Elderly mother recently diagnosed

tdisibio

Elderly mother recently diagnosed

tdisibio

Hi everyone,

My grandmother (really a mother who raised me) was recently diagnosed with breast cancer. Unfortunately when she went to the doctor and received her diagnosis she was alone and didn't ask any questions. I live in Dallas which is about 3 hours from where she lives. To her the only options that were presented at the time of diagnosis were lumpectomy and mastectomy and she has chosen to do the mastectomy. We have never dealt with breast cancer in our family and I am kind of clueless as to options for her. She is 76-years-old and isn't in the best of health. She is cognitively fine but her motor skills are on the decline and she currently lives with COPD which almost killed her at the beginning of March when she was found unconscious due to respiratory distress. I am concerned about her going into surgery and the stress the recovery will put on her. Granted I know nothing about the mastectomy procedure and how invasive it is or how hard on the body it is. Next week she will come to Dallas to meet with her surgeon and I am hoping we get more information. I don't know the stage or size of tumor? I am wanting to learn as much as I possibly can about treatment options and questions to ask with the doctor before we just jump into surgery. 

Any help out there would be greatly appreciated and any resources give I would love as well.

Thank you so much

Moderators

Understanding your cancer and questions to ask your doctor

Dear tdisibio, We are so sorry to hear of your grandmother's cancer diagnosis. In addition to the support and information you may receive here you also may want to click the link above which may offer you and your grandmother information and questions for the upcoming appointment. Also check into the forum specifically for caregivers Caregivers where you will find support from other daughters, granddaughters and resources for yourself as well as your grandmother. Good Luck and keep us informed. The Mods

duckyb1

T..............Not sure if I can help but just a little bit of information........

I was 76 when I was diagnosed with BC........It came as a shock, cause some how I thought I had dodged that bullet............I had a mild heart attack in 2007, so BC in 2011 kind of put me over the edge.........just to let you know what i did...

This is the worst part of it all....just finding out..............the initial shock, and the reality "oh boy I have cancer".....first thing you think is "Ok I'm gonna die", or if the cancer doesn't do it, the treatment will..........well that was further from the truth then I imagined.

Once you see your BS, get a plan going, have your biopsy done, and find out exactly what your dealing with.....honestly....it becomes easier................I went into the BS office after diagnosis for a consult, with full intentions of having a mastectomy........."take them both I said....I am not dealing with this again"............well that too could not have been further from the truth...............after a 2 hour consult with my 6 children with me.....I went home sat around the table....talked and said "lets go with the lumpectomy............which I did.......

My BS set up appts with a Medical oncologist, a Radiation oncologist, gave me a date for my biopsy, and at the same time a date for surgery...............I met with each of those Dr's before surgery, and on the day I was operated on knew exactly what the next steps would be..........I felt so relieved......

Surgery was a lumpectomy, with the sentinel node being checked for cancer also..which turned out to be negative no node involvement, which means it did not spread.........I went home the same day.....with a drain, which was more of a nuisance then anything else.............that was it......no pain, no pain medicine, I felt great..............

6 weeks later I began Radiation.......received 38 treatments which went extremely well .......you go everyday Monday thru Friday till  you are finished....each persons amount of treatments is different........I had no problems..........not one....other then it does cause you to get tired, but that was it...........

There was no chemo.......all I take is 1 pill every night for 5 years...........I will not lie, that pill is the worst part of the entire thing.......I get joint aches and pains and I take that because my cancer was "estrogen positive"..................

So I am not sure if I have helped at all, but anything you need to ask you can PM me,, I don't mind..............I too am a grandmother of 18 and a great-grandmother 4 girls............

The good news is my tumor was not large, even though it was IDC.....Invasive Ductal Carcinoma......it was smaller then the BS thought.....being only 1.2 cm.......if not for the aches and pains I would be great, but then I refuse to take pain meds, so I am partly to blame....just don't want anymore medicine..........by the way.........I also have Asthma.............

Good luck whatever decision your grandmother makes, and she is fortunate to have you hugs.......

duckyb1

T............when you said elderly I thought.............ok probably way too old for me to give advice too, I was only 76 when I was diagnosed..................when I said "my grandmother is 76", I thought...............ok I guess I am in the elderly bracket too............LOL....]

Guess I never looked at it like that....................and I don't get around real easy either, but would if not for the aches...........but I do whatever I can, and I do live alone..................just saying........LOL

duckyb1

T............when you said elderly I thought.............ok probably way too old for me to give advice too, I was only 76 when I was diagnosed..................when It said "my grandmother is 76", I thought...............ok I guess I am in the elderly bracket too............LOL....

