Pleural Effusion Question - 1242360

emmy
Posts:1

My mom got a call from her Onc. tonight. She has had 4 fluid withdraws for her pleural effusion in the past 7 weeks. The onc asked her to choose between the talc procedure, or have a catheter put in to drain the fluid herself. She is suppose to let him know which one to do tomorrow morning. (he called at 8:30 pm tonight) She said she has to sleep on it. If she picks talc, it will be done next week. If she picks catheter, it will be done this Fri. Dr. thinks her lung is full now. The draw of fluid has been very painful to her the last 2 times. She said it is like they are hitting a nerve. It takes her 2-3 days to recover from the pain (even with meds). She is to start carbo/taxel after she completes talc or catheter. She is pretty strong, just suffering a little with neuropathy (meds are helping with this).
Anybody have any suggestion for this? She is stage IV adeno. Left upper lobectomy in July. 4 months cisplatin/docetaxel. 15 rads on tumor in lymph middle of chest. Pleural effusion started in Jan. Tumor grew from 2.2 cm to 3.5 cm during chemo. No test yet to determine what mutation is driving the cancer. 1st draw of fluid was neg. 2nd was suspicious. 3rd positive. 4th no cells found. Rad Dr. said to not get hopes up that is was gone, just they couldn't find anything in the fluid.

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Reply # - February 29, 2012, 06:13 PM

laya d.
Posts: 714

Hi emmy:

I'm so sorry to read about what appears to be the progression of your Mom's disease, and I hope that our faculty here can give you some insight. Unfortunately, you've posted your question in the general site comments forum. . .not the lung cancer forum - - and I don't know how often the doctors actually look here. I will try to link your post here to a post I'll start for you in the lung cancer forum. Hopefully the docs will pick it up from there and will come here to respond. . .

Sorry about all this confusion. . .

Laya

Reply # - February 29, 2012, 06:58 PM

Dr West
Posts: 4735

We actually do check here, but this isn't the best place for this question, which, for future reference, would fit better in the forum on treatments and symptom management or the lung cancer forum.

Here's a post that describes some of the plusses and minuses of the various ways of managing a recurrent pleural effusion, including both a pleurodesis (the talc procedure) and placement of a PleuRx catheter:

http://cancergrace.org/lung/2007/03/18/mpe-managment-options/

I hope that's helpful. Good luck.

-Dr. West

Reply # - March 1, 2012, 03:15 PM

dr. weiss
Posts: 206

Both are reasonable options. In my practice, I have a bit of a bias towards the catheters. While drainage can cause pain (as you note) talc can often do so even more. Further, the pain may be for some gain when the drainage is daily. In about half of patients with a catheter who drain it every day, a wonderful thing happens--the problem goes away for good and the catheter can come out.

Why? Well, when the drainage is done, the two layers of the lung (visceral and parietal pleura) come together. This can be irritating, which can cause short term pain. However, the irritation can also sometimes cause the 2 layers to stick together--the same mechanism of action as talc.

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