Sorry for posting so many discussions. But as I was browsing the site I came across a comment http://cancergrace.org/lung/2007/03/18/mpe-managment-options/ made by 210ben on Sept. 3 2012 where he or she had stated that they had hoped for the pleural effusion to get controlled before starting chemo.
My questions are :
1. If there is in uncontrolled pleural effusion chemo should not be started?
When my husband was first diagnosed in 2011 the doctors firs drained the effusion from his left lung and performed pleurodesis only after which chemo was started.
2. Can pleurodesis be done on both lungs? Will lung function be compromised too much if this is done?
Recently when my husband had the fraud mediastinoscopy by the Torhacic surgeon whom we hardly knew he advised us that while the mediastinoscopy was beng done he would also perform the pleurodesis to the right lung. We were happy. But we realised tha he opened up my husband jus to make him a number on his list of number of surgeries done in a day. Nothing was successful. He claimed that he could not find any mediastinal lymph nodes but the same nodes showed up in the latest pet scan too. It was a journey of regret. Never knew that such heartless doctors could exist. When we confronted him he said my husband would not live long anyway :-(
He has already had 3 thoracentesis done on the right lung and is now breathless again on the slightest exertion.
Reply # - March 22, 2013, 12:17 PM
Reply To: Chemo and pleural effusion
Hi Apra,
I think the reasons your husband's doctor wanted to drain his effusion and perform the pleurodesis before starting chemo are twofold: The first reason would be symptom relief - chemo is tough enough by itself to be also dealing with a painful effusion. Draining the effusion by thoracentesis is the quickest way to obtain relief from the effects of the effusion. Second, although neither procedure is greatly invasive, any procedure can lead to infection, and with chemo's tendency to lower blood counts, creating a greater risk of such infections, it makes sense to perform those procedures first.
As far as performing a pleurodesis on both lungs, I wouldn't think that would normally cause a problem with lung function, since the procedure aims only to "glue" the inner and outer walls of the pleural cavity together, preventing recurrence of the effusion.
JimC
Forum moderator
Reply # - March 22, 2013, 12:43 PM
Reply To: Chemo and pleural effusion
Thank you Jim,
My concern is because the right lung had already had a failed pleurodesis done. It was a fraud pleurodesis, because the fluid was not allowed to drain out slowly until it reached a minimal level, only after which pleurodesis is normally done, according to my understanding, which process may take some days in the hospital. This was the process followed when my husband had his first pleurodesis on the left lung which was very successful.
Now that i come to think of it and after reading several posts on cancergrace, the thickening FDG avid small focal enhancing involving on right pleura which is beng seen in the latest pet scan could be an after effect of this right lung failed talc pleurodesis. Maybe even the small right pleural deposits seen on the pet can which are a new finding. I am just thinking aloud.
During thoracentesis the doctor said the right pleural fluid was already loculated, so he was draining it from the cavities which showed the most fluid.
Under such circumstances I wonder whether pleurodesis could ever be done again and even whether a pleurex catheter could ever be employed.
Thanks for listening.
Reply # - March 23, 2013, 07:29 AM
Reply To: Chemo and pleural effusion
Jim's thoughts are very good here. To add some further comments, some chemotherapy drugs, most notably Alimta (pemetrexed), are thought to potentially be "sequestered" in fluid pockets like pleural effusions or ascites, so it's generally recommended they be drained to keep from the chemo getting in their and not being metabolized at a predictable rate. Beyond that, both for comfort/ability to tolerate the challenge of chemotherapy, and to do a procedure with minimal risk, it makes sense to pursue invasive procedures before rather than potentially just after chemo is given.
Yes, a talc pleurodesis done recently can definitely lead to thickening around the lung and PET uptake, and that's going to be essentially impossible to distinguish from active disease on imaging.
I would have to say that if there's already loculations and a prior failed pleurodesis, I think it would be very unlikely that a repeated attempt at a pleurodesis will be successful. Also, a PleuRx catheter is really an appealing option only when there's freely flowing fluid and not many small loculated areas of fluid.
-Dr. West
Reply # - March 23, 2013, 08:17 AM
Reply To: Chemo and pleural effusion
Dr. West,
You have confirmed my fear. So that means in such a scenario, the only resource left to us would be repeated thoracentesis which would also become more difficult as the days go by.
I rue the day when we met that hotshot thoracic surgeon at Fortis. Never realised anyone would be so callous. Only because he said he would perform the pleurodesis at the same time did we agree to the mediastinoscopy. But we also failed to remember that pleurodesis takes time, days in fact before a sclerosing agent could be introduced. When we asked him why the pleurodesis failed, he said the fluid was coming out too fast not giving time to the sclerosing agent, the talc to cause the pleura to stick together. Now we are neither here nor there as regards this pleural effusion. I hope loculation means it will thicken and stop flowing.
Dr. West, the new finding on the recent pet scan wich I mentioned in another post said 'small right pleural deposits are new fibdings'.
This was the only new finding on this pet can. Could this also be the remains of the talc on the pleura? The failed pleurodesis was done on December 13th 2012. The pet scan was taen on 21st March 2013.
Just a thought that occurred.
Thank you for your response.
Reply # - March 23, 2013, 09:48 AM
Reply To: Chemo and pleural effusion
Yes, as I said above, a recent talc pleurodesis can lead to inflammation in the area that shows up as abnormal uptake on a PET and is not distinguishable from cancer. That's one of the reasons to not get a PET scan in this setting.
-Dr. West
Reply # - March 23, 2013, 10:14 AM
Reply To: Chemo and pleural effusion
Thank you Dr. West. Though it sets my mind at rest that the new finding of small deposits on the pleura could be talc.
Being off the Tarceva seems to help his stomach but is making his bone pain worse. So I upped the pain med Tramadol 50 mg to twice a day along with Lanol ER 650 mg. he is having this Lanol paracetamol ever nice his deviations copy so even if he was feverish we would not have known.