67 over 20%: Aggressive tumor, chemotherapy will likely be needed.
WHAT IF THE BIOPSY RESULTS HAVEN'T ARRIVED YET, OR NOT ALL OF THEM?
This happens. How you can use this time:
Has the genetic test been done? This data is very needed, and if you don't have it, it's very useful to collect it.
Start gathering information based on the indicators already present in the biopsy.
Important: Unfortunately, AI in our 2026 can give inaccurate information, so cross-check the data manually.
Where to check: official websites dedicated to oncology in general (for example, in America, the American Cancer Society) and to the specific type of oncology. Additionally, the doctors of the NENAPRASNO charitable Russian-speaking foundation provide free second opinions to oncology patients and their loved ones (The "Just Ask" Project: https://ask.nenaprasno.ru/).
Get other tests done and save yourself time in the future: while waiting for my biopsy, I went and got all the tests related to egg freezing, and by the time I approached that task, I already had all the fertility data in hand.
Find other patients with a similar story who can share advice on navigating this experience. Where to look for patients who have gone through breast cancer: a) there are closed groups in almost every social network; b) on any women's forum or in a motherhood group tied to a city or region, there is someone who can share contacts.
Be careful! If you feel that you found a group or patient, but the communication alerts you or drains your energy, move on. There are many groups, many people; look for those who can share information calmly.
Walk, move, take care of yourself. Life goes on; the body needs care just as much, and even more than usual.Remember this care.
JOURNALS AND MEDICAL NOTES: SELF-SUPPORT AND KEEPING A FINGER ON THE PULSE
If you absorbed all the information in the biopsy section after one reading, you might not need treatment journals and notes. But for most of us during this period, they are very helpful.
Why medical notes are needed:
To withstand the avalanche of information that falls on the patient in the first months. It is vast; treatment often involves many factors; for some, focus drops sharply due to stress—writing it all down to compare, cross-reference,and remember the main points helps immensely. I mentally referred to it as my "war map"—any strategist verifies the coming battle not only in their head but also on a separate map.
To verify what different doctors in the medical team said at any moment (opinions about the same thing can sometimes vary greatly among different oncologists—surgeons, radiologists, chemotherapy doctors, treating oncologists).
To keep medication protocols! This is super important for double-checking, and if receptionists or nurses mix something up or forget (unfortunately, this happened to me repeatedly—and if not for my notes, I would have burned a lot of nerves and time).
Journals greatly help in blowing off steam and maintaining orientation in what is happening. For many patients, the perception of time is distorted, and it is sometimes impossible to remember whether a doctor's meeting was yesterday or three days ago. Remembering what happened a week ago is even harder.
Therefore, it is very useful to keep at least a short history—today I was here, the doctor said this, they advised such-and-such support group or to inquire about this method. Memory works very poorly during oncology, so such notes regularly save the day.
I also really love Julia Cameron's creative method, where you set a timer for thirty minutes and write down any thoughts about anything, without sorting. A loud car drove past the house, the blanket under me is soft, I hope the next test results come quickly, the cat climbed onto the sofa and is lying next to me. It seems like nothing special to write down thoughts one after another, but many tens of thousands of Cameron's readers say that this technique incredibly helps to skim off the "thought foam" and add clarity to the day.
And the third type of journal entry that I highly value is the fear questionnaire. Once a week, I sit down and write down the maximum answers to the question, "What am I afraid of?" When fears are illuminated by the flashlight of attention,they often shrink in size and scale and turn into tasks that I can approach myself or with friends.
TABLES, PLANS: CANCER AS A MANAGEMENT PROJECT
In a way, I got the diagnosis at the most opportune time, during the last week of a business tracking course. A business tracker is when you come to a company with a briefcase of tables and verify with the managers step-by-step how the work processes are set up and whether the business is making money as originally intended.
And one of the first things I told myself upon receiving the call about the positive biopsy was that since I was studying to be a tracker, I would turn my treatment into a case study for productive and successful treatment. And that's what happened.
I compiled several types of tables and documents, and thanks to them, I kept all the levers of the multi-factor problem assigned to me under control for ten months.
What my tools were:
For Action Plans:
Overall perspective: where I want to get to and how I want to feel about myself in a month, a quarter, a year, three years*.
Mid-term perspective: the next month, broken down into main directions with key tasks each week and the expected final result.
Immediate perspective: a list of tasks, questions, and dreams for the day*.
Were you surprised that I included dreams in these lists? What the heck are dreams about life in three years when you have cancer? But the clear stance that the future will happen and that I am making plans for it no matter what was my guiding compass and gave me the backbone to traverse the road, keeping cancer in the place I assigned to it in my worldview — a difficult event, but not the main or central one, just another one that I will break through and emerge to my future life.
For Information Gathering:
Document with contacts for the entire medical team (these people are regularly numerous, or they change, but new doctors ask for the contacts of previous specialists).
