Hello,
*Disclaimer, I usually do well with spelling but not too familiar with medical terms.*
My Father was diagnosed with Stage IV Adenocarcinoma approximately a year ago. It has metastisized to various areas in his lung, lymph nodes and his spine. (Upper region)
He went through his rounds of chemo, and radiation. They successfully shrank some of the tumors and thought it was in remission.
Most recently (90 days) he's been in the hospital for malignant pleural effusion. (the fluid tested positive for cancer) They did the talc treatment twice, but he was still accumulating fluid. They sent him home with the drainage wound still open, and he was still leaking/producing a bit when he started his most recent bout of chemo.
Today he's on his way to the hospital, symptoms are irregular heartbeat, loss of blood and nausea. I suppose the chemo can perhaps be attributed to the heartbeat and nausea, but the loss of blood is worrisome. (none spotted in stool)
I've read some studies online, most recently "Management of Malignant Pleural Effusions" by John E. Heffner, MD. According to the study, the survival rate isn't the greatest. I'm not asking for a timeline because I know it's all relative. T
That being said my father wasn't in the best of health to begin with. Heavy smoker /drinker, had a couple heart attacks prior to his cancer diagnosis. His brother died of cancer, his mother had it but survived and his father died of a heart attack.
I have a few questions:
What are some possibilities for the loss of blood/irregular heartbeat?
And, I'm currently stationed in another state, I'm not exactly sure what to do, but am not going to ask; but present a scenario. If you were in my place would you head back home to be close to your loved one, or would you wait for further testing. I've never experienced a loved one going through cancer, and am not sure what to do. I want advice, not a prognosis. I suppose no one can accurately give that.
Reply # - April 18, 2013, 07:48 PM
Reply To: Stage IV Adenocarcinoma-> Malignant Pleural Effusion->
sreagan,
Welcome to GRACE. I'm sorry to hear of your father's diagnosis and recent difficulties. With regard to his loss of blood/irregular heartbeats, you state that he has had previous heart attacks. Does he have any history of irregular heartbeat? Also, how is the loss of blood manifesting itself?
As far as whether you should head home now to be with him, that's a difficult question which many loved ones face. As the doctors here often say, they are not very good at being able to determine how long a patient will survive. They can usually give a general idea of the direction and aggressiveness of a patient's cancer without being able to put that information into numbers. Your father's doctors would be best equipped to give you that kind of assessment, so I think you shouldn't hesitate to ask them. When my wife was declining, I told her oncologist and his PA that members of her family were planning a visit and I asked them point blank whether they thought that was soon enough and got a straight answer. So I think a frank discussion, as painful as it might be for you (as it was for me), could be helpful to you.
It's not clear from what you wrote just how much of a disruption of your life going back home would entail, or for how long you would be able to do so. Depending on those factors, I think my personal choice would be to try to go back soon for at least a visit. The downside of that action would be that it can become very difficult to leave, so you should probably consider that issue before making your choice. If you visit for a short time, how difficult would it be to return after just a short time should it become necessary?
There was a discussion of a similar question here: http://cancergrace.org/forums/index.php?topic=6004.0
Best wishes to your father for quick resolution of his symptoms. And I wish you clear thinking and good guidance in reaching an appropriate plan of action.
JimC
Forum moderator
Reply # - April 19, 2013, 06:52 AM
Reply To: Stage IV Adenocarcinoma-> Malignant Pleural Effusion->
Hello Jim,
Thank you very much for your reply and insight, and my condolensces for your spouse. I imagine it must have been a difficult journey. Your advice and experience are valuable to others who have loved ones enduring cancer, its very honorable what you and the others contributing to this site are doing.
As far as the source of the blood loss, or how they are reading it, I have no idea.
I get all my information through various family members so have to piece together things. I've asked to speak to a doctor before but my father has kindly deflected those attempts in subtle but firm ways.
I imagine the only way to get a straight answer is to speak with a doctor face to face. Are there any particular questions I should ask? In one of the studies I read (regarding malignant pleural effusion) 3 factors contributed to a shorter life expectancy based on a number of patients/average/etc.
Im currently in the military with a permanent change of station move 26 days away.. getting away isnt easy, but not hard.
Its hard trying to balance when to go, or know. All I keep thinking about is being too late, or not being able to help. I dont know if this is a steady decline, or just a complication to deal with.
I guess that's something I'll have to work out on my own. Thanks again for your advice and insight.
Reply # - April 19, 2013, 09:30 AM
Reply To: Stage IV Adenocarcinoma-> Malignant Pleural Effusion->
I wouldn't read much into the specifics of life expectancy based on variables with a pleural effusion: that's just one study, and there is no widely accepted perspective on this. There are people who live for years after presenting with a malignant pleural effusion, and there are others who decline more quickly. The condition of a patient and his or her response to treatment is more important for me as I try to estimate what to expect for the future.
As for the "blood loss", I suspect that it's not actually blood loss but anemia you're speaking of. If you aren't seeing blood being lost, through a chest wound or in the stool, etc., and the hematocrit (the lab test measuring the percent of the blood volume that is red blood cells) or hemoglobin (another measure of red blood cell volume) are down when a patient is on chemo, it's extremely likely that it's just an expected effect of anemia (for which blood loss is just one of many potential causes) from the chemotherapy decreasing red blood cell production, not a diagnostic mystery. If the anemia is severe enough, transfusions can be given, but otherwise we just monitor this. If the anemia progression is just slow and steady, it doesn't require anything more than ongoing monitoring.
As you've read here, and determined for yourself, the question of whether and when to go there is a judgment. There is always a risk that things will get harder over time, so we generally favor that people do what they can sooner rather than later, just because complications may emerge and sometimes people have a precipitous decline that couldn't have been foreseen.
Good luck.
-Dr. West