Dear Cancer Grace,
First of all I would like too thank you for your previous comments on my last posts. I really appreciate that
you give a scientific very correct answer, and by giving information you help people psychologically to feel at least a bit in control.
My question regards,again, my father who has a malign pleural effusion. The Pleurodesis failed due to a trapped lung. They did one thoracentesis after the pleurodesis which made him cough a lot and was very painful. I asked the doctor about a PleurXcatheter but they said the risk for infection is too big. My father also thinks it would not relieve his symptoms because the lung is trapped anyway and will not unfold. He is now dealing with strong shoulder pain and feeling sad. They didn‘t see anything on the CT though (except the pleural effusion).
My question:
Could a drainage relieve the shoulder pain ?
He is never smoker, but negative on nearly all known mutations and translocations ( KRAS, EGFR, ALK, B-RAF, RET, ROS1, P53..) Could Tarceva help anyway?
Kind Regards
Malte Schuldt
Reply # - December 1, 2013, 01:29 PM
Reply To: Malign pleural Effusion: Relieve of back pain
It's possible but I'd say unlikely that the pain will be improved significantly with a thoracentesis if he has a trapped lung.
Yes, it's possible to get significant clinical benefit from Tarceva (erlotinib) in someone who doesn't have an EGFR mutation, though it's quite uncommon to see a major response or a prolonged benefit in someone who doesn't have an EGFR mutation. I write more about that here:
http://cancergrace.org/lung/2010/09/21/benefit-from-egfr-tki-if-egfr-wt/
Good luck.
-Dr. West
Reply # - December 1, 2013, 02:44 PM
Reply To: Malign pleural Effusion: Relieve of back pain
Thank you very much Dr West,
I just wanted to ask if you have any suggestions what could cause this pain.
The doctors don‘t tell very much. I have read somewhere that the: "Irritation of the central portion of the diaphragmatic pleura, innervated by the phrenic nerves, causes pain referred to the neck and shoulder."
I am not sure what this means. However, he has sometimes a lot hiccups, so I thought it might have something to do with the diaphragm..Could an operation of some sought be an option to resolve the pain?
Kind regards
Malte
Reply # - December 1, 2013, 07:17 PM
Reply To: Malign pleural Effusion: Relieve of back pain
It's very common for inflammation/scarring around the diaphragm or pleura at the bottom of the chest to be associated with shoulder pain. That's called "referred pain", which is basically when a nerve going to several areas can't reliably tell where the pain originates. This is kind of like when a branch is shaken from one end and you see the branch moving but can't tell where the movement originates. The nerve just kind of "guesses" where the pain along the branch is, but it's wrong in reporting it's from the shoulder.
-Dr. West
Reply # - December 1, 2013, 07:17 PM
Reply To: Malign pleural Effusion: Relieve of back pain
It's very common for inflammation/scarring around the diaphragm or pleura at the bottom of the chest to be associated with shoulder pain. That's called "referred pain", which is basically when a nerve going to several areas can't reliably tell where the pain originates. This is kind of like when a branch is shaken from one end and you see the branch moving but can't tell where the movement originates. The nerve just kind of "guesses" where the pain along the branch is, but it's wrong in reporting it's from the shoulder.
-Dr. West
Reply # - December 3, 2013, 06:08 AM
Reply To: Malign pleural Effusion: Relieve of back pain
So what could potentially be done about the pain. Would a small surgery be possible? Could they localize the area and treat it with radiation?
Reply # - December 3, 2013, 06:40 AM
Reply To: Malign pleural Effusion: Relieve of back pain
I don't think surgery would be fruitful. Perhaps radiation, but we would often use pain medication to control it. Perhaps meeting with someone specialized in pain management would be helpful.
-Dr. West