Document with key notes from doctors and patients (diagnosis, who said what about treatment (different doctors say different things), what medications and dosages were prescribed (this turned out to be incredibly important when the medical team ignored me for a week), which patients used which life hacks for surgeries/procedures).
Document with all the doctors and clinics of interest to me outside my medical team (I changed my doctors twice in total).
Database of non-profits (the area I needed, contact details, when I last contacted them).
Document with key information for non-profits (diagnosis, address, oncologist contacts, trusted individuals, etc., which needs to be filled out many times and is easier to copy—or pass this information to a social worker).
Personal journal, which I also used to orient myself as to what was happening and when, because time flies at cosmic speed at first.
It seems like a lot, right? But as I wrote above, the firehose of information in the early days is so strong that it's easy to lose focus, and that is very dangerous. Here's why else:
Every case of breast oncology is highly individual, and if you don't have the strength to search for your own path, you might give up due to fatigue and agree to someone else's solution, which will be very costly in the long run—either financially, health-wise, or aesthetically.
The other side of overload is treatment fatigue, as it's called in America, where the experience is so overwhelming that the patient gives up and stops calling doctors, ignores procedures, and turns away from treatment altogether. They postpone surgeries, pretending nothing is happening.
The third problem with overload is insufficient energy for negotiations, which happen constantly with so many variables, and in most cases, the odds are not in your favor; you are just another client at the door. Negotiating, persuading, charming, cross-checking, arguing, complaining, raising hell, threatening —you do all this regularly and simultaneously because here a nurse has been slow to send urgent documents for three weeks, and on the other line, they are charging you ten thousand dollars more because the financial department screwed up the math again.
These documents also helped me incredibly when the opinions of different doctors, even within the same medical team, diverged, and I needed to weigh and make a decision by comparing different data.
QUALITATIVE AND QUANTITATIVE GOALS
Another piece of business wisdom that helped me greatly in oncology: every goal has a qualitative and a quantitative side. And we often confuse them or fail to fully define them.
"I want to be happy"? That's a qualitative goal. But if you don't answer yourself in what metrics this is reflected, it remains a wish and a dream. "I need to earn a lot of money"? That's a quantitative goal, but if it lacks a qualitative compass ("to what end"), the drive to move toward that point is small.
I defined my first qualitative goal at the time as: "to feel maximally calm and balanced, understanding my diagnosis and the subsequent steps." How? I needed to gather all the information available to me. When did I want to feel this way? One month from the current point (the third day after diagnosis).
Then I started looking for quantitative questions. "Where do I feel uneasy and what do I not understand? What can I do about it?" I applied this question to all the areas I saw before me then.
Diagnosis: What is written in the biopsy report? Is it similar to my mother's diagnosis? How exactly was she treated? What is the most common type of breast cancer treatment here in America? Who can I ask among patients? Who can I ask among doctor acquaintances? What questions must I know the answer to at the start, and what can I ask my future team of doctors?
My Medical System: Who will treat me? Can I find good doctors? How? Do I need to check anything else related to my genetics?
Housing: In two weeks, I'm moving out of my current apartment, and my travels are definitely canceled—so, I also need to sort out housing in California. I already asked close friends about the option of renting a room in their country house for a while—is that enough? What belongings around me do I take with me, and which do I pack and leave in my storage unit? Which medical tests can I do anywhere, and for which procedures do I need good doctors, where geography isn't a priority?
Quality of Life: What can I do to please myself amidst all this, where can I breathe out, relax, and what can I admire?
Having fixed these questions, I planned out my entire next week day by day so that I could gradually advance on each point every day. For that same day (Sunday), I scheduled the following immediate steps:
Diagnosis: Schedule a call to join a local closed group of oncology patients. Read about my type of tumor, decipher the biopsy report, read how the most common cases are treated (this task was on my daily to-do list).
My Medical System: Post a request about doctors in my insurance in a local FB group, asking who people can recommend. Later in the day, when answers started appearing in the post: schedule interviews with several patients who responded and who underwent my type of treatment with those doctors.
Moving: Sort belongings for the move for about thirty minutes—what goes with me, what goes to storage. Then lie down and rest.
Visit Friends and while in a traffic jam, call another friend who had breast cancer and discuss how she went through her experience. Be maximally present during the visit, not lost in my head (and it was indeed a wonderful evening).
And so on every day, step by step. "Fight one enemy at a time," an Iranian taxi driver in Manhattan advised me many years ago at the very beginning of my American immigration, and I’ve kept that phrase in my pocket for years when facing multi-layered situations.
One by one. We break it all down one by one.
It’s also always useful to note how much time each task takes — it makes them much easier to integrate into the overall schedule of work and other commitments. If the planned tasks for the day were finished, but the day wasn't, I moved on to the next questions and steps.
Each completed step brought me new information and new questions, which I first recorded in my notes, equally accessible on my computer and phone. I also quickly recorded any new thought or question that arose—and I continue to do so now, in the twelfth week, as I write this text.
