At 41, Bryna Dilman was working full-time, married, parenting her daughter and finding ways to stay active eight months into a global pandemic. She was healthy.
In November 2020, she saw blood in the toilet one morning. It was surprising, but without any other symptoms or pain, she didn’t think too much of it.
“It was weird, but I thought maybe I’d cut something,” she says. “I mentioned it briefly to my husband who said, ‘that’s not normal, let’s keep an eye on it.’”
When she was still experiencing some symptoms later that evening, she reached out to a virtual care doctor who told her it was likely an internal hemorrhoid, but she should follow up with her family physician as soon as possible to get examined.
Her family doctor didn’t find an internal hemorrhoid, though, and booked Bryna for a colonoscopy on Nov. 23, 2020. During the colonoscopy, a doctor found that a cancerous tumour was causing her bleeding.
“I was waking up [from the procedure] and the nurse came to get me and said, ‘we’re going to go into another room. We’re just grabbing your husband.’”
Bryna says she still wasn’t thinking about a cancer diagnosis, but she knew something was wrong. She was sitting in a room, holding her husband’s hand, when the doctor arrived and informed Bryna they’d found a five-centimetre mass of cancer.
“I was just in shock. Me? This is impossible,” she says.
Bryna says the doctors were positive about her prognosis, but she wasn’t able to process that in the moment.
“I don’t think I understood anything beyond the word ‘cancer’.”
Getting a treatment plan
Her diagnosis began a whirlwind of CT scans, MRIs, bloodwork and other tests to determine what treatment she would need, which turned out to be five weeks of radiation before surgery to remove the tumour.
Radiation was scheduled for the week after Christmas, and her surgery for January 2021, both at Sunnybrook.
And amidst the tests and scans and bloodwork, Bryna was still trying to cope with a cancer diagnosis during a pandemic, which made it even more complicated.
“I had to call my parents [and tell them], and it’s a pandemic so they couldn’t come over and hug me. I think that was the hardest part; you couldn’t touch anybody,” Bryna says. “We decided to pull our daughter out of [in-person] school because there was no vaccine and we were very nervous she would catch COVID and give it to me. That was tough.”
It was an impossibly difficult time, but Bryna says the support offered to her from Sunnybrook throughout the process helped her immensely. Shortly after her diagnosis, she was connected to a nurse navigator who was available to answer questions and advocate for her prior to surgery. And she was also referred to Dr. Petra Wildgoose, clinic lead of Sunnybrook’s Young Adult Colorectal Cancer Program.
“The aim of the clinic is to address the complex and unique needs of young adults under the age of 50 who have been diagnosed with colorectal cancer, and the concerns they have to live with in the decades following that diagnosis, which is very specific to a younger population,” says Dr. Wildgoose, who runs the clinic alongside Dr. Shady Ashamalla, surgical oncologist at Sunnybrook.
Dr. Wildgoose provided care to Bryna throughout the process, answering questions, providing resources and offering support. Through the Young Adult Clinic, Bryna was able to connect with support groups and therapy for her and her husband, both pre-surgery and afterwards.
“I am forever grateful to Dr. Wildgoose and Sunnybrook for [connecting] us with these resources because the act of searching for them is more stressful than attending them, and I can’t imagine if this had been on me,” says Bryna.
Bryna’s surgery was successful. Dr. Ashamalla removed Bryna’s tumour on Jan. 13, 2021.
Life after surgery
Recovery had its challenges, from pain due to the incisions, to the realization that radiation had thrust Bryna into early menopause. And learning to live her life following a surprise cancer diagnosis at 41 was scary at times. But Bryna didn’t once feel as though she was walking that journey alone because of the support she had from Dr. Wildgoose and the Young Adult Colorectal Cancer Clinic.
Dr. Wildgoose referred Bryna to a fertility specialist when she was experiencing hot flashes following surgery. She’d been waking throughout the night with the flashes, clothes soaked through with sweat.
“[I got] estrogen patches and progesterone pills,” Bryna says. “We tested the patch numbers and what dosage would be good for me. But right away, my hot flashes stopped and I was able to sleep through the night.”
These are the kinds of concerns that Dr. Wildgoose says are specific to adults under 50 who have been diagnosed with cancer, and why the Young Adult Colorectal Cancer Clinic is so valuable.
“Discussing fertility preservation is very important. Radiation, for example, can affect sperm or cause premature ovarian failure [as it did for Bryna],” says Dr. Wildgoose.
Other concerns specific to a younger population are sexual health and identity, and concerns with body image because of scarring or treatments. And while mood is commonly impacted in all patients, in young adults it presents differently.
“Anxiety related to why this happened, to fears of dying before seeing their children grow up, and how they’re going to live the rest of their lives knowing they’ve had cancer,” says Dr. Wildgoose.
Living a ‘new normal’
In part thanks to the support from Dr. Wildgoose and the Young Adult Clinic, Bryna has been able to find what she calls a “new normal” following her cancer diagnosis and surgery.
“I’m living a normal life,” she says. Her family has recently moved to Guelph, where they have been able to enjoy activities like hiking and biking more frequently than they could in Toronto. “We can spend more time with our daughter and take advantage of life as much as we can.”
Following her diagnosis, Bryna began ensuring her family and friends were aware of the importance of cancer screening. She’s had family members go for colonoscopies and have polyps removed; they told her they never would have gone if she hadn’t urged them to.
“You have one life. Pay attention to anything that feels different or off, and check it out,” she says. “You’re in charge of your own body and your own life. You have to take control of it, and the only way to do that is to be aware and get screened.”
Screening recommendations from Cancer Care Ontario for colorectal cancer can be found here.