Ascites and Lung Cancer

Lung Cancer stage IV has so many companions. We have talked about pleural effusion, but I have not seen any discussion on Ascites or retention of water in the stomach causing stomach distension, feeling of fullness, loss of appetite etc.

This time my husband's latest pet scan showed mild ascites, I talked this over with the onc and he said it was nothing to worry about. But ofcourse I think it is very worrying, he just finished the 10th maintenance Alimta infusion, but as there has been progression, he will not have Alimta anymore.

A new biopsy has been done taking a piece of bone from the iliac bone which was a new bone progression. He also had pleural effusion in the right lung (his primary is in the left lung), I requested that this effusion which was tapped today also be sent for cell block testing and if Positive for mutation testing as my husband has never had any mutation testing done.

Need a lot of support and comfort stories with this new unexpected development. More than anything else I am so worried about the 'mild ascites'.

Anyone of you dealt with ascites? What was your experience?

Thank you for listening.

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Thank-you for posting about this. My husband has not had any experience with this so I can only offer you an internet hug. Hopefully it will resolve itself once he is off the Alimta? Good for you for getting the effusion tested. Best wishes for your husband's recovery. Mel

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A,

Does he have liver involvement? I have never heard of ascites associated with lc unless there is liver dysfunction.

G

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Bifnreg, thank you for your warm hug. It means a lot. God be with you in this struggle.

G, That was a very wise reply. A liver function test from blood was carried out but found to be normal. This was done before the Ascites was found on the pet ct can.

G, ascites is connected with lung cancer, it is one of the cancers that can cause this condition. But as you mentioned, I believe the liver merits a closer look. Perhaps we will ask the radiologists once again to go through his pet scan and comment on the liver. Thank you.

An old post in Cancer Grace by Dr. Ramachandran also said a clot in the liver could also cause fluid to build up in he stomach.

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By the way ascites is very difficult to diagnose in he early stages. Ours was diagnosed by a pet ct scan though we were not looking specifically for it.
My husband was having stomach distension, feeling of fullness, loss of appetite and severe stomach ache for sometime before the pet ct scan. From some months back he was also having pain in the tummy while drinking water, so it was becoming difficult to keep him hydrated.
I hope this is very rare for LC and none of you experience this.
Here is a link to information on ascites in lung cancer.
http://www.macmillan.org.uk/Cancerinformation/Livingwithandaftercancer/Symp tomssideeffects/Othersymptomssideeffects/Ascites.aspx

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Malignant cells can rupture the surface of a primary tumor and released into the peritoneal cavity. The presence of ascites doesn't automatically indicate dissemination, there must be cytologic evidence of malignant cells. The malignant cells float in the fluid and begin to grow on any tissue reached by the fluid. This is called implantation or seeding metastases. Tumor clusters floating in ascites fluid can derive nourishment from the fluid itself. However, these floating balls of tumor cannot expand beyond microscopic size, without attaching to a surface and stimulating the ingrowth of capillaries.

These tumor (micro) clusters (if there is enough of them) contain tiny capillary (endothelial) cells, running throughout the micro-cluster. When performing a cell culture assay, these micro-clusters are plated into medium of polypropylene, which does not allow them to stick to the bottom and spread out and grow. They remain just as they were. Drugs are added immediately, before the cells and cultures have had the chance to change in any way. When the drugs work, they trigger apoptosis and cells die and they detect cell death 96 hours later.

Data suggest that patients' patterns of sensitivity and resistance do not change in the absence of intervening (active) chemotherapy. And even after a patient fails a previous chemotherapy treatment (which developing ascites can indicate), the testing can be done once a patient waits at least four weeks. If proper protocol is followed, evaluability rates are very high. Greater than 95% of all specimens submitted produce clinically useful results.

This is how your ascites are assay tested from ascites and pleural fluid. This is not the same technology as using cell block testing. The cell-block technique is useful for special stains and immunohistochemistry (IHC) and can give morphological (structural) details by preserving (in paraffin wax) the architectural patterns. However, when it comes to drug selection, investigators can only measure those analytes (substance or chemical constituent) in paraffin wax they they know to measure.