At the end of the day, I checked the day's progress and added new questions and tasks to the schedule. In the morning, I woke up and continued along my weekly map.
EMOTIONALLY SUPPORTING YOURSELF: THE ROADSIDE FIRST-AID KIT
The difference between ordinary life and oncology is that in life, like a zebra, we regularly have a black stripe followed by a white stripe; in oncology, especially at first, unsettling news arrives non-stop.
And at such a time, internal support is more critical than ever. This is the same task as feeding yourself. We don't expect food to magically appear on the table — we choose a recipe and go to the store for missing ingredients.
The same approach to internal nourishment during a difficult time saves both your mind and productivity.
In psychology, this set of self-support ingredients is sometimes called a "roadside first-aid kit." And just as each of us has favorite food ingredients, this kit holds the most cherished sensations that instantly return a feeling of comfort, support, and safety to the consciousness.
The rules for using the kit are as follows: if you hit a rough spot—pull out two or three sensations to your taste. Practice this self-support daily.
What was stored in my kit:
Food: Do you have any tastes that take you straight back to childhood? For me as Eastern European, it's borscht, cutlets, and Napoleon cake, and also caprese, caponata, and any Italian sweets—memories from the Italian side of the family.
I don't think I ate as much borscht and burrata in any winter! And I think the power of memories in those tastes largely outweighed what was happening. Because it's impossible to suffer and eat borscht at the same time.
Also, if I visited friends and we spent a cozy time together, I would take a photo and later order the teas we drank together. So, through tastes, I mentally returned to the memories that supported me.
Calmatives: Antidepressants and tranquilizers during oncology treatment are not shameful; sometimes they are a necessity. After oncology, I spent another year separately repairing my body, because cortisol, which was driven out of control by stress, broke down insulin, and the broken insulin pulled everything else down with it.
Stress hits the body no less than illness, and it's important to at least cushion the impact. Sleep, meditate, drink calming agents. You still have valerian, motherwort, and melatonin at your disposal (it is also believed that 5mg of melatonin slows the growth of estrogen-dependent tumors).
Meditations of all kinds: remember that meditation is an umbrella term, and for some, meditation is silence and breathing, but for me, driving a car while listening to lectures on music was excellent meditation. If you haven't had a meditative "break" in your last three days, it's already time to arrange one.
Tactile Comfort and Movement Facial gymnastics: it's good to do anyway when you're an adult, and during oncology, it also returns consciousness to the present moment, like any touch. In addition, I had a curious case: over six months of the oncology experience, one eyebrow went up so often from everything happening that I had to spend a month exercising to return it back to the same level as the other. That’s how stress can change your appearance if you don't monitor it.
(While I was fixing my face, I learned that this is generally a common age-related phenomenon—one side of our face is more active than the other, so the likelihood of asymmetry increases closer to older age, and it's generally useful to sometimes do preventative exercises for facial muscles starting in your forties. Just saying.)
…Comfortable and pleasant-to-the-touch clothing helps greatly; during my oncology, I finally transitioned to the world of leggings and light sneakers. It is very important to take care to stock up on enough blankets and pillows: one needs a lot of pillows after surgeries so that the body has soft support. During treatment, I also got an electric blanket so I could quickly wrap myself in warmth even on the coldest winter evenings.
Breathing practices help greatly, as does the Eastern technique of Qigong, which helps concentrate on the here and now. During treatment, I also discovered and fell in love with lymphatic massage, a gentle self-care technique that can be used after surgeries, after flights, and whenever you feel swollen and tired.
And a very simple practice for walks: when was the last time you walked through familiar places on new routes? Try changing the street or turning at a new intersection. Such micro-changes help the brain pay more attention to the surrounding world and distract a little from the flow of thoughts inside.
Music and Scents: Every morning, while I was gathering information and choosing doctors for my future medical team, I started the day with Louis Armstrong and Ella Fitzgerald's album, and the warm, honeyed quality of their voices set me up for grace and lightness throughout the day.
And when I sat down to deal with insurance or reconcile information in tables, I put on upbeat electronic music.
What music sets you up for confidence, and what calms you down? Are there any scents that remind you of something good? Incorporate them into your day.
Favorite Books, Things, and Activities: What books supported you in childhood? What games? What activities? Do you like fresh flowers? What beautiful and comfortable clothing do you have that you haven't worn out in a while?
Are there kind movies you've been meaning to watch? Now is exactly the time for them.
…and generally, add everything to your life that sets your attention on the bright and measured side of things. Whatever happens, no one will ever take away our ability to enjoy small things and flirt with life daily.
Every day, we create our lives, step by step.
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Author here. Thank you for reaching this point! I am truly glad if this excerpt provided some comfort or guidance. The future book is currently in the works with the publishing house, but to stay in touch for publication updates and download links for the full version, you can join my Telegram channel below.
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