WEST RICHLAND — There is no more "normal" after a cancer diagnosis.
There is life before cancer and life with cancer, but there is no life after cancer -- even with successful treatment.
Cancer is always a presence.
"It's not just diagnosis and then treatment and then, 'Hey! Back to normal!' " said Kay Kerbyson, 44, of West Richland, who is fighting her third bout with ovarian cancer. "In some ways, survivorship is more difficult than the treatment."
The U.S. National Cancer Institute estimated 12 million Americans were living with cancer in 2008, the last year for which data was available.
About 1.6 million people will be diagnosed this year, and more than 571,000 people will die of some form of cancer.
The most common types of cancers are breast, prostate and lung cancer, according to data collected from the nation's cancer registries.
The Washington State Cancer Registry reports more than 34,000 incidents of all types of cancer observed in the state in 2008, with 777 reported in Benton County and 227 in Franklin County.
There were 11,374 cancer deaths in Washington that year, with 281 occurring in Benton County and 77 in Franklin County.
While it is easy to focus on the number of deaths, the statistics show more people live with the disease than die from it, and those survivors must find ways to define their own normal, their own ways of living with cancer on their own terms, and sometimes they do it in ways that are surprising and inspiring to those whom cancer has not directly touched.
"My personal motto is: I have cancer but cancer will never have me," said Shanda Braithwaite, 32, of Richland. "I just look at it and go, 'OK. I have this diagnosis. I know what the doctors told me. The odds are not in my favor.' Right now I live a pretty normal life other than surgery. I take care of my kids. I work out. I play tennis five days a week when I can. I know I have this black umbrella over me, but I can't think about it. I can't live each day in fear."
Braithwaite has had a lot to overcome since getting her diagnosis of stage four appendiceal cancer in January 2010. The cancer had spread to many of her internal organs, and the treatment was a radical surgery that involved a major incision down her abdomen and removal of the abdomen wall so that doctors could wash her abdomen in 110-degree chemotherapy drugs to kill the cancer.
She has undergone the surgery three times, and in about two weeks will learn whether the latest surgery got all of her cancer.
"Right now I'm kind of in limbo," she said.
But Braithwaite isn't letting cancer rule her life. She said she stays positive and looks for the silver lining in each day -- even on days when that seems near impossible.
"There were some days I was literally on my death bed, just begging to make it to the next morning," she said. "I had to find ridiculously tiny things to keep going."
On Wednesday, it was the simple act of driving to Safeway on her own for the first time since her most recent surgery.
"I was excited to go somewhere out in the world. Those are the little moments I've captured," she said.
But the best moments are the ones she finds with her daughters, who are 8 and 4.
"Today, my moment was morning snuggles," she said. "I have spent so many nights alone in the hospital, to wake up with a little 4-year-old face -- eyelashes right up to mine -- I don't think the world can get any better than that. Fears just melt away."
One of the attitude shifts made by many people living with cancer is to savor each day or each moment of life, and to stop letting small problems or petty considerations affect their lives.
"Cancer really is a life-changing event -- most people think in a negative way, but it can be in a positive way," said Cindy Miller, community educator for the Tri-Cities Cancer Center.
"So many people tell me this is one of the most positive things that has happened to them. It is encouraging not only for me, but to be able to share with other patients. ... I think the public as a whole has this fear and anxiety about cancer, but those going through it have an amazing attitude," she said.
Finding ways to create a new normal after a cancer diagnosis is one thing Miller and the cancer center try to impart to patients during a five-week "Living with Cancer" class series.
"That is a constant thread when I work with support groups," she said. "People think they can get through treatment and get back to normal, but they find life will never be the same."
Kerbyson said the biggest change for her was confronting her own mortality.
"Everybody goes about their lives thinking, 'In five years I'll be doing this,' or 'When I retire, I'll do this,' " she said. "When you have cancer that totally goes out the window. You have to live every day as it comes. Every day has to be precious. I call it cancer mindfulness. You think so much more about what's going on around you."
Kerbyson first was diagnosed with ovarian cancer on Nov. 17, 2006. Her doctor told her at the time that she had a 15 percent chance of surviving five years.
"I'm pretty glad to be here," she said.
She went through treatment and was in remission for 10 months before her cancer came back and she had to fight again.
She entered an experimental clinical trial in Seattle, and her second remission lasted three years, but she said she never relaxed during that time. She never forgot that cancer could -- and likely would -- return.
"I've talked to other survivors and when they got to seven years, 10 years, they could stop thinking about it every day," she said.
Because her form of cancer carries a marker that doctors can track to determine if it is coming back, Kerbyson never had the luxury to stop thinking about cancer during her periods of remission. She would get a reminder once every three weeks whether the marker showed her cancer returning. Last month it did.
But cancer being part of her life doesn't mean it rules her life. Kerbyson uses visualization to calm her mind, and she writes. Some of her columns about living with ovarian cancer have appeared in the Herald.
And she formed a support network for other ovarian cancer survivors called Ovarian Cancer Together.
"If I'm helping other people, that helps me in my own healing," she said.
The support and friendship she has found in the group have been invaluable as she once again battles her own cancer.
"I feel I have some close friends I can talk to and share what I'm going through," Kerbyson said. "Even though I had it twice before, it was a huge shock again. You need some other people around you to pick you up off that floor again."
Braithwaite also uses writing and visualization to maintain hope through her treatment.
"For me, I have to picture what I want," she said. "I have silly sticky notes around my house that say, 'I'm strong, healthy and cancer-free.' I have to visualize what I want my life to be and keep going for it. I don't see it as my end."