My husband has stage 4 lung cancer . Has had 2 lobectomies-RL (lower/mdle). Cancer however came back after each lobectomy. Rad/Chemo followed in 2013. No pain.but chronic cough since 2nd lobectomy and sob after rad/chemo. He has gained most of his weight back and has a good appetite and has no lung or chest pain. Just a chronic cough followed by sob if cough comes in spasms. For cough.. Fentanyl patch, fentanyl nose spray, salbutamol/flovent are his go to meds. to quell the terrible cough..which severely impacts quality of life. Some days are better than others-but it does curtail activity and outings as he is embarrassed especially when cough is accompanied by thick, stringy mucous. Oct. xray was described as remarkable by Onc. (in response to treatment) but Jan xray showed some fluid build up. Onc is not too concerned as he sees no changes from last xray.. but radiology suggests it shows 'more' build up than the prev. xray.. So CT scan has been ordered. Could this explain increase in coughing? And how significant is fluid build up in the first place-given that no one said anything about it to us in Oct when it was supposedly there? Don't know if it is significant (to cough or sob) but his blood work indicated anemia for which he is on Ferrous Gluconate.
Chronic Cough and difference of opinion - 1261665
drgoogle
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Reply # - January 21, 2014, 04:15 PM
Reply To: Chronic Cough and difference of opinion
Hi drgoogle,
An increase in fluid buildup (pleural effusion) can certainly cause increased cough and shortness of breath.
With a pleural effusion, the fluid is in the pleura outside the lung. It is one of the places to which stage IV lung cancer can spread, although such effusions can have causes other than cancer. As the doctors here have stated, an increase in pleural fluid is not a very accurate indication of whether the cancer is progressing, but when there is a substantial amount it can cause the type of symptoms your husband is experiencing. At that point it may be necessary to drain it to relieve those symptoms. You can read some previous posts by Dr. West here:
http://cancergrace.org/lung/2007/03/17/intro-to-pleural-effusions/
http://cancergrace.org/lung/2007/03/18/mpe-managment-options/
JimC
Forum moderator
Reply # - January 23, 2014, 01:53 PM
Reply To: Chronic Cough and difference of opinion
thanks for response. However it gives rise to another question that perhaps you can respond to. Is it possible for fluid to build up in lungs and NOT be as a result of a spread? Or is the development of fluid in the lungs always associated with spread and definitive for progression?
Reply # - January 23, 2014, 02:45 PM
Reply To: Chronic Cough and difference of opinion
Pleural effusions can have various causes, and an increase in the amount of fluid is not a reliable indication of progression. Most oncologists would want other evidence of progression (e.g. scan results showing an increase in the size of a tumor) before considering a change in treatment.
JimC
Forum moderator
Reply # - January 23, 2014, 06:45 PM
Reply To: Chronic Cough and difference of opinion
Yes. By the formal criteria used in clinical trials to assess for response or progression, a change in a pleural effusion does not constitute a significant change in disease status. This is because inflammation or infection, or even heart failure, can cause an effusion, and it's also a product not just of production of fluid but also the draining ability. There are enough variables that we prefer to see it decrease or resolve, but we don't consider a worsening effusion as clear evidence of progression.
-Dr. West
Reply # - January 23, 2014, 06:45 PM
Reply To: Chronic Cough and difference of opinion
Yes. By the formal criteria used in clinical trials to assess for response or progression, a change in a pleural effusion does not constitute a significant change in disease status. This is because inflammation or infection, or even heart failure, can cause an effusion, and it's also a product not just of production of fluid but also the draining ability. There are enough variables that we prefer to see it decrease or resolve, but we don't consider a worsening effusion as clear evidence of progression.
-Dr. West