Husband NSCLC stage 4 - 1256510

I am very sorry your husband is in this situation. I'm sure Grace will be able to help with your understanding of what's going on and even how to manage some that is manageable.

Mayo Clinic describes a collapsed lung as, "A pneumothorax (noo-mo-THOR-acks) is a collapsed lung. Pneumothorax occurs when air leaks into the space between your lungs and chest wall. This air pushes on the outside of your lung and makes it collapse. In most cases, only a portion of the lung collapses." from, http://www.mayoclinic.com/health/pneumothorax/DS00943

Dr. West has written a post on pleural effusions which contains info specifically on places that are loculated. I think these 2 resourses will help you understand a bit better. http://cancergrace.org/lung/2007/03/17/intro-to-pleural-effusions/As always please don't hesitate to ask more questions.

Janine
forum moderator

Dr. West explained it in another thread and sounds much like what you reported about your husband's tumor near bronchial tubes, " Hemoptysis is most typically caused by a tumor invading a nearby blood vessel that is also near a branch of the bronchial tree. It may also be from a blood vessel that is part of the cancer eroding. If it's a large volume, it can be life-threatening or even fatal, though that is fortunately quite unusual, especially compared with just a minor tinging of blood in sputum of someone with cancer, which is pretty common. Still it's always worth being in good communication with a person's medical team about this symptom, how mild or severe it is, and whether it's getting worse, better, or just stable. And "anti-angiogenic" targeted therapies like Avastin (bevacizumab) and some others in that class can be associated with worsening of hemoptysis that more often becomes quite worrisome in its severity, so these agents are highly recommended to be avoided in people who have a history of anything more than slight hemoptysis." The whole thread can be found here,
http://cancergrace.org/forums/index.php?topic=6242.0

dcareprovider,

I'm sorry to hear of these developments. I understand where both the doctors and you are coming from. I don't like to favor futile interventions that will likely do no good, but it sounds as if there MIGHT possibly be a value to doing radiation to an area of bulky cancer in the chest if it's causing collapse of an airway, coughing up blood, or other "local" problems. This is often minimally challenging for patients to tolerate and may lead to a significant shrinkage in the size of the cancer that can lead to a temporary but still pretty meaningful improvement in symptoms, and sometimes it improves survival as well. That wouldn't be feasible if radiation were already given in the area, but if he hasn't received radiation, I think it would be very reasonable to at least ask whether a short course of 2-3 weeks of radiation might help. If there's progression more diffusely throughout the body, and he'd be symptomatic from all sorts of other issues, that wouldn't make sense, but if a bulky tumor in his chest is causing problems far ahead of more distant problems, it can make sense to "get out the lead runner", as an analogy I use from baseball.

-Dr. West

Hallo dcareprovider. I wanted to come in on your thread as your husband's experience sounds similar to my own. Like him I was diagnosed as stage IV with a bronchial tumour that kept blocking my airway and causing the lung to collapse. It is great that his doctors warned you about this - it is not as frightening as it sounds, especially now you know what to expect. It can come on very quickly but your husband will get to know the warning signs. I usually get some kind of pain in my rib cage or my collar bones beforehand. It helps not to carry anything - anything at all - as that tends to aggravate the breathlessness and anxiety.
I think your attittude is great but wanted to reinforce Dr West's point that there are measures that can be taken to make your husband more comfortable if necessary. I had chest radiation on dx and then more radiation targeted at the tumour six months later, which was helpful. I also had the support of a fantastic respiratory physician/pulmonologist who was prepared to clear the tumour out of the airway with an interventional bronchoscopy. It isn't a painful or a difficult procedure but it worked wonders. However my lung collapsed so often that eventually they put in a stent to keep the airway open.
I understand why your husband is not being given chemotherapy. In a setting where the lung gets blocked often, there is a danger of infection building up behind the blockage, and chemotherapy depresses the immune system so it becomes harder to fight any bugs. However, I do wonder whether you might want to ask his doctors about mutation testing, particularly if his tumour is an adenocarcinoma. Very best to you both.

I think it depends a lot on the individual and where exactly the blockage is. It's happened to me quite often, and the experience has varied at different times. The pain has not generally been that bad - Tramadol or codeine usually work well. It's just rather sudden and that can be a bit unnerving. It helps to take things slowly and have lots of reassurance, which I am sure you will give. But it's not frightening in the way that a bad asthma attack is frightening, for example.
As to being in hospital, again it would depend on exactly why the collapse happened. Sometimes the lung will re-inflate naturally, sometimes it needs a bit of help. I would usually stay a day or two until they'd done a bronchoscopy to clear the airway, a procedure that has always been very effective for me. But it's probably true to say that everyone is different.

You'll know what to do instinctively because you are the person who knows him best, and your love, hugs and reassurance will make all the difference. To give a small example, just after my dx I had a bronchoscopy to clear the airway. In the recovery room, I kept trying to take off the oxygen mask they had given me. The nurse got quite annoyed but my husband was able to coax me into wearing it.
We had a little routine in which he would count to help me with my breathing and slow it down - if you are taking fast, shallow breaths, that's when you tend to become anxious. I saw a physiotherapist who was enormously helpful in teaching me to understand what was going on with my breathing.
I am conscious this is none of my business, but I hope you will not mind if I say that as a patient I would be unhappy to know that my husband was withholding any information about my condition. Your husband may know more than you realise. We were told the implications of my diagnosis from the outset, but even if that hadn't happened, I would have had my suspicions - not least because I heard a random doctor talking to his medical students about me. Very best to you both.

certain spring thank you so much for speaking up. I knew you would have the best information in this situation and was sure to hear from you.