instruction: hi doctor my grandmother was diagnosed with breast cancer three years ago and had a right mastectomy she however did not have chemo or radiation she has a little extra fat to the lateral area of the breast that after surgery it looked like a small third breast right over the old incision has developed a large ulcerative cauliflower like wound the tumor is protruding and is very vascular it currently has no odor but it is bright red and bleeds excessively once the dressing is removed she is 86 years old with a history of high blood pressure cold chef diabetes cad tia and pacemaker she still ambulates alert and oriented also she understands what is going on we visited the oncologist and were told she will either need to undergo chemo or radiation the surgeon who did mastectomy is recommending surgery to remove the protruding tumor which is the best option to do first my family is very leery about her ability to handle chemo and frankly does not want her to have chemo we know that removing it does not cure the cancer should we do radiation first then remove it with surgery if we were to consider chemo should we do some cycles first then remove it with surgery which option would you say is the safest route we want to keep her around many more years if we can thanks for your time
output: hi here are my suggestions assuming that you want to undergo full treatment the best method would be to start chemo and radiotherapy the cycles of chemotherapy will depend on the medicine chosen by your oncologist this will reduce the tumor size then go ahead with the surgery and then complete the treatment with further cycles of chemo and radiotherapy another option is surgery followed by a few cycles of chemo and radiotherapy the above options are important because if left untreated the site may get infected other complications are of course to be considered the other option is no treatment at all just palliative medicines to keep her comfortable this way she can live a comfortable life considering that you have said she is stable please note that I am just explaining the option the choice of treatment would be your decision I suggest getting a pet scan before deciding for further information consult an internal medicine physician online