Expert: Claes-Gustaf Nordquist, M.D. - 7/6/2009

Question
My grandmother is 75 and was just diagnosed with stage 3B breast cancer.  She was diagnosed based on the biopsy results of a large (4cm) tumor in her axillary lymph nodes.  She has also developed, in less than a week, another tumor that is walnut sized on the front of her neck on that same side.  It just popped up out of nowhere.  CT scan showed no spread to her lungs but did show advanced emphysema.  She has lost a ton of weight, she is just skin and bones.  She is also pretty frail otherwise and is having a little bit of trouble with being unsteady on her feet.  She is having a lot of pain in that shoulder and in her back, but hasn't mentioned this to the doctor yet.  She thinks it might have spread into her bones.  She can't decide whether or not to begin treatment-she is understandably more concerned with quality of life than quantity.  And as far as chemo, she's concerned because she can't even take two advil without getting lightheaded and chemo sounds like it might be too much for her.  But the doctors won't give us a straight answer as to what kind of prognosis she has with vs. without treatment.  Can you give me any idea that I can share with her?  How long might she expect to live without treatment, and if she gets treatment, how much longer might she have than if she didn't get treatment?  I really feel like this is a decision that she needs to make now- if she thinks about it for too long and then decides to get treatment, I'm afraid it will be too late.  Please help?

Answer
If she does not tell her dr. ALL her relevant symptoms so that her dr. can make the appropriate actions we can not be sure that the stage you have told me is the correct one! Since I must base my advice on as sure facts as possible it is in this situation not possible to provide such advice. First of all the lump on her neck must be checked (for example by fine/thin needle aspiration biopsy), second her pain must be checked (x-ray examinations, MRI scans, PET scans & other isotope scans). Probably also CT and/or MRI scans of her lungs (there only CT scans) & liver (there maybe also ultrasound scans) should be done. Based only on available information it is IMPOSSIBLE to predict anything of those things you ask for. Let me put it like this. If she was my grandmother I would try any means to try to give her chemotherapy if at all possible. But at the moment I do not fully know what you are dealing with - and nor does her dr. - so more information is needed for a correct reply!