My Mom was just diagnosed with IDC. She is 82 and has dementia.

wascal

Her diagnosis isn't too bad considering everything. It is 9mm and is slow growing. Grade 1 and stage 1. They don't think it has spread to lymph nodes. It is er+/pr+ her2-. The surgeon says he would be comfortable doing a lumpectomy only and then hormone therapy.

My biggest worry is the general anesthetic. I know how much risk there is because of her dementia. She has worked hard to keep her quality of life the best it can be. The surgeon says it won't be a problem but we could tell a difference in her after a colonoscopy in April. He says he could do the lumpectomy under a local anesthetic but he didn't make it sound like something we would want to do

I am wondering if it is possible to have a consultation with an anesthesiologist ahead if time to see if there are other options. Talking to an anesthesiologist immediately before surgery makes me too nervous. Maybe an epidural type procedure would be possible? My Mom would do fine with the surgery (she says she is a tough old bird) it is just the general anesthetic holding us back.

rainnyc

We're going through something similar: my mom is 85 with dementia and is going through the diagnosis process for possible lung cancer. She did have minor surgery for something unrelated last fall and did fine. But yes, I've been told that any general anesthesia is something to be avoided.

I would definitely ask for a consultation with an anesthesiologist. We also have been working with a geriatrician who consults on my mother's other medical issue and has been extremely helpful with this sort of question. She also does periodic cognitive assessments so we can chart the course of mental decline; this does help us in our efforts to make plans.

Good luck to you and your mother.

Kicks

I think it's a good idea to have a Consultation with the anethesiologist prior to showing up for surgery. But even before that, I think it would be good to have a Consultation with the Drs who deal with her dementia and any other possible health issues she deals with. Those Drs might have some good input for the anesthesiologist regarding her potential issues.

It would seem to me that as she has dementia issues a surgery done via local numbing might become an issue during surgery. Has she seen the Medical Oncologist (Chemo Dr) yet? At her age and other issues, it might be possible to do an AI (aromatase inhibitor) as you say she is ER+/PR+ to keep it under control or possibly shrink it. It needs to be remembered that while Surgeons do deal with BC but they are only one part of the Team and their expertise is just that - cutting. The rest of the Team includes the Medical Oncologist and Radiological Oncologist who have expertise in other fields that are just as important for the optimum outcome as is the Surgeon. There may be other viable options than just jumping into surgery.

wascal

Thank you rainnyc. I wish you good luck and hope your mother will not have lung cancer.

Thank you kicks. We saw the surgeon last Thursday. The breast center sent us there first. He is trying to get an appointment for us with a Medical Oncologist...they unfortunately are a doctor short and backed up. My head knows we have some time to get this all worked out but my heart would love to have these appointments lined up yesterday.

I have learned so much from this community. I have read about AI and hope that will be a good option for us. The surgeon doesn't think that doing just the hormone therapy would be a good idea because in 6 months or a year we might find it has grown or spread and we will wish we had done the surgery. My thoughts are that in that 6 months or a year she would still be able to go to church, enjoy her yard and flowers, and play with her cats...enjoy her life.

We have lots of information to get yet. We haven't ruled out surgery but we need to get all the information we can before making a decision(as I told the surgeon).

Momine

Wascal, for what it is worth, I think you are thinking along the right lines. You are putting QOL at the top of the list, and I think that is completely reasonable given the parameters.

wascal

We have an appointment with a medial oncologist next Thursday. Hopefully he will give us some good news. Thank you all for your input. I believe it would be easier making decisions for myself rather than a loved one. It doesn't help that I am in Florida and she is in Indiana. I have racked up lots of miles in a plane for sure. We lost my Dad (who also had dementia) three years ago. Thankfully my brother lives with my Mom so she isn't alone.

MinusTwo

wascal - I hope you have a doc who knows something about old age and dementia. I can't imagine trying to do chemo with dementia. Or rads. Or even having anesthesia. Or trying to help someone with dementia understand why all the punishing treatments. Some of the side effects can be severe & long lasting. You don't have the diagnosis & treatment area filled out, but you might ask what the life expectancy is with OUT any treatment. Personally that would probably be my choice at 82, even with no mental impairment. I'm 73 if that gives you some perspective.

wascal

Thank you so much for all of your thoughts. We saw the MO on June 22. He said our concerns about the anesthesia were valid concerns. I just wanted to kiss him because the surgeon made me feel like I was being ridiculous. The MO suggested starting femara and doing another mammogram in 3 months and 6 months. He expects that it will shrink and then maybe we can have it removed with a local anesthetic. We can do the lumpectomy at any time if he feels that is best.

My Mom is pretty healthy other than the dementia and she would handle the surgery just fine if it weren't for that. The MO says if and when she has the surgery she will not have to have the lumph nodes removed or have chemo or radiation. He said her cancer is 95% plus curable which is wonderful news. The side effect of the femara he is concerned about with my Mom is the hot flashes. She had them really bad when she went through menopause. So we are keeping our fingers crossed that she can handle the meds and get this small enough to remove with the local. It is small (9mm) and slow growing now.

I had asked the surgeon if we could have a consultation with an anesthesiologist and he told me no because we wouldn't know which one we would have until time for surgery. I don't think 5 or 10 minutes before surgery is a good time to find out what a persons options are. The MO said before she has any surgery he would arrange for us to see an anesthesiologist. (Did I mention that I wanted to kiss him?)

I haven't been able to find much about experiences people have had with breast cancer surgery and dementia so I hope maybe what happens with us can help someone in the future.

Tappermom383

I'm glad you're getting some good answers.

May I say what a good daughter you are?

MJ

wascal

Thank you Tappermom383. Like I told the surgeon "She's my Mom". I would do anything I could for her.