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 increased 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 it is not an appropriate means to control blood sugar during surgery.....
Any form of surgery really has risks, and these risks can be more pronounced in the elderly population. The presence of comorbid conditions like diabetes adds to these risks. Aside of blood sugar problems, there can also be problems regarding the heart and blood pressure (like myocardial infarction or CHF). Before the operation, it is highly recommended that she receive a thorough cardio-pulmonary evaluation (EKS's, Chest X-ray, etc.) to correct any problem that may interfere with the surgery.
You are correct about the incurability of cancer once it has spread, and I suggest that you discuss well with her surgeons the exact purpose of the bilateral mastectomy (seems too aggressive for me). If the tumor is hormone positive, then there is good data that she will benefit from hormonal treatment and some would fore go with the surgery.
If bilateral mastectomy seems too aggressive in your opinion, what do you think might be a reasonable alternative? (also forgot she has a heart murmur - since childhood).
I was wondering if it might be better (less trauma) for my mom to have only the left breast (containing the triple negative tumour, breaking through the skin) removed and then she could take possibly take Tamoxifen to control the tumour in the right breast which is hormone positive... and perhaps leave the lymph nodes? Then perhaps she could take Biophosphanates to manage the sternal metastasis?
I'm going to wade in here with some personal opinions. First of all the bilateral mastectomy may seem a bit aggressive for her age but if as you stated only the one breast were removed then it would no doubt mean Chemotherapy and Radiation for the tumor in the remaining breast. This is when her age would be a factor .. Chemo might be too hard on her. Bilateral wouldn't be that much different than a unilateral mastectomy; NOT as an outpatient procedure though. I would insist on at least an overnight stay. I don't approve of the O.P. mastectomies for anyone and I was told that Medicare would NOT pay unless I remained overnight. As far as the sternal metastises;bone mets not curable of course but very manageable. Radiation is the Rx for bone mets. In your mother's case (all things considered) I firmly believe that there should have been a consultation with an Oncologist BEFORE surgery was scheduled. Recovery from the mastectomy isn't all that troublesome or uncomfortable and I wouldn'dt consider it the first in many procedures to come though. Every surgical procedure carries with it some risk but in most cases the risk is fairly small in this day and age. Being a retired medical professional I would recommend a quick second opinion before you go any further and I'm saying this as if I were talking about my own mother. By the way .... 75 isn'st all that old !! Best wishes to you both.
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