Pleural Effusion Question

Portal Forums User Community Comments/Suggestions Pleural Effusion Question

This topic contains 4 replies, has 4 voices, and was last updated by  Dr. Weiss 2 years, 6 months ago.

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February 29, 2012 at 5:41 am  #1242360    

emmy

My mom got a call from her Onc. tonight. She has had 4 fluid withdraws for her pleural effusion in the past 7 weeks. The onc asked her to choose between the talc procedure, or have a catheter put in to drain the fluid herself. She is suppose to let him know which one to do tomorrow morning. (he called at 8:30 pm tonight) She said she has to sleep on it. If she picks talc, it will be done next week. If she picks catheter, it will be done this Fri. Dr. thinks her lung is full now. The draw of fluid has been very painful to her the last 2 times. She said it is like they are hitting a nerve. It takes her 2-3 days to recover from the pain (even with meds). She is to start carbo/taxel after she completes talc or catheter. She is pretty strong, just suffering a little with neuropathy (meds are helping with this).
Anybody have any suggestion for this? She is stage IV adeno. Left upper lobectomy in July. 4 months cisplatin/docetaxel. 15 rads on tumor in lymph middle of chest. Pleural effusion started in Jan. Tumor grew from 2.2 cm to 3.5 cm during chemo. No test yet to determine what mutation is driving the cancer. 1st draw of fluid was neg. 2nd was suspicious. 3rd positive. 4th no cells found. Rad Dr. said to not get hopes up that is was gone, just they couldn’t find anything in the fluid.

February 29, 2012 at 6:13 pm  #1242396    

laya d.

Hi emmy:

I’m so sorry to read about what appears to be the progression of your Mom’s disease, and I hope that our faculty here can give you some insight. Unfortunately, you’ve posted your question in the general site comments forum. . .not the lung cancer forum – - and I don’t know how often the doctors actually look here. I will try to link your post here to a post I’ll start for you in the lung cancer forum. Hopefully the docs will pick it up from there and will come here to respond. . .

Sorry about all this confusion. . .

Laya


1/10 – My Mom (58) dx w/ NSCLC-Adeno 3a; 1 cycle of neoadjuvent Carbo/Alimta before finding out EGFR+ (Ex. 19), then switched to 7 wks of neoadjuvent Tarceva/150 mg (major shrinkage); 4/10 – right pneumonectomy; 6/10 started 3 rounds of adjuvent Cis/Alimta w/ concurrent chest radiation (7 wks); 8/10 – NED; 11/10 – small nodule in left lung; 1/11 – 3 small nodules in left lung, start Tarceva/100 mg; 4/11 – suspected sclerotic met to hip, continue w/ Tarceva, add XGEVA, brain MRI clear; 9/11 – solitary 3 cm met (adeno w/ T790m mutation) to cerebellum, surgery and gamma knife, up Tarceva to 150 mg; 11/11 – 2 left lung nodules growing, biopsy on 1 shows mutation from adeno to squamous (shocker!), brain MRI clear, continue Tarceva & Xgeva; 2/12 – brain MRI clear, CT scan, remaining nodule slightly bigger – – monitor for now, Tarceva (reduced to 100 mg) & Xgeva continued; 4/12 progression and rebiopsy (confirmed adeno), stop Tarceva, switch to Carbo/Alimta; 6/12 maintenanceAlimta; 8/12 back to Tarceva; 10/12 Gemzar; 11/16 difficulty breathing; 12/12 hospice initiated…my Mom passed away peacefully on 12/19/12. Heartbroken.

February 29, 2012 at 6:21 pm  #1242397    

laya d.

emmy: just as an FYI, here’s where I linked this thread to a thread in the lung cancer forum: http://cancergrace.org/lung/topic/emmys-plueral-effusion-question/

I’m sure the faculty will be along soon. . .

Laya


1/10 – My Mom (58) dx w/ NSCLC-Adeno 3a; 1 cycle of neoadjuvent Carbo/Alimta before finding out EGFR+ (Ex. 19), then switched to 7 wks of neoadjuvent Tarceva/150 mg (major shrinkage); 4/10 – right pneumonectomy; 6/10 started 3 rounds of adjuvent Cis/Alimta w/ concurrent chest radiation (7 wks); 8/10 – NED; 11/10 – small nodule in left lung; 1/11 – 3 small nodules in left lung, start Tarceva/100 mg; 4/11 – suspected sclerotic met to hip, continue w/ Tarceva, add XGEVA, brain MRI clear; 9/11 – solitary 3 cm met (adeno w/ T790m mutation) to cerebellum, surgery and gamma knife, up Tarceva to 150 mg; 11/11 – 2 left lung nodules growing, biopsy on 1 shows mutation from adeno to squamous (shocker!), brain MRI clear, continue Tarceva & Xgeva; 2/12 – brain MRI clear, CT scan, remaining nodule slightly bigger – – monitor for now, Tarceva (reduced to 100 mg) & Xgeva continued; 4/12 progression and rebiopsy (confirmed adeno), stop Tarceva, switch to Carbo/Alimta; 6/12 maintenanceAlimta; 8/12 back to Tarceva; 10/12 Gemzar; 11/16 difficulty breathing; 12/12 hospice initiated…my Mom passed away peacefully on 12/19/12. Heartbroken.

February 29, 2012 at 6:58 pm  #1242399    

Dr West

We actually do check here, but this isn’t the best place for this question, which, for future reference, would fit better in the forum on treatments and symptom management or the lung cancer forum.

Here’s a post that describes some of the plusses and minuses of the various ways of managing a recurrent pleural effusion, including both a pleurodesis (the talc procedure) and placement of a PleuRx catheter:

http://cancergrace.org/lung/2007/03/18/mpe-managment-options/

I hope that’s helpful. Good luck.

-Dr. West


Howard (Jack) West, MD
Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or Swedish Cancer Institute. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

March 1, 2012 at 3:15 pm  #1242440    

Dr. Weiss

Both are reasonable options. In my practice, I have a bit of a bias towards the catheters. While drainage can cause pain (as you note) talc can often do so even more. Further, the pain may be for some gain when the drainage is daily. In about half of patients with a catheter who drain it every day, a wonderful thing happens–the problem goes away for good and the catheter can come out.

Why? Well, when the drainage is done, the two layers of the lung (visceral and parietal pleura) come together. This can be irritating, which can cause short term pain. However, the irritation can also sometimes cause the 2 layers to stick together–the same mechanism of action as talc.


Jared Weiss, MD
Lead Medical Oncologist

Views expressed here represent my opinion, not those of GRACE or University of North Carolina. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

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