Where will lung fluid go after Pleurodesis

My mom has lung AdenoCarcinoma, which caused fluid build up in her left lung. We found out ~ 1 month ago, still going over the shocking and fearing stage.

She was drained 450ml first time (6/16/11), and ~240ml 2nd time (7/19/11). Doctor was suggesting Pleurodesis, basically fuse the lung with chest wall, so that fluid can not accumulated in lung anymore.

My question is: where will the fluid go?

Since the cancer is the cause, the fluid should kept on coming back. Is it better to let it drain in the lung (her cancer is still localized in lung only), instead of letting it sip through her whole body?

This maybe just silly thoughts. Any advice is greatly appreciated.

Thanks,

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my Mom has the same ca and had pleurodesis on May 7th. So far no more pleural effusions. The first time they drained her for 1500 mls in the er. that is how they found the cancer bc she couldn't breathe and we called
911. Pleurodesis worked for her, it scars down the area bc the talc irritates the lining of the lung and doesn't allow the fluid to reaccumulate. It simply has nowhere to go.
Good luck,
Dee

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My guess is that it would be reabsorbed into the body instead of accumulating. Dad had a massive plueral effusion and has a pleurex catheter to drain it. They empty it every few days.

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I had pleural effusion. My lung full of fluid was drained in the hospital. Had small amount of fluid before I started chemo. Fluid went away (don't know where) and never returned

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Thanks so much for your replies. I was worried that it could make things worse (spread cancer faster), maybe it is not so bad.

Do you think Pleurodesis is what doctor will provide mainly for Stage IV cancer patient? So, the focus is to relief the symptom. I am yet to believe that she is Stage IV. Pet scan showed cancer is still local in her lung, and only reason for stage IV is that cancer cells were found in her pleural effusion. Am I too unrealistic?

I like this website a lot already. It has a nice supporting group. Thanks again,

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I am sorry for what your mom is going through, I too have had a lot of problems with fluid, an unlucky small percent of us get pleural effusions. I always assumed the fluid gets absorbed throughout the body, but I never asked, might be a good question for Cancergrace.org. It is important to get rid of the fluid because as I was just told by my pulmonologist, if the fluid stays too long the lung may not work properly even when the fluid is removed. As far as staging, I believe that any effusion is considered stage four is a more recent change in staging. Here is a link with some information about living with LC and how it is staged.
http://www.nationallungcancerpartnership.org/index.cfm?page=contents
Best to you and mom
Lia

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The fluid is absorbed by the lymphatic vessels that naturally drain that space. Even in healthy lungs there is always a small amount of pleural fluid between the two pleural membranes that line the lungs. I think of it as a sort of lubricating fluid that lets everything move smoothly as the lungs expand and contract. When there is a problem (in this case lung cancer) excess fluid sometimes accumulates there. Too much fluid accumulation compresses the lung tissue nearby making it hard for the lung to do it's job. If enough fluid gathers it can partially or completely collapse the lung. In such cases the fluid needs to be drained to help the person breathe. For some cancer patients this becomes a chronic and/or recurring problem. If so, they may opt to do pleuradesis in which a sterile irritating substance, such as talc is injected into this space via a chest tube. The irritation causes scar tissue formation and the two pleural membranes fuse together, thereby preventing further fluid accumulation.

Letting the fluid stay in the lung area (between the membranes) may be ok if there is a small amount but isn't a good option if there is very much of it since it can hamper breathing.

If you want a picture of what this all looks like just go to Google Image Search and enter "pleural effusion". That will give you a good idea of what's going on.

S

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My husband also had pleurodesis (spelling?) But I am learning from this site that it means fusing d membranes together. Very Interesting. Yes, I wonder where the fluid will go if the cancer is still producing the fluid.
Apra

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The cancer doesn't produce the fluid. It is normal to have some fluid there. Most likely the cancer impedes the normal drainage of the fluid out of this space through lymphatic vessels and as a consequence fluid builds up there. Fluid from the pleural space normally drains out though lymphatic vessels into the lymphatic system and eventually is returned into blood ciruclation.

