Double Mast @75yrs w/ bone met: risks?

[ezap]

My 75 yr old mother is presently booked for a bilateral mastectomy and sentinel lymph node biopsy for a week from today (July 17th) which is scheduled as an outpatient procedure. She is apprehensive (terrified actually) about surgery and possible secondary health set backs; at this time she is fully functional (other than some impairment from arthritis).  I am not sure what to advise her and no one has discussed treatment options and/or expected outcomes of a) proceeding with full surgery, b) a surgery of reduced scope, c) no surgery or d) other possibilities.  Could someone please kindly review her case and advise?

My concern is that  if her the surgery it is not curative, but rather the first in a long list of painful and debilitating medical procedures from which she may never fully recover (due to her age etc), the quality of what is left of her life may be considerably diminished. I feel we don't have enough data to make an informed decision.  

Biopsy results: somewhat unusual in that they found 2 different types of Infiltrating Duct Carcinoma (IDC) in each breast. The tumor in the right breast showed cells with progesterone and estrogen receptor involvement and the left breast was triple negative and is presently breaking through the skin.

Staging tests: Bone scan report indicated “extensive metastasis” in her sternum that is worrisome. Ultrasound and chest x-ray were clear.

Note:  It is only because I requested and read the bone scan results that we learned about the metastasis to the sternum - no doctor has talked to us about metastasis and a prognosis. From what I understand, once the cancer has metastasized to the bones it is incurable and therefor has significant implications re: prognosis and treatment options. Is this right?

Possible complications: With increase stress of testing and news of cancer, her blood sugar levels (type 2 diabetes - under control up to now without medication) have been consistently elevated (13-16). Yesterday she received a prescription for a diabetes medication, Diamicron (glyclazide) - I just read is not an appropriate means to control blood sugar during surgery.....

Any input on would be greatly appreciated!

[HeinrikMD]

Hi,

Your concerns are pretty valid. If there is bone involvement then the surgery would thus not present as cure.

Discuss with the doctor the indication for the surgery. Some women still undergo a mastectomy to avoid some complications associated with an open wound (as you say the cancer is breaking through the skin). This type of mastectomy is not radical and is less stressful. If the other breast seems to be intact, then a mastectomy may not be needed.

You could also explore repeating the testing for hormone receptors on the triple negative sample. This is because the elderly nearly always would have positive hormone assays. This would impact on the choice of management beyond mastectomy.

Around the time of surgery, Diamicron and some other oral diabetes medications would be less useful than insulin for diabetics with blood sugar out of control. Diabetics with fair control need not be shifted to insulin.

Stay positive.