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

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.

Teaka this must be among the most miserable weekends you've ever spent. I'm so sorry.

The only advice I can offer is not to jump the gun. Sit tight and wait until you have more certain information about what exactly your poor MIL is facing; and make today as pleasant and light-hearted as you can. If it does turn out to be bad news - prepare for the worst, hope for the best - you will all know soon enough; so while I know this is easier said than done try to put the worry aside so that at least you can enjoy the moment.

If your MIL decides she does want to talk about it, though, that's different. But all the same the only truthful answer you can give her, to just about every question, is "we don't know yet." I hope her bladder is more comfortable today, anyway - that's all she needs, poor love.

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.

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.

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.

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.

Babalou I hope this was just abad experience especially at midnight. Did they find anything?

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 agree with Veronica91 above. Don't worry until you get exact answers, none of the "I think" or "I believe" stuff, I would want results that know for sure. Then one can plan the attack.

If it turns out the lump is cancer, then find a surgeon who is a "breast cancer specialist" not just a general surgeon. Your Mom-in-law will feel much better with a woman specialist [unless she is of the mind set that only men are good doctors, my Mom was that way].

If the cancer is only in the breast, then a mastectomy is recommended, then that way one wouldn't really need chemo, maybe radiation or not. But radiation would also be difficult on an elder because their skin is now so thin. There are pills that one can take, but the side effects aren't user friendly.

Believe it or not, mastectomy is now an out patient procedure. If your Mom-in-law has this surgery, make sure there is someone at home to do full-time caregiving because it usually takes a week to get back up on your feet. One can barely walk the first day back home.

Hopefully immune therapy is on the rise for this cancer, where one is given meds to boost the immune system to fight off the cancer.

Emergency room doctors did physical exam, x-ray and ultrasound. From everything they saw they said it "supports a cancer diagnosis". We will see her primary care doctor (from her AL facility) today or tomorrow. He will do a referral for the local and excellent cancer care center. I do not know what type of testing would be done next. I do know that her verbal and legal written wishes are to provide comfort care only and we have always agreed with that. Based on that do we do any testing? So if the testing shows cancer it would not change anything really. We would know and have an idea of what stage it is at, but I don't know what else. Does a biopsy testing mean a lumpectomy? A mammogram my not be possible with a fist size lump? I can't see putting her through a lumpectomy when it will not change what direction we take when we get to a fork in the road. I greatly appreciated all the responses as this is all new to me/us and I do not know medically what I write of.

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.

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!

Depending on what else is going on with your MIL it might be best to do nothing.
If she has any type of dementia the anesthesia will be difficult for her.
Recovery and rehab will be difficult
Treatments will be difficult.
It might be best to leave it alone and provide comfort.
After you talk to the doctors and get all the options it might be determined that Hospice would be the best thing for her at this stage.
Ask the doctor one extra question..."If this were your Mother or Grandmother what would YOU do given the same circumstances?

I think that if the mass is painful for her, it should be removed--but with the understanding that there is to be no chemo or radiation even if it is cancer. Since it appears to have come up rather suddenly, it probably isn't cancer but a cyst. But only a biopsy or examination of the tissue will tell.

teaka123, a biopsy is required to find out what type of breast cancer, there are 6 common ones. Depending on what type of cancer would be what type of treatment would be recommended.

MIL is scheduled for an appointment at the Cancer Care center on Monday. We will get more information then. She has blisters under her right breast (not shingles which she had in July and involved the left breast) and a fist sized tumor. Thank you for your caring and supportive responses.

Teaka, good luck to you and your MiL gettings answers to all your questions tomorrow. Thinking about you!

Start by making a complete list of medical history items, surgeries with dates, medications and vaccinations and illnesses with dates of occurrence. Be sure they are away of the shingles and dates of flare ups.

Teaka, good comments from the others; most say don't let the doctors frighten or stampede you into surgery, chemo, radiation.... my poor mil, only 73, had surgery and chemo 10 years ago and says she would never have done it if she had known how awful it would be; chemo did all kinds of bad things to her .... can't imagine someone of 86 dealing with any of it, and perhaps she won't.