If you are not aware of and capable to measuring a biologically relevant event, you cannot seek to detect it. The cell-lines (cell-block) in paraffin-embedded tissue can change over time. These proliferating populations of cells are biologically distinct in their behavior from "fresh" live cells that comprise real human tumors.

The problem is that cell-lines do not predict for disease or patient-specific drug effects (drug selection). If you kill lung cancer cell-lines with a given drug, it doesn't tell you anything about how the drug will work in real-world, clinical lung cancer (real-world conditions). In a nutshell, cancer cells utilize cross-talk and redundancy to circumvent therapies. They back up, zig-zag and move in reverse, regardless of what the sign posts say.

Using genomic signature to predict response is like saying that Dr. Seuss and Shakespeare are truly the same because they use the same words. The building blocks of human biology are carefully construed into the complexities that we recognize as human beings. However appealing gene profiling may appear to those engaged in this field (for drug selection), it will be years, perhaps decades, before these profiles can approximate the vagaries of human cancer.

http://cancerfocus.org/forum/showthread.php?t=241

Greg

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Thank you Greg. Your inputs are very helpful.

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My mom had acites. She passed within a month of devloping it. She had Adenocarcinoma IV. SHE had carboplatin,alimta, 2 clinical trials, and pemetrexed. No mutations, she died just short of a year after dx.

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Leebrownlisa,

So sorry about your Mom, yes, ascites is bad news, but I hope we can fight it. Thanks for your input.

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Hello. My husband had adenocarcinoma IV of lungs and was given carboplatin, avastin, & taxol. Oct 2010) Had 7 treatments, then took 3 months off. (March - May 2011) They began Tarceva w/Gemzar after the 3 months. (June and July 2011) August 2011 he developed ascites and was gone a month later. During that last month I drained him at home, but he was miserable. Any little bit of food or liquid brought him such discomfort that he threw up constantly and lost 20 lbs. Before that he had maintained his weight, even thru chemo. The cancer cells in the ascites fluid attached to his intestines and grew so large that they twisted and that was it. I have heard of people having ascites for quite a while, like a year. But it took my husband down so quickly that I still can't get my head around it. He was doing so well and then, gone. I will pray for your healing. I think if they catch it early enough they may be able to keep it in its place. God Bless all our warriors and caregivers!

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Hi! My Dad developed acsites. He had diarreha and was unable to eat due to stomach pain and a feeling of fullness. He went into the hospital and they drained 2 liters of fluid from his stomach. The fluid was tested and unfortunately they found that his lung cancer spread to his stomach which is uncommon according to his doctor. Two days after draining his stomach, they drained him again and got 4 liters of fluid. He felt better and was able to eat a little. However, the next day, his stomach was filled again. He had some disstension but nothing horrible- like a beer gut. Unfortunately, he passed away 3 days after the second draining. his body just shut down and it happened quickly. I wish I could have given you a better experience. I would say if he is uncomfortable and unable to eat, they need to test the fluid to see if there are other issues. Good luck and keep us posted!

Jamie

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My father's experience is just like Jamie's father to the tee. Now keep in mind this is 38 years ago. The doctors did not know until they drained his stomach that he has pancreatic cancer. My dad was a mail man and back then they walked house to house. He was about 6 feet and buff. He all of a sudden lost tons of weight and his stomach got real large. He had a flat stomach and all of a sudden he looked like a bone with Sarran wrap around it and 9 months pregnant. They finally put him into the hospital and drained I think like 2 liters of fluid. He felt much better but the fluid was all back the next day. It was from the fluid that they found out he had cancer. This was on a Thursday they drained for the first time and also found it was cancer. On Friday all the fluid was back again. They drained him again and he was finally able to eat. He passed away the next day. I always thought that had they not drained him and exposed the fluid to air he would have lived. He was sick for months but the doctors could not figure out what was wrong. Then he goes in the hospital and they drain him and 3 days later he died. I'm sure things have changed since then of course but that was our familes experience. Karen

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