Quality of Life

An 80yr old lady comes into the clinic. She's strong (for her age), sharp mind, good hearing, good eyesight, can walk fairly well with a cane for assistance. She's had a good life - her children have their own families and are doing well. A son is taking good care of her.

She has cancer - a big one in her neck. But otherwise she's fine. She wants to get an operation because, well, it's cancer...

How can I make her understand that it's not that simple a decision? A few years earlier, it would be an easy decision.

She might not survive the surgery. If she does, she might not fully recover and wish she didn't get the surgery in the first place. If she does survive, she might not survive the radiotherapy and chemotherapy that has to come after the surgery. If she does survive, she might not fully recover. If she does fully recover... that's a lot of "IFs".

How can I make her understand that the extra time the surgery MIGHT give her could be spent bedridden and totally dependent on her relatives?

How can I tell her that if she doesn't undergo surgery, she might even die of old age before the cancer kills her?

But then again, I'm not even sure of any of the above. They are all just possibilities.

And yet, I know more than she does. And I know once she undergoes surgery, there is no turning back. The end of her life is inevitably near and the cancer might not even have an effect on her lifespan. And surgery could.