While breast cancer is commonly associated with the presence of a lump, it is not always the case. Sharon Cassar Laudi tells Stephanie Fsadni how she discovered she had inflammatory breast cancer, a rare type of cancer where no lump is formed, and shares her long path to recovery.

Tattoos are not just a fashion trend. Many carry a meaning and are significant to their wearers: they may tell their story or represent important phases of their life... just like the pink ribbon that Sharon Cassar Laudi has on her left arm.

Sharon, 42, got it done a year after being diagnosed with inflammatory breast cancer, a rare type of cancer where the breast looks swollen and red, as if it were inflamed or infected, rather than forming a lump.

“I had never heard of this type of cancer before,” says Sharon, who has a rich family history of breast cancer: her mother and her four aunts all had the disease.

“For me, no lump meant no cancer.”

In June 2012, the mother of two noticed that her right breast nipple was dripping. She checked it out but was told it was nothing to worry about.

In April/May 2013, when she was actively going to a gym, she started feeling pain but thought it was muscular pain due to all the exercise she was doing.

“At one point the pain got so bad that I would go home and cry myself to sleep,” she says.

She also saw some dimpling around her right breast, like orange skin peel.

“I thought it can’t be I have cellulite in my breasts,” she quips.

She visited her gynaecologist for a check-up and was told that it was probably an inflammation, which can also cause redness, swelling and pain. Sharon did an ultrasound but nothing abnormal resulted.

She then went to a breast specialist who gave her the same answer and prescribed antibiotics. But apart from a severe reaction to these pills, the pain didn’t go.

This specialist suggested a biopsy called FNA (fine needle aspiration) which investigates lumps or masses just under the skin. Sharon had an appointment booked three weeks later but the results were inconclusive.

Feeling frustrated and needing answers more quickly, she thought it best to have a second opinion and she visited another breast specialist.

“As soon as I removed my top, this specialist told me: ‘Sometimes breast cancer presents itself like this’. And he repeated the phrase.”

Sharon was incredulous because she had no lump and she was in pain, whereas breast cancer usually presents itself with a lump and no pain.

I had never heard of this type of cancer before. For me, no lump meant no cancer

She was given an appointment thefollowing morning for an ultrasound-guided biopsy, where anaesthetic is administered and a thicker needle is used for a larger sample. Following that, she did a mammogram.

A week later, on September 5, 2013, she got the news that she was diagnosed with Stage 3 inflammatory breast cancer.

As her world came crashing down, Sharon hoped she wouldn’t have to go through chemo because her mother didn’t have to and that she wouldn’t need surgery.

“I thought I had caught it right in the beginning, so I had higher chances of being treated successfully without chemo and surgery. But I was wrong.”

By the time she was diagnosed, she had developed microcalcification extending over a distance of five centimetres.

“I was very angry, because it had been almost two years since I had noticed that abnormal nipple. Had I been diagnosed before, the cancer would not have progressed so much,” she laments.

As treatment, she started with neo-adjustment therapy, where one is given chemo to shrink the tumour as much as possible. She did a number of tests, including MRI and various blood tests and in September 2013 started the chemo sessions.

Through the advice of her oncologist, she had a portacath inserted.

A portacath is a small medical appliance that is installed beneath the skin and where a catheter connects the port to a vein. The port has a septum through which drugs can be injected and blood samples can be drawn many times. It requires an operation by a heart surgeon.

“For me it’s the best invention ever,” Sharon says, pointing to what she calls ‘a battle wound’ rather than a scar on her chest, where the device was inserted. “It is less discomforting than having a needle inserted each time.”

When it came to start the sessions, Sharon admits she was petrified. She walked into Sir Paul Boffa Hospital accompanied by her husband Mario and her sister-in-law Rose holding her hands.

“You have this ugly disease, you’re scared and you need to go for treatment in this very old and ugly environment,” she says, referring to Boffa Hospital, which has since ceased operations as an oncology facility.

“But as soon as you reached the Oncology Day Ward and saw the faces of the staff – the doctors, the nurses, the medical assistant and even the cleaners – you forgot about the ugliness of the place.

“These people would move heaven and earth to make their patients feel comfortable. They were so nice and sensitive to our needs.”