S

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ming

My wife received talc pleurodesis in 1972, which is a common treatment modality for patients with malignant pleural effusion, secondary to ovarian cancer. She went 24 years before having a recurrence from a stage IV ovarian cancer.

She developed a metastatic transdiaphragmatic tumor from that original ovarian cancer with attachment to the lung and other midline structures of the chest. Parts of those structures were surgically resected.

I remember the thoracic surgical oncologist telling me the talc oozed down to the bottom of the cavity and was as hard as rock. She had to literally use a hammer and chisle to clean it all out. It seems that my wife's twenty-four years without any recurrence gives some credence to a recent study at the University of Florida.

Researchers there have discovered that talc stunts tumor growth. The soft powder stimulates healthy cells to produce the hormone endostatin. Within a day of having talc inserted, they found that patients had 10 times the level of endostatin. Talc may be able to stop the growth of metastatic lung tumors by cutting off blood flow to tumors.

http://news.ufl.edu/2007/06/06/talcum/

Greg

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I learned so much from all of you. THANK YOU! I felt much better about Pleurodesis. It is amazing if talc can even help to kill cancer cells. I will definitely let my mom have this procedure. Thanks Greg.

S, It is nice to know what caused the fluid accumulation. You are so knowledgeable. I can finally stop worrying about the fluid itself, but focus on draining it out.

Lia, Thanks for sharing the staging info as well. The doctors are right. I need to stop day dreaming.

I am glad that doctors are suggesting all the right things. We are also waiting for EGFR test, and hopefully she can have the target therapy.

Love you all, will keep you posted,
Ming

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Hi,

I am about to schedule the Pleurodesis for my mom. since the fluid is back again (1.5 months after doctor drained 250ml on 7/19/11).

One major concern is that she is 79 years old, weight ~120lb, not particularly strong. I am not sure if the success rate of 85% would still apply to her. We are actually worried about putting her through any procedure.

She hasn't start any cancer treatment, not sure if we will ever do anything due to her age. There wasn't enough cells to tell for EGF R mutation, so no Tarceva yet.

I am hoping our concern is not necessary. I need help to make up my mind. And this is the only place that I trust. Looking forward to hearing your opinion.

Love, Ming

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Ming

An option to the talc pleurodesis, if it is to your mother's liking, is having the next drained fluid sent to have a functional profile done at either one of two functional profiling labs, providing tumor cells are still present, and only live "fresh" cells can be used. Generally 100 - 1000 ml of malignant effusions are required.

It would not matter if she would be EGFR positive, or EGFR negative, or any other mutation positive or negative, a functional profile examines not only for the presence of the molecular profile, but also for their functionality, for their interaction with other genes, proteins and other processes occuring within the cell, and for their "actual" response to anti-cancer drugs (not theoretical susceptibility).

At 79 years young, there are a number of new oral-dose targeted drugs that her cancer cells may be sensitive to. Patients would certainly have a better chance of success had their cancer been "chemo-sensitive" rather than "chemo-resistant" where it is more apparent that chemotherapy improves the survival of patients, and where identifying the most effective chemotherapy would be more likely to improve survival.

Peruse the websites of these two functional profiling labs in California and get acquainted with the technology. Only the pleural effusion goes to California, not your mother.

http://www.rationaltherapeutics.com/
http://weisenthalcancer.com/

My best wishes to your mother.

Greg

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Hi, Greg:

Thanks for your insight and encouragement. Personal medicine is certainly the best for the patient and is the way the medicine field is going toward. I didn't know it is in practice already!! We will see her oncologist this Thur, and I will definitely ask if it is possible to get the functional profile done for my Mom. Insurance probably won't cover this, since it is so new, plus we are not in California. Do you know any institute in Boston area?

Thanks for sharing this valuable information!!

Enjoy the rest of long weekend,
Ming

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