First let me say how much I appreciate this website. It has been a godsend. My mom has stage 4 lung cancer. Diagnosed in 8/2010- inoperable, stage 3 or 4. Treated with chemo/radiation. Progressed to brain and supraclavicular lymph nodes in 3/2012. Alimta and SRS to brain. Difficultly with Alimta due to Chrohns so chemo was stopped. Supraclavicular lymph nodes radiated feb/early march 2013. Vocal chord paralyzed august 2013. Procedure to fix paralysis in Sept 2013. New diaphragmatic paralysis in left side on 3/2014. She has not had a brain mri in probably a year since 2 clear. No CT in a year, since not doing chemo. Diaphragmatic paralysis diagnosed by gp from an x-ray. Sorry for the long back story, but even though this has been a long battle, we are very lucky to still have my mom here. However, she is really struggling since the diaphragmatic paralysis. Her right lung was the one with the tumors, so it is not able to pick up the slack. She has trouble with breathing and needs constant oxygen since the paralysis. Her onc has not been doing CTs since she was not going to do chemo and she is 80. However, I am curious about where a tumor would be located to cause this paralysis and her vocal chord paralysis (this seems to be worse again since the diaphragm). Is it most likely it is a tumor in the chest causing this? In the neck? Or could it be a tumor in the brain? I know this is conjecture, but I was just wondering. I would like her to get a CT just so we have a better idea of where she is at. But I was wondering if it would be worth it to have her do a brain MRI, if another brain tumor could be the cause? Also is there anything other than oxygen we can do to help her? Thank you so much for the help.
Diaphragmatic Paralysis with Lung Cancer - 1262952
tico
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Reply # - March 25, 2014, 07:19 PM
Reply To: Diaphragmatic Paralysis with Lung Cancer
Hello tico,
I am very sorry to hear of the troubles your mom is experiencing. In the context of lung surgery Dr. West has said:
"unfortunately it’s absolutely possible that lung surgery can damage the phrenic nerve, which leads to hoarseness and diminished voice. It also leads to loss of the function of the diaphragm on that side of the chest, which can contribute to more shortness of breath, since the diaphragm helps to compress and expand the lung on that side during the breathing cycle." - http://cancergrace.org/topic/voice-lost-due-to-nerve-damage#post-1250283
But as Dr. Creelan pointed out in the same thread, the damage to the phrenic nerve can also be caused by tumors:
"It is not unusual for lung tumors or some lung surgeries to injure the nerve that goes to the voicebox, especially on the left side. This is because the left recurrent laryngeal nerve goes all the way down to the middle of the left lung, before going back up to your voicebox. Any disruption or interruption along its course can cause temporary or longer-lasting problems with function of the vocal cord. Sometimes cancer will adhere to the nerve, so the surgeon may have no way of knowing it is involved before removing the cancer.
It is also possible for a vocal cord to be injured after multiple attempts at intubation, or prolonged intubation itself, since this procedure involves trying to push a plastic tube between the vocal cords. Since intubation is a life-saving procedure, we usually consider the benefit greater than the potential risk."
It may advisable to see an ENT who specializes specifically in vocal procedures. For single-side paralysis, an injection (injection laryngoplasty) or cord implant (medialization thyroplasty) can usually improve the voice and reduce cough."
JimC
Forum moderator
Reply # - March 25, 2014, 08:39 PM
Reply To: Diaphragmatic Paralysis with Lung Cancer
Thank you so much! She never had surgery, so I think that's out. So I am assuming it is a tumor causing this damage. I'm wondering if the vocal paralysis and the diaphragm paralysis is connected. She had the procedure with the ENT to put in the filler and it was helpful. I guess we are just trying to figure out where the tumor is that could have caused this (brain, lung, clavical?), is there anything we can do about short of chemo (because she is definitely in no shape for chemo). And what is the prognosis when the diaphragm is paralyzed. As a side note - I can't tell you how much I appreciate this site and all you do.
Reply # - March 25, 2014, 08:40 PM
Reply To: Diaphragmatic Paralysis with Lung Cancer
In this situation, I think it's overwhelmingly likely that the cause of her diaphragmatic paralysis is damage/disruption of the phrenic nerve from either the cancer tumor itself or lymph nodes enlarging and pressing against the nerve. Cancer in the same area is very likely to compromise both vocal cord function and diaphragmatic function. This pattern isn't what you'd expect from a brain lesion.
Unfortunately, I think it's also extremely unlikely that there is an effective way to reverse this problem. Even if it were possible to remove or shrink the cancer causing compression of the nerves, function often doesn't return after the nerve has been damaged for weeks or months.
Good luck.
-Dr. West