positive pleural fluid cytology - 1255290

neetu22
Posts:3

Dear Dr West
My 73 y old father-a smoker all his life , was diagnosed a poorly differentiated squamous lung cancer on a routine chest xray done before surgery for inguinal hernia.Having no other co amorbities and being an active golfer,he was advised medistinoscopy and then undrewent left pneumonectomy.The pathol report after surgery-size around 6cm,grade 4,poorly differentiated,no lymph node or blood vessel involvement,visceral pleural involvement positive and pleural fluid cytology positive.He underwent chemo foll lung surgery.One year later he started foergetting things and a brain MRI and pet CT showed large liver and brain mets.Had craniotomy and chemo with Abraxane and carbo,but we lost him and our entire world 6 months later.
He was absolutely asymptomatic even with a 6cm tumour till it got diagnosed incidentally and went downhill so fast with treatement.His surgeon is really accompalished and above all a good man,so we know he did his best.
My question to you is - did the surgery hasten the spread of tumour cells.With positive pleural fluid cytolgy,could the cancer cells have gone into the cut parietal pleura blood vessels during the surgery and then into systemic circulation?

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Reply # - March 31, 2013, 08:22 AM

JimC
Posts: 2753

I'm sorry to hear of your father's passing. Unfortunately lung cancer is often not detected until it has already metastasized and become incurable. In your father's case, the fact that the pleural fluid tested positive for the presence of cancer cells means that his cancer had already entered his bloodstream. Lung cancer with a malignant pleural effusion is categorized as Stage IVa, which was the diagnosis my wife received under very similar circumstances. In her case a bronchoscopy was inconclusive so her pleural fluid was drained and the cancer found.

From personal experience, I know that it is hard to understand and accept how an otherwise healthy person can suddenly be taken by this awful disease. But in your father's case it does not appear that he received anything but quality care; at the time of diagnosis his cancer had already spread beyond the lungs and the intent of treatment in such circumstances is palliative rather than curative.

My thoughts are for peace and comfort for you and your family.

JimC
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Reply # - March 31, 2013, 12:54 PM

Dr West
Posts: 4735

I'm also very sorry about your father's death, but as Jim said, the fact that the cancer cells were already in the pleural fluid signifies that it was not really possible to cure it right from the time of diagnosis, as hard as that may be to believe.

Were it known that the pleural fluid was positive for cancer cells before the surgery, there would be no clear role for surgery, since it couldn't be realistically anticipated that surgery would cure it. On the other hand, there is no reason to think that the surgery itself facilitated the spread of the cancer, even if it didn't end up helping in the long run.

Those of us here share your frustration with how awful cancer can be. I'm sorry it has touched you and your family.

-Dr. West

Reply # - April 1, 2013, 01:12 AM

neetu22
Posts: 3

Thank you so much for your prompt and valuable reply.You are doing such a great service - wish you all the peace and happiness in life!
Being the only daughter and having to make all decisions regarding papa,s treatment has been tough and i hope i did not make a mistake.Just that he was so fit till the diagnosis of lung cancer and when the pet ct and chest ct showed no systemic spread or pleural effusion, we were hopeful, but he was gone within 2 years of diagnosis.
Miss him a lot.

Reply # - April 1, 2013, 06:43 AM

catdander
Posts:

I know you did what was best for your papa. This is a horrible disease that makes second guessers out of us all if we aren't vigilant of it's power to make us worry that we did everything we could. It sounds like the disease took it's lousy course on another healthy vital person.

I hope you begin to remember the father before cancer more often as time passes.

Janine

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