My Mom: 68 years old, very active, eats healthy, very positive, no symptoms, my best friend
She lifted something heavy while doing work in her garden, and tweaked her back for the first time. Went to have x-ray to see if slipped disk. Radiologist found a "shadow" on lung. She had lung biopsy, diagnosed with NSCLC adenocarcinoma.
MRI, PET scans completed, no metastasis outside lung/chest area.
Suspect lymph nodes near trachea, biopsy conducted, cancerous cells found
Pleural Effusion developed in last few weeks, they found cancerous cells in fluid
she was tested for ALK, EGFR, KRAS and Ros....no luck
So, now we find out from oncologist, yesterday, that we are dealing with Stage IV a.
The recommended treatment is chemotherapy to try and stop the major issue with the pleural effusion. She is still not showing any signs of being unhealthy, is still active, etc. She can handle a more aggressive treatment path.
I have read that chemo may be not effective for pleural effusion....We just want to get in front of this and find the right treatment.
I have a 2nd opinion lined up early next week, with an NCI funded cancer center to see if they can recommend alternative treatments.
We need to get treatment started quickly, but no not want to start on the chemo path if that is not going to be that effective. Any advise for us?
Reply # - October 9, 2014, 04:13 PM
Hi michellemybell,
Hi michellemybell,
Welcome to GRACE. I am sorry to hear of your Mom's diagnosis, which has brought you here. I hope that we can provide you with the information you need to help her make informed choices.
Unfortunately, finding lung cancer cells in the pleural effusion does make her cancer stage IV. The standard of care treatment for stage IV lung cancer is chemotherapy or if appropriate targeted therapy. Chemotherapy can kill cancer cells wherever they may be found in the body, including in a pleural effusion. Chemo may or may not reduce the excess fluid in the pleura, in which case symptoms of the effusion may persist.
With stage IV lung cancer, local therapies such as surgery or radiation are not typically pursued, because there are cancer cells which have reached the bloodstream, and those cells eventually will produce tumors somewhere in the body. Since those local treatments have consequences and can weaken a patient to the point where they cannot tolerate chemo, the treatment they really need. Exceptions to this principle are made for brain metastases, in cases in which a tumor is pressing on a vital structure, causing a great deal of pain or in the case of a bone metastasis threatening fracture of a load-bearing bone. In those situations surgery
These posts by Dr. Weiss and Dr. West may be helpful as you begin this journey with your Mom:
http://cancergrace.org/search-results?q=an%20introduction%20to%20lung%2…
http://cancergrace.org/lung/2007/03/17/intro-to-pleural-effusions/
Please let us know if you have further questions.
JimC
Forum moderator
Reply # - October 9, 2014, 06:17 PM
I'm sorry about your mother's
I'm sorry about your mother's diagnosis. To address what I think your specific question is, the treatment for someone with stage IV NSCLC and a pleural effusion is exactly the same as the tretment for someone with stage IV NSCLC and no pleural effusion. There's no evidence that chemotherapy is less effective for a pleural effusion -- it's just one of the areas of disease that can get better or worse with treatment. It's not readily "measurable" the way a solid mass can be measured to shrink or grow, but plenty of patients experience a reduction or even resolution of their effusion from chemotherapy, just as people can sometimes have a good response to a targeted therapy.
Here's a link that may be of some value:
http://cancergrace.org/lung/2007/03/18/mpe-managment-options/
Good luck.
-Dr. West