Should Mom have cancer surgery with her dementia?

Heather d asked...

My mother is 86, has vascular dementia, has been in a nursing home for 6 months & has adjusted pretty well. 29 years ago she has a radical mastectomy (left breast). Recently she had complained of soreness, the doctor found a lump and scheduled a scan of both under arms. The results just came back - they said there was a strong possibility of cancer in a lymph node. We don't know what to do. Should we have a needle biopsy done? It seems bad to put her through that just to rule it out, because I can't see her going through surgery, etc. at her age and with dementia. I've read that surgery can accelerate dementia. Can you give some advice or point me to where I can obtain more information so we can make a decision?

Expert Answer

Harvey Gilbert, MD, is a radiation oncologist with more than 35 years of professional experience in the medical field, working with cancer patients. He has edited 14 medical textbooks and coauthored 40 papers in the field of oncology. Dr. Gilbert is the medical director of the Ben Schaffer Cancer Institute in Lodi, California.

I would like to address your question about answering the question of whether a patient with dementia should undergo surgery for a suspected recurrent cancerous lymph node in the arm pit. Much of the answer to this, is as you suspected, related to her expected survival from the dementia and the extent of her dementia. Many patient are just entering a dementia state and have several years to live. These patient can be helped and may have a good quality of life for prolonged periods. I am guessing that your mother has advanced dementia and is unable to assist in making decisions for herself. Thus, her expected survival may not be that long. This is a question for her physician, since I would not have a way to assess that at this time. But, the first step is to do what you suggested, and have a needle biopsy or a simple node excision to remove the lump. This is not hazardous and will not accelerate her dementia. If the nodes are cancerous, than that is when the decision process about further therapy might take place. The answer frequently lies in the art of medicine, when you try to assess whether the disease that is found is likely to cause her problems during her remaining life, or not. If all that is found is one cancerous lymph node, and she has a short expected survival froom her dementia, than one might just observe the situation. If, on the other hand the disease is very aggressive, and she has an unknown expected prognosis from her dementia, than some other therapy might be indicated. The final issue relates to your question about surgery accelerating dementia. I personally do not believe sinple surgeries do that. The one thing that might be present, is if she had major surgery, her coping skills might be compromised by her dementia, and thus the stress of major surgery would be less well tolerated than it would be if she did not have dementia. Hope that this helps. It usueally is important in most patients to know what they have and what impact those findings may have on the patient's quality of life. Then, one can make good decisions.