Follow
Share

MIL is in assisted living. Early this evening we rc'd a call from a nurse there who said my MIL came to her saying her breast was hurting. The nurse took a look at it and found she had a very large hard lump. Her son, my husband, headed right down and took her to an urgent care clinic, doctor there sent them on to ER. After several tests, etc a doctor came in and told them it is not an infection and he and the other professionals who both examined her and reviewed the tests believe it is cancer. We will get her in to appropriate doctors on Monday if possible. Based on the information the doctor got from my MIL he thinks is is an "aggressive" cancer. The lump is the size of a fist. She had not complained of breast pain prior to this (that we know of). She stopped wearing a bra several months ago because it was irritating an area she had shingles at. They also diagnosed a bladder infection at the ER. She seems to only be concerned with that right now which is not surprising. Hospital said she could stay there or she could go home. Of course we wanted to have her come to our house, but she wants to go back to her place. We did not push her to come here and did not push the C word on her. Just given the limited information at the moment can anyone offer any insight for us. What things will we need to be certain to ask? We will see her tomorrow. BTW ER is a nationally recognized hospital. It is a long way to Monday. Thank you.

This question has been closed for answers. Ask a New Question.

36 Answers

Most
Helpful Newest
First Oldest
First
1 2
I looked up Letrozole and found it it was also called Femara, which is given to women who have breast cancer and have gone through menopause. It's an anti-estrogen drug. Apparently the estrogen is feeding the tumor.

I was on that pill for a couple of years and had to switch to something else, for me it was not user friendly. It made you feel like you were going through menopause all over again big time. Plus other major side effects.

So I am keeping my fingers crossed that if your Mom has those side effects that they are mild for her.

If Mom just cannot handle Letrozole, ask the doctor about Tamoxifen, which is another common pill. Yes, there are side effects but not as difficult.
Helpful Answer (2)
Report
I would call a local hospice organization and ask THEIR medical staff to evaluate her. it seems unbelievable to me that someone thinks shes not eligible wit a stage four aggressive tumor
Helpful Answer (1)
Report
Yes, the skin is ulcerated in spots - under the breast and there red sores on the tumor itself. But, there is the risk the tumor being as large as it can break through the skin. She would then have a very large open would. I believe it may be referred to as a fungating (sp?) tumor. That would be very hard on her emotionally and physically. I think my main issue was the nurse saying she was not critical within 6 months. With all we know and what we don't know I just am having difficulty thinking she has that much time. It is not that I'm don't want to be optimistic my personality or coping response is to be the organizer ask questions type. I am glad that you seem to agree I am not out of line to ask my brother-in-law to clarify hospice and her care with the oncologist. My husband and I will be out of the country and we will ask him to check with the oncologist on things. Got her all set up with little wrap gifts to open for each day we are gone!
Helpful Answer (1)
Report
But isn't the skin already ulcerated..?

If your MIL understands the possible side effects and is much happier to be taking medication than facing surgery - which you can quite see she would be - then it's worth trying the Letrozole and seeing what happens. In that case, I'd shift gear and remember that if she struggles with it, or if it's not helping, she can always stop taking it (under medical supervision, of course, not unilaterally).

I'm extremely surprised at what the nurse told you about hospice too. Actually, surprised is a bit of a euphemism - it sounds like hooey. Why not just start again when you see the oncologist?

There is quite a lot of information online - Google "Letrozole in the elderly," otherwise you'll get too much irrelevant stuff. The bone density really isn't a worry so much because it takes years to happen; but I wouldn't dismiss the other side effects just because they're not lethal. The question is how they make her feel, and if the cure is worse than the disease... But, maybe she'll get lucky. Goodness knows she's due some good luck!

Where there's life there's hope isn't a bad attitude if it's keeping your MIL in good spirits. Just don't let it make her doctors think she's all gung-ho for heroics after all. Hope you're all looking after one another, too - this is a rough experience for everyone.
Helpful Answer (0)
Report
Thank you Churchmouse. We (husband, brother, mother, myself) all agree that we are going for comfort care not extending her life by any mans possible. She has a health care directive in place which states that. Letrozole will be taken to stop or perhaps even shrink the tumor. From my readings, not from the nurse practitioner, I understand this stopping or shrinking the tumor growth may prevent the tumor from ulcerating/breaking through the skin. From what I've read having the tumor ulcerate through the skin would negatively impact her quality of life. A masectatomy would serve no purpose since it has spread unless it were done because the tumor ulcerated. We are not having a body scan as the results would not change anything. Thank you for the answer on hospice. I was surprised given everywhere they know the cancer is, her age, her health directive choices, and the cancer being stage IV that they did not feel she qualified for hospice. The tumor is the size of my husband's fist. I also didn't understand being told the side effects to the Rx is photoflashes and issues with bone density. She is 87 and I would think the side effects would be more intense and well, just more. I will be thankful if all she gets is hot flashes. My MIL was happy to hear she has to take a pill for the cancer thinking it is going to stop or slow it down. She is a blinders type of person - more so with age.
Helpful Answer (0)
Report
How is your MIL feeling about this?

If it were me, I would ask again about hospice. I would also ask for a detailed, considered assessment of the pros and cons of the proposed treatment, perhaps asking for quality of life to be prioritised as a factor. Support your husband in remembering that just because treatments are possible it doesn't mean they're necessarily the best option *for your MIL.* The questions to ask are "what happens if..." followed by

we accept this treatment option
we consider other treatment options
we do nothing

I'm very sorry that she has received such a discouraging assessment. How are you and your husband coping?
Helpful Answer (1)
Report
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?
Helpful Answer (0)
Report
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!
Helpful Answer (1)
Report
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.
Helpful Answer (1)
Report
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.
Helpful Answer (3)
Report
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.
Helpful Answer (1)
Report
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?
Helpful Answer (1)
Report
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.
Helpful Answer (3)
Report
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.
Helpful Answer (0)
Report
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.
Helpful Answer (2)
Report
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.
Helpful Answer (2)
Report
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.
Helpful Answer (2)
Report
Teaka, good luck to you and your MiL gettings answers to all your questions tomorrow. Thinking about you!
Helpful Answer (2)
Report
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.
Helpful Answer (1)
Report
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.
Helpful Answer (1)
Report
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.
Helpful Answer (2)
Report
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?
Helpful Answer (0)
Report
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!
Helpful Answer (5)
Report
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.
Helpful Answer (4)
Report
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.
Helpful Answer (4)
Report
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.
Helpful Answer (1)
Report
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.
Helpful Answer (3)
Report
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.
Helpful Answer (5)
Report
Babalou I hope this was just abad experience especially at midnight. Did they find anything?
Helpful Answer (0)
Report
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.
Helpful Answer (4)
Report
1 2
This question has been closed for answers. Ask a New Question.

Recent Questions


Popular Questions


Related Questions

Ask a Question
Subscribe to
Our Newsletter