Guess I never looked at it like that....................and I don't get around real easy either, but would if not for the aches...........but I do whatever I can, like today I went to BJ's which is a warehouse store in our town, and did just fine..........and I do live alone..................just saying........LOL

farmerlucy

An 80 something friend of mine recently was diagnosed with BC in a couple of places. She had a lumpectomy, and even that surgery was quite tough for her. She developed secondary pneumonia. It took her quite some time to recovery from that. She is not doing radiation or hormonals, so she is good to go now.  A mastectomy with no reconstruction is certainly easier than one with reconstruction, but a lumpectomy is much easier than either one. Best of luck to both of you!

Infobabe

Exactly how old is your grandmother?  People have vague ideas about what age is old.

I, too, was 76 when diagnosed.  I did have a lumpectomy and finally did refuse radiation.  I intended to have a mastectomy but found it wasn't necessary.  So 2 years later, I have clear follow up mammograms.

Every one is very different especially with this disease.  I don't expect your grandmother will follow my path but my point is, things are not as black as they appear.  The COPD is a complicating factor that her doctors will take very seriously.

Try to go with her to the doctors office.  Be sure to get all pathology reports including biopsy, lumpectomy, or any other surgery.  You are not entitled to them but your grandmother is.  Your grandmother can authorize you to receive copies.  You really cannot make any informed judgements without them.  Be prepared with questions and take notes.  You will need to know, Stage, grade and size.

She is very lucky to have you.  Come back here and we will help too.

tdisibio

thanks everyone for the responses. She has already had her biopsy but the doctor didn't really give her much information. Wednesday we go to the surgeon for a consultation where I will make sure we get ll of the information before moving forward with any decisions. So I guess my next question is what are the things I need to know. I actually have lupus so I know how important it is to be your own advocate in the health system. So I guess it's important to know the stage, tumor size, and what else should I mKe sure I know? Thank you for all of the help! I feel so ignorant to this process.

Infobabe

That is what you need but get a copy of that pathology report.  Your grandmother is legally entitled to it and she can authorize you.  All the more so since the doctor was not too forthcoming with information.

Kicks

'Old' is not an exact number of years anyone has lived. One of my GMothers was OLD at 50, other was not old at 96 when she died.  I'm 67 and I can do a lot more than many 1/2 my age.

What type BC is she?  TX plans differ greatly with the different types (LCIS/ILC/DCIS/IDC/IBC).  Individual health is a big 'thing' that comes into play.  Even with a very healthy body, TX is hard on it but with already compromised health, it can be BAD.

As much as you love her - bottom line (unless you are her Legal Guardian), any TX is her decision.

Annette47

My mother was diagnosed at 75 with early stage, but multi-focal disease.  She was offered a lumpectomy but there wouldn't have been much left, so avoided radiation by choosing a mastectomy.  She chose not to reconstruct because as she put it, "they don't make saggy old lady implants" so she would have needed surgery on the other side for symmetry, which was more than she wanted to go through.  Similarly, a flap procedure would have been too much for her.    She had a relatively easy and uncomplicated recovery and now, over a year later is doing quite well.    She does have high blood pressure, but no breathing issues.   Your grandmother should be sure to discuss her COPD with the anesthesiologist no matter what surgery she chooses to select a technique that will work for her.   One of my friends had a mastectomy (with delayed reconstruction) using a spinal block similar to what they gave me for one of my c-sections - the block was just put in higher up her back than mine.   Point being, there are options, and hopefully her medical team can figure out what will work best for her.

Infobabe

Of course it is the grandmothers decision, but she needs a strong, informed advocate.

tdisibio

I'm going to get her to get her pathology report Monday and bring it with her to doc Wednesday 

Thanks again everyone

vbishop

T - 

Final path report won't happen until after surgery.  It is not uncommon for the final pathology report to differ from the biopsy in regards to tumor size, number of tumors, etc.  Staging doesn't happen until the final pathology report.  I would be surprised if doctors provided her with stage prior to that (tumor grade - yes, staging - no).

I agree with others that mastectomy w/no reconstruction seems a far easier path than lumpectomy and radiation (I have not heard of any lumpectomies without radiation...and its the radiation that makes it a harder surgery, in my opinion anyway).

Bottom line, talk to the doctors, listen to your gut, and hang on.  The next few weeks will be a roller coaster ride.  There is an end to the ride once surgery is over, final reports are in, and final treatment plan is in place.

Just know that more and more women are living active lives with breast cancer!

encyclias

Annette, I love your grandmother's line: "they don't make saggy old lady implants."  That is exactly what I have been saying if I find I may need a mastectomy in the future.  Wouldn't even consider reconstruction.

Sending best wishes for grandma to kick this cancer to the curb.

Carol

voraciousreader

For older women, according to the NCCN guidelines, radiation following lumpectomy should be considered and is not absolute.

ruthbru

I found this article in the BCO research archieves.

Some Older Women With Hormone-Receptor-Positive Disease May Be Able to Skip Radiation After Lumpectomy

Published on January 28, 2014 at 5:22 AM

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In most cases, the usual treatment for early-stage, hormone-receptor-positive breast cancer is lumpectomy to remove the cancer followed by about 6 weeks of radiation therapy (you receive treatment 5 days per week) to destroy any cancer cells that may have been left behind after surgery. This two-step approach reduces the risk of breast cancer recurrence (the cancer coming back).

