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Lung Cancer

Any way of stopping pleural effusion?

07/05/2007

Question:

My mother was diagnosed last February 2007 of bronchogenic CA with bone metastases, large cell CA, Stage IV. She is 57 years old and a non-smoker. She also has diabetes mellitus type 2 and had experienced cardiomegaly during her hospital stay (february~april).She was given navelbine feb.13, zometa on feb.14 and went home.But she has to go back to hospital due to ON and OFF vomiting.On Feb.19 she was given cisplatin.But since she was experiencing severe pain on her back when trying to change into sitting position after lying down.While doing this, she also coughed up.So, that`s when she has to undergo radiation therapy on her chest starting Feb.21 for 7 sessions.She underwent thoracentesis last march due to pleural effusion on her left lung only.About 460cc of fluid was drained.After staying home for about a month, she was again hospitalized due to difficulty in breathing.Fluid was drained from her left lung (about 900cc) and from right lung(about 150cc).A certain amount of fluid was also drained from her heart.Last May 2006, prior to being diagnosed of lung cancer, she was treated for PTB minimal, UTI and cardiomegaly. The doctor told her that based on the X-ray,her lung already had scarred.At that time,she noticed a small mass in the area where the right parotid gland is located.Her doctor just didn`t do a thorough examination on that and instead just told her that it`s just something as a result of her PTB.The mass becomes bigger as months passed.Until last January, based on FNAB, she was told that she has malignant salivary gland tumor but the primary origin is still unknown.On the same month, her right parotid was removed.It was only last February, after performing a CT scan in the head, chest, whole abdomen and neck that her attending physician had ruled out that the cancer originates from the lungs.Even after draining the fluid last May 2007,she again experienced shortness of breath. Last month she experienced pain in her neck that`s why she was given Pamisol.She was also prescribed with tarceva 150mg.But since the cost of 1 tab is too much for us, she wasn`t able to take this.Until now she still have this difficulty in breathing. I am sure that the fluid had again accumulate. I would like to ask if there is still a way of stopping the fluid from accumulating again, or else we will be going back always to hospital just to have the fluids drained.Any advice please?

Answer:

There are 3 options for treating the fluid.  The first option is to have the fluid drained whenever it reaccumulates.  The second option is surgery: pleurodesis.  For this surgery, a scope is placed in the chest and talc is inserted to help the lung scar up to the chest wall.  The surgery is usually successful; however, not every patient is a candidate for the operation.  The third option is to place a catheter in the pleural space (pleurX catheter) which can then be hooked up to a drain every couple of days to drain whatever fluid is there.  I would recommend discussing these options with her oncologist and if appropriate ask for a referral to a thoracic surgeon. 

I hope this helps.

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Response by:

Sandra L Starnes, MD Sandra L Starnes, MD
Assistant Professor of Surgery
College of Medicine
University of Cincinnati