Sharon had two types of chemo: FEC (a combination of three chemotherapy drugs), which affected her stomach, and Taxotere. Two days after taking the latter type, she would become paralysed from the waist down, so she would need help for every little chore, like taking a bath.

She remembers that in Christmas that year, she broke many things because she couldn’t pick anything up with her hands as they were numb.

‘I am strong, I will survive’

But one of the things that bothered her most was her hair falling out.

“My hair is really a part of who I am,” says Sharon, who worked as a hairdresser until some years ago.

She regrets following everyone’s advice to cut her hair extremely short after the first chemo session.

“It was inevitable that my hair would fall out but I feel I was robbed of my hair by a couple of weeks.”

Sharon finds it hard to explain this feeling but says that “when you’re in such a situation, you latch on to the most insignificant things”.

“One day my husband returned home to find me weeping and saying that I miss my hair.”

If you notice anything you don’t like, check it out. And make sure you’re happy with the reply you get

But she jokes that it’s a good thing she changed jobs: “Imagine myself styling other people’s hair, while I’m picking mine off the floor!”

Two things she wasn’t prepared for was that the eyebrows and lashes fall out as well. Also, she didn’t know that it hurts when the hair falls out.

“It’s not falling out naturally but sort of forcefully from the bulb,” she explains.

Her husband was indeed a shoulder to cry on and would make her laugh even in the most difficult times.

Her sons, Steve, aged 21, and Mark, who is about to turn 20, were also very supportive. The eldest one focused on house chores like cooking while the younger one would tend to his mother’s every need.

“What was heartbreaking for me as a mother was that my children had to grow up overnight,” Sharon says, as her eyes redden.

She recounts an episode when she went to a mini-market near her house wearing a cap but not her wig. Her younger son accompanied her.

“At one point I felt like everyone was looking at me and I couldn’t concentrate on what I needed to buy.

“Mark sensed my discomfort, and told me: ‘You should be proud because you’re fighting it head on’. That was truly encouraging.”

Along the way Sharon received a lot of support from her immediate and extended family, friends and colleagues, as she kept her full-time job. At hospital she bonded with the other patients, most of whom were women.

“A sisterhood developed and they made the chemo sessions less daunting...”

She says that in such situations, one realises whose one true friends are: “Many don’t know what to tell you but they text you anyway, while I never heard from others when this ordeal began. I don’t call these friends anymore.”

The chemo worked well and the tumour shrank so much that the doctors couldn’t see anything after her last session in January 2014.

However, mastectomy wasn’t an option for her and the following month she had to undergo surgery and inserted what is called a tissue expander, that is an empty breast implant. In April, she started radiotherapy sessions and took Herceptin, an intravenous medication used to treat breast cancer.

The following November, she removed the expander, had an implant done and she made the difficult “but right decision” to have prophylactic mastectomy on the left breast, to reduce the risk of developing breast cancer again. Last May, she had some more reconstruction surgery.

Nowadays, Sharon feels a mix of emotions.

“Different days and situations call for different emotions. There are days when I’m okay with it and days when I’m angry as it’s still ongoing. Although surgery has been a success, I still feel I’m a cancer patient.

“Some days I’m sad and ask myself ‘why did this happen to me when my life was perfect’. I could be driving to work and a song on the radio would come on or I’d see a writing on some billboard or truck that would trigger a weep...

“When this happens I use my Bluetooth to call my husband, my mother or friends to take my mind off it.”

One thing she cannot take anymore are jokes about boobs.

“It upsets me too much,” she says.

Sharon would advise everyone to take a good look in the mirror.

“Breast cancer does not discriminate against gender, race or creed. If you notice anything you don’t like, check it out. And make sure you are happy with the reply you get,”she recommends.

She has a daily mantra: “I am strong, I will survive.”

“It may sound trivial but it really helps,” she claims.

And when she’s having a tough time she looks at her tattoo.

“I purposely had it on my arm to make sure I can see it. When I’m down I look at it and think I’ve been through hell and back, I can do anything.”

Once she finishes the daily medication and the reconstruction surgery is over, she intends to get another tattoo done.

“When I truly feel I won my battle, I will add the word ‘survivor’.”