But in 2004, this treatment approach changed for older women. Large studies showed that while lumpectomy plus radiation did reduce the rate of recurrence among older women, it didn’t improve overall survival. Overall survival is how long the women lived, whether or not the cancer came back. So the National Comprehensive Cancer Network modified its treatment guidelines: radiation therapy became optional for women ages 70 and older diagnosed with early-stage, estrogen-receptor-positive breast cancer who take hormonal therapy medicine for 5 years or more after lumpectomy.

Doctors then wondered if certain postmenopausal women younger than 70 also might be able to skip radiation after lumpectomy. They also wondered what the rate of recurrence was among these women who skipped radiation.

New research suggests that the rate of recurrence among women 65 and older diagnosed with early-stage, hormone-receptor-positive disease who are taking hormonal therapy is low; these women may be able to skip radiation after lumpectomy.

msphil

I was the first in my family with breast cancer, I have 3 other sisters who I make sure they get their mammo yearly, she needs someone to go with her and take notes, to get all info from doctors and even a second opinion also. msphil(idc,stage2, 0/3 nodes, L mast, chemo and rads and 5 yrs on tamoxifen) 

tdisibio

Thank you again everyone. I got the report yesterday. I am preparing my questions and now all we do is wait until appointment in the morning. On a positive note my grandmother is feeling well and is in positive spirits. She has been through a lot this past month. I hope we can some positive news. I am thinking it will all be ok. She is such a special lady and 33 years ago she gave up her life to raise me and I was difficult at times so now it is my turn to take care of her and make sure she gets the best possible treatment. She is a wonderful, strong, stubborn and amazing woman who I know will come out on top of this. 

Thanks again to everyone for the support and help

Infobabe

So glad you are making progress.  I can see you are so much more confident that when you started.  You really seem like you have a handle on things and it shows in your grandmother's attitude.  She is so lucky to have you.

ruthbru

Stubborn is a definite plus in this situation! Let us know how the appointment goes.

tdisibio

Well we had our appointment and our next step is evaluation with cardiology and pulmonary doc to determine if she can even receive general anesthesia to have surgery. Doc wants to determine that and then we will re-discuss options in a week or so. She was not impressed with her medical history. My grandmother has COPD and her lungs are pretty diminished. It sounds like she is hoping we can go in and remove breast but she is doubtful about getting lymphnodes to test. And if we can't do anesthesia we will just have to do local anesthesia and just get the tumor. And then do the hormone therapy. I think my grandmother has come to the conclusion already, though she hasn't admitted this to me yet, that she would rather just risk the surgery and if she doesn't make it then she will pass in her sleep and be unaware anyway. I want my grandmother to have whatever she wants. I really don't think she would make it through surgery. She just coded at the beginning of March and is still very weak. But I guess we will know more in a few weeks. THank you again to everyone.

Tamara

Infobabe

Tamara, I am 78 and I totally understand how your grandmother feels.  When quality of life is so diminished, you just want to quit fighting.  You are doing all you can.  

When all the info is in, it will be up to your grandmother.  I don't know what risks the doctors are willing to take, but I hope your grandmother gets her way whatever it is.

ruthbru

My mom had COPD, so I know how daunting it is to make medical decisions in that circumstance. My thoughts & prayers are with you guys during this difficult time.

bevin

HI there, I wonder if  your grandmother is likely wanting masectomy as that is the treatment that was standard of care and that she is familiar with from when she was growing . There are  that show lumpectomywith radiation is as successful as mastectomy. They also state that for some, mastectomy can be a worse outcome.  As you know its a big surgery and with your Grandmothers co-morbidities thats a big surgery with far greater risk attached to it.  My loved one had COPD and did need surgery for a different reason. The COPD was extensive and we did need to find a anesthesiologist who was experienced in dealing with the level of disease he had.Here is the article for your perusal on success of lumpectomy vs masectomy and the outcome.  I wish you luck. Its so wonderful you are helping your grandmother.

http://www.medscape.com/viewarticle/778276

ruthbru

If she is at the end stages of COPD, another choice would be to do nothing. Any surgery at that point is very dangerous and extremely problematic to recover from (speaking from my mother's experience with an unavoidable surgery...she broke her hip). If she does opt for surgery, a lumpectomy under the lightest anesthesia possible, and no future treatment would seem to be the choice with the best chance of survival. (Of course, I am not a medical expert, this is just my opinion from helping out with my mom.)

Infobabe

I agree with Ruth.  Could this poor woman tolerate rads which have a good chance of hitting the lung?  Chemo?  This is why it is important for this to be the grandmother's free choice with no pressure from well meaning others.  I doubt the doctors will be up for heavy duty treatment either.