Hi Teaka
My GM had Breast cancer when she was about 83. She had her breast removed. No radiation. No chemo. She died at 89 of bronchial problems. She was no stranger to cancer in her family and made what was a good decision for her situation. This was back in the 80s. A lot of progress has been made in treating cancer but my concern would be with the quality of her life after whichever treatment is offered. Make sure your MIL signs the appropriate paperwork for information to be released to you so that you are able to communicate on her behalf as needed. Hopefully all the ER records have been forwarded.
Let us know how you and she are doing.

So appreciate all your support. MIL had an ultrasound, core biopsy (took 4 or 5 samples), and a diagnostic mammogram. Radiologist confirmed it is cancer and it is in her lymph nodes and the blisters/ulcers are cancerous nodules in her skin. The tumor is 6 cm! Results should be available in four days and we will then have an appointment with the breast care team including oncologist. The seriousness of this is lost on her - this has always been her personality, but with age more so. We hope the tumor does not rupture between now and the next appointment. My thanks for your suggestions, personal and professional insight, and kind words.

Teaka, thank you so much for the update. Sounds serious, but it also sounds as though she's in good medical hands. Keep coming back here; you're in good hands here, too, I think.

That's something to be grateful for, that it's all going over her head, don't you think? As long as she really isn't frightened, and isn't just putting on a brave face. How is the rest of the family coping?

Teaka, was the cancer staged? I.e., Stage I, II, III, IV??

I am sorry to learn of this diagnosis, but agree with CM, and applaud you for being on top of the situation and participating actively in this stage of her life.

Teak if the cancer is far advanced and it seems to be with the involvement of the lymph nodes, the surgery and subsequent chemo would be very hard on her and take many months of recovery. They can just do simple R?T which will just shrink the swelling and make her more comfortable and let nature take over from there. don't pressure her into something she does not want to do and make sure she really understands the risks of the treatment. Drs can be very persuasive especially if they think the fact that you are seeking proper diagnosis means you are wanting treatment. We all have to die sometime and maybe this is what will kill her and maybe it will be something else we just never know, but honor her wishes.

Teaka - lymph nodes involved, right? If the surgical oncologist & the oncologist are thinking that there are likely to have a lot of lymph nodes removed, please try to get insight as to whether MIL is likely to have lymphaedema. If so, it can be chronic and debilitating all on its own. She will be hopefully cancer free but the lymphaedema can be a daily battle & doing her ADLs most difficult. The swelling may not be there right away. If she needs daily PT, OT or massage to get it manageable ask her current AL what services can be done. She may need to move to skilled nursing care.

Lat stage breast cancer with lymph nodes removed have lymphedema about 1/3 of the time in upper arms, chest, neck. Melanoma has the same issues with lymphedema as the sentinel nodes get removed proactively now. It's a side effect that tends to be glossed over IMO.
You can google Kathy Bates lymphedema for articles on it.

Igloo makes very good points about the possibility of eventual lymphedema if the lymph nodes are affected, and might have to be removed.

I saw my aunt suffer through lymphedema, even though she never had cancer. I made a resolution that whatever may eventually happen during the rest of my life, I won't give up my lymph nodes!

Update. Cancer is stage 4. She has it in breast, lymph nodes and skin (ulcers on and under breast). She has had core biopsy and a CA15.3 blood test which confirmed cancer other places in her body. CEA blood test positive for cancer in liver. MIL will start Letrozole to stop or shrink tumor. Have not met with oncologist yet, but met & spoke by phone with nurse practitioner. I am very concerned about two things the nurse said given that my MIL is soon to be 87. One, when my husband asked the nurse about hospice, but she said MIL's life expectancy is more than 6 months - so no referral. Two, nurse said the side effects to the medication were hot flashes and possible bone density issues. Mil is monitored for kidney function problems already and I understand that this medication can effect kidney function Any thoughts on my concerns and any suggestions for things we should be asking?