Mother-in-law (86) diagnosed with breast cancer. What things will we need to be certain to ask?

First cancer treatments are changing all the time and secondly they grow very slowly in the elderly and I believe 86 is elderly but I may not agree in another 8 years .
There is no basis for making assumptions about the nature of a lump. She needs a mamogram ultra sound, biopsy, CT scan or MRI or whatever combination of the above they choose to do. Some of which may make her anxious but are not intrusive in them selves except the biopsy which will be done with a needle under local anesthetic and she will only feel the initial prick no worse than an injection. If she is willing any of these procedures will cause her minimal distress and at least you will know the answer and can go from there. All are outpatient procedures.
Once you have an answer MIL can decide where to go from there. They can do a simple lumpectomy, a radical mastectomy, R/T and Chemo or any of the above.
Cancer when confined to the breast is rarely painful so that is a good sign. Oncologists are very aggressive and always predict the worst.
Any major surgery has significant risks both from the anesthetic and the actual operation. At 86 it could take 6-12 months to recover. Does she want to waste a year of whatever time she has left. As it is so painful she may have a simple abscess which is easily treated with antibiotics.
Try not to think of the worst and get other opinions if it proves to be cancer. If MIL decides to do nothing which is her right and may be the sensible thing to do please support her decision. As was said above don't do the tests if you are not going to do the treatment and above all don't panic, she does not need to go for surgery this week. Give her and yourselves time.

At this point the doctor (oncologist?) and others who reviewed the tests "believe" it's a cancerous mass, and "believe" it's aggressive.

I wouldn't make any decisions until the tests have been reviewed by an oncologist. An outpatient biopsy might be recommended, and that would be more determinative of whether the cancer is an aggressive one, and what stage it is.

Then you can make decisions whether to proceed with treatment, if at all.

Chemo and radiation are absolutely horrible on anyone, and would be harder on an 86 year old woman. If the cancer is aggressive, and is in a later stage, it would be unkind and not fruitful to put her through the slash and burn regimen of treatment.

In the meantime, research Gilda's Club and CURE magazine online to see if you can find a local Club which will offer support groups for your family, and the magazine to look for articles on similar situations - knowing how others proceeded might help you in making this tough decision.

If it were me, unless the cancer was stage I and the treatment was merely medicine (no slash and burn), I wouldn't consider putting any of my family through the hell of chemo, radiation and/or surgery.

I'm so sorry
Waiting and worrying is hard but it seems you MIL is not yet worrying which is the most important thing
If you have a referral to an oncologist from the hospital then I'd suggest getting a notepad that you can take to the appointment - write down a few questions before the appointment and try to take notes during the appointment if a lot of information is thrown your way

Thank you. I'll be prepared with a pad & pen - good suggestion.

Years ago, a very wise geriatrician told me " don't do the test if you're not going to do the treatment". ( this was in reference to my mom; they'd found some suspicious cells in a chest tap and wanted to do a bone marrow biopsy. She was 90, with dementia. We declined. The oncologist was horrified. Mom is still with us 4 years later).

Would your mil be able to cope with radiation, chemo, mastectomy? How will they determine if this is cancer and what stage? Can the biopsy ( if that's what they need to do be done in the hospital and not outpatient ( i would have opted for leaving her in the hospital, but that's another story).

Does MiL have dementia? Can she make treatment choices?

That would be my list.

To clarify...it wasn't at midnight. I was NPO after midnight, meaning nothing by mouth after midnight.

"Just" calcifications which they removed. Interestingly, in the same place my mom's breast cancer was. So i feel blessed and lucky. But this was not a " nothing" procedure...and lest you think I'm a weak sister, I've had three unmedicated childbirths.

I would not put a patient with dementia through this outpatient.

I'm so sorry to hear your MIL received bad news by way of a lump in her breast. Getting this sort of news over a weekend is the pits! As others have said, arm yourselves with good questions, by doing some research over the weekend, look up breast cancer in the elderly and even more specific in your 80's and 90's, and go from there. It sounds like your MIL is a strong and independent type, and this will only work in your favor as time goes forward. If comfort care is all she is interested in, they still may recommend a lumpectomy if the site continues to be uncomfortable, and that might be enough to earn her several more years, at this point, you never know, and you should try not to get ahead of yourselves, thinking the worse, which is easier said than done. I'll be praying for a kind outcome!

Veronica, i had a needle biopsy as an outpatient about 18 years ago; they put me in a mammogram machine after having me come into the facility npo after midnight. By the time they got me in, it was 11 am. After compressing my breast, they placed needles to indicate what the surgeon was looking for. I passed out while in the machine, i guess from dehydration and anxiety. THEN they decided to give me valium.

Whenever i go to this facility for my annual mammo, i ask if anyone is there for a needle biopsy. If there are any takers, i tell them to get their valium before the procedure.

I would not have this done outpatient on an elderly patient.

If they've done an ultrasound they shouldn't need to do a mammogram. The biopsy, I'd guess, would be a needle biopsy and shouldn't be too uncomfortable (I think Veronica's already described that, hasn't she).

Comfort care might include minimal surgery. I don't want to be too graphic about it, but if there is an aggressive tumour in your MIL's breast it could all get pretty miserable and gory long before it sees her off - and in that case, it would be greatly to her benefit to be treated surgically even without any expectation of a cure.

I'm doing exactly what I said not to do: getting ahead of the information. I hope your MIL's primary care doctor is able to gee the local centre up a bit and get her seen there quickly. Please keep us updated.

If your MIL is able to make decisions, what does SHE want? I just had this exact conversation with my mother (86). She said, "If I get any kind of cancer at this stage of my life, I am not doing a single thing to treat it." I said, "Ok, thanks for letting me know."
At some point, the TX is far worse than the extended life they're given. My FIL had CLL (a type of leukemia). He lived 10 years past what he was told he would--but he aggressively treated everything. At the end of his life, his oncologist told me his blood looked like water, he had so few red blood cells. He was planning to do another chemo round--but his dr just said "Pal, you KNEW someday we'd get to "that point" and we're here." Dad just feared death so much, I know he fought it tooth and nail. We respected that he fought so hard. His last couple of years were awful--but he was alive and that's all he cared to be.

Honor your MIL. I hope you can find out what she wants to do. If she cannot aid in her own decision making and recovery, it will be really, really, hard on everyone. Obviously, of course, her first.
Be aware some drs are going to be "pull out all the stops" on every patient, and some are more "quality of life"---I wish you well in dealing with this.