Malignant Pleural effusion

• By MarciaGreer
• Posted October 28, 2008 at 7:37 am
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I was dx Stage IV w/malignant pleural effusion 3 years ago. I'm surprised you've found many stories of Stage IV surgeries, because they almost never do surgery. Sometimes they will remove the whole lung and even some ribs and the chest wall. But once you've got cancer cells in the pleural area that means the cancer has left the lung itself, and has probably migrated elsewhere, even though it isn't visible on a PET or CT. They can't do radiation on the pleural area, so chemo is the only treatment for that. My pleural effusion shrunk after several rounds of carbo/taxol/avastin. It later reappeared and had to have drained several times. Finally had a pleurodesis - a procedure where they drain the fluid from the pleural space, and inject talc to seal the space so fluid can no longer collect there. A plus to this procedure is there is some evidence that the talc itself may have anti-cancer properties! So keep that in mind if your mom continues to have fluid problems.
Good luck to you and your mom.

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• By pia
• Posted October 28, 2008 at 7:51 am
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Thank you so much Marcia for responding. Your story really gives me hope! You and your family are in my prayers!

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• By Ray
• Posted October 28, 2008 at 10:02 am
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Pia

I am sorry. They can't treat the pleura area with radiation because it will make the lung stick to the chest wall and breathing would then become extremely painful. They call this "wet" stage 3b.

Ray

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• By aps
• Posted October 31, 2008 at 6:23 pm
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Hi,

My mom was diagnosed 1 month ago, with stage 3b nsclc with pleural effusion which ended up being malignant cancer.
She has not had any chemo or radiation, she is taking tarceva and so far, knock on wood she is feeling good. Her breathing is fine, she does take oxygen once in awhile when she feels she needs it and she is walking slower than usual, but overall feeling great..
Hope that helps.

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• By tonie
• Posted November 1, 2008 at 11:44 am
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I was diagnosed on 11/19/07 with stage 3B NSCLC with malignant pleural effusion. I had the VATS pleurodesis with talc procedure done on 12/7/07 and started Tarceva on 12/26/07. I have never felt better in my life than I do today. So far, so good. Keep the faith.

Tonie

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• By ValS
• Posted November 1, 2008 at 1:46 pm
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I was diagnosed in May 2007 3B NSCLC inoperable advanced 19mm x 29mm tumor with large pleural effusion, one lymph node, no mets, "studding" of CA cells all over pleura extending up to the heart. Given poor prognosis. Had thoracentesis which showed CA in the fluid, then started Carbo/Taxol/Avastin for 4 cycles. Effusion stopped after 2 cycles. At end was NED. Put on Avastin every 3 wks and Tarceva daily. Last week 10/22/08 CT scans were also NED.

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• By pia
• Posted November 1, 2008 at 2:34 pm
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Thank you all for your responses. This whole experience has really rocked my world. My mom is doing great and has a wonderful attitude. I on the the other hand am a total wreck but am starting to pull myself together. This site is a God-sent for me!

My mom is currelty doing six rounds of carbo/avastin/alimta. First round was tolerated very well! Blessed be God! Please pray that she continues to respond well!

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• By daughternumber2
• Posted December 13, 2008 at 12:21 am
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Hi Pia,
I completely understand how this could rock your world. My dad was just diagnosed with mantle cell lymphoma. I did want to offer some advice, our family friend was diagnosed with stage 3B wet lung cancer 4 years ago. He was told my several cancer centers to get his affairs in order. He then went to MD Anderson in Houston TX. Again that was 4 years ago. After my father's diagnosis we also went to MD Anderson after Dana Farber. He starts chemo after Christmas and while we are scared we are hopeful to put it into remission. I will add you and your mom to our prayers.

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• By gpawelski
• Posted December 13, 2008 at 11:01 am
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Pia. Why is surgery sometimes an option for stage 3bs and 4s?

There are very good reasons. NSCLC is not intrinsically sensitive to chemotherapy (SCLC is). And at advance stages, cancers are even more notably resistant to many drugs. So some patients want to know what drugs are resistant and those drugs that will have the most benefit at working against their cancer cells.

Some researchers believe the reason for better survival for patients who could undergo complete resection without any tumor left behind is that these tumors are biologically less aggressive and would do better regardless of the type of treatment they receive, and that the removal of lymph nodes at the time of surgery may additionally contribute to a better outcome.

Surgery is an integral part of the multimodality treatment of many cancers. Surgery is thought to remove resistant clones of tumor cells and thus decrease the likelihood of the early onset of drug resistance. The removal of large masses, likely to be associated with poorly vascularized areas of tumor, improves the probability of delivering adequate drug doses to the remaining cancer cells.

The higher growth fraction in better vascularized small masses enhance the effect of chemotherapy. Smaller masses require fewer cycles of chemotherapy and thus decreased the likelihood of drug resistance. The removal of bulky disease enhances the immune system. Patients who present with a large mass are suffering because of that mass and they need that tumor out to relieve symptoms. It's important to deal with the bulk.

More successful treatments begin with first being diagnosed in a laboratory and that means getting a surgical sample for analysis.

Some thoracic surgical oncologists take out as much fresh "live" tumor specimens and send them (in their natural state) to be tested for cancer drugs that are resistance to the tumor cells and find those drugs that are sensitive to killing all cancer cells. This is done prospectively within about a week. After surgical healing, the patient will then know what cytotoxic cancer drugs to avoid and which ones to use for adjuvant treatment.

Sources:

Mayo Clinic
American Board of Surgeons
Society of Surgical Oncology

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