side pain after chemo - 1262696

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dongsheng
side pain after chemo - 1262696

my dad was diagnosed feb 2013. He recently re-started chemo ( single agent - Alimta ) as he started having mild left pleural effusion again. He just had his 4th infusion.

The pain started a couple of days after his 2nd infusion. All of sudden, he had severe pain around the bottom of left rib cage on the side ( where left elbow would meet body when standing up with hands naturally pointing down). He described the pain felt like side stitch. It was worse when he lies on the left side, as well as when he lay down on the back. It felt much less when he lies on the right side. He also felt it when he coughs and does deep breathe. It was bad when it started, but then gradually got better. By the time he need to have chemo again, it almost went away. But then several days after the 3rd infusion, it started again, same place, and then gradually went away before his 4th infusion.

Now he had his 4th infusion. On day 4, he started feeling it again. Although not as bad as previous times, he can still feel the discomfort. We asked his oncologist, who think it was pulled muscle. We also did Colour Doppler Ultrasound (while suspecting enlarged spleen), but result came back normal.

not knowing what is causing the pain, I am wondering if anyone here has any ideas on what might be going on, or what test might help figure out what's going on. Thanks for your feedback in advance.

JimC
Reply To: side pain after chemo

Hi dongsheng,

Without seeing the patient, it would be hard for the faculty to determine a cause, but if it were something like a bone metastasis, it wouldn't be likely that the pain would get better, then worsen...cancer pain tends to stay constant and worsen over time.

The faculty have addressed a somewhat similar question, expressing doubt that such pain is caused by the chemo. As Dr. Weiss said:

"It's hard to answer this one without knowing [the patient]. Is the pain constant? Is [the patient] short of breath? While there may be no problems shown on a normal scan, chest pain is never to be taking lightly, as it can be the sign of concerning problems such a heart attack or a pulmonary embolism (blood clot in pulmonary arteries). Chest pain can also be from benign causes, likely inflammation of muscle or connective tissue... I have not before heard of pain from tumor shrinkage, but I'm open to this being possible." - http://cancergrace.org/forums/index.php?topic=4586.msg27550#msg27550

And Dr. West added:

"I agree that this is really something that you'd want to directly evaluate a patient to try to get a better sense of what's happening. My leading concerns would be for a pulmonary embolus (blood clot in the lung) or perhaps spontaneous collapse of the lung...but both of those should be able to be evaluated for and ruled out with scans.

Like Dr. Weiss, I haven't seen sharp pain associated with tumor shrinkage but would consider it within the realm of possibility. Though you'd definitely want to try to determine the underlying cause, if that's not possible, the next best thing is to rule out the serious, treatable problems that could present as sharp chest pain, both cancer-related and unrelated (such as heart disease)."

I hope that any serious issues can be ruled out by your dad's doctors, and that he can find relief from the pain very soon.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Reply To: side pain after chemo

The waxing and waning nature of the pain you describe makes it a little different, not likely to be from something like lung collapse or a pulmonary embolus. I don't have a good idea to suggest what it might be, but I suspect that a chest CT would be the study most likely to offer some kind of insight.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

dongsheng
Reply To: side pain after chemo

Thank you Jim and Dr.West for your feedbacks!