Update on latest surgery and possibe Pleural Effusion?

michael916

Hi all. I have a few questions/concerns re: my mother's recent VATS which included the resection of her upper right lobe. Pathology did confirm recurrent poorly diff. carcinoma. According to surgeon entire tumor was removed, yet it was noted that tumor had arisen within her scar (from prior radiation) and that the tumor did reach the visceral pleural surface. My questions are 1) Does the fact that the tumor grew back within the radiation scar suggest radiation was completely ineffective (not sure if that really matters now) and 2) Does the fact that the tumor reached the pleural surface mean that Pleural Effusion is inevitable? Last question is that there still is a small tumor within the lymph node adjacent to the preaortic ciliac artery. Was told this location is close to impossible to get to and not sure radiation is an option given the vital organs it would have to travel through. Has anyone dealt with a tumor in this location? And if so how was it treated? Thank you for any assistance. I know these are questions for her onco yet have not had the chance to discuss with them yet and who knows when I'll get the chance. Also, thanks so much for all of the help and advise and sympathy I have receieved for so many of you. While it is really unfortunate for all of us to have a need for a site like this, this site has been a great benefit. I am truly thankful for all of your help.

Thoughts and prayers to all in their struggle with this disease. Cancer truly is a horrible thing.

mommysgirl

Hi Michael
It sounds like your moms vats procedure went well for the most part. I am not of much help in the areas you have questions. The only person I have ever known to have a tumor in that area it involved almost the entire aortic arch and WAS inoperable. I know he did have radiation and chemo, but to no avail. I do not really understand your question regarding pleural effusion, since this is a process that has nothing to do with the cancer itself. A pleural effusion is simply a layer of fluid building up in the pleural space of the lungs. The pleura being the thin layer that covers the lung. This could happen to anybody, but as for your mom she would be at higher risk for this to happen, post VATS procedure. Some pleural effusions resolve on their own some have to be drained off. I hope this helps.. Good Luck
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mommysgirl

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pbj11 · Site Admin Joined: 12 May 2007 Posts: 1035

Hi Michael,

Glad to hear the VATS procedure is over and I hope your Mom is on the mend. I find it interesting to hear that the tumor re-grew in the scar tissue. I just posted information regarding one of my husband's tumors that also reoccurred after having been nuked and gone for over a year. He also had poorly differentiated adeno. Not the one to pick out of a hat.

I don't know much about radiation in the mediastinum, as that was not considered in my husband's case. He had large sub-carinal masses and later one tumor that encompassed the pulmonary artery. They mentioned, at one point, that radiation or laser opening might be done for palliative purposes on the pulmonary artery. I guess it's a tricky area to nuke.

I don't think that it necessarily means that she will have effusion issues because of the contact with the pleural area. Effusion does occur from a variety of reasons, the advance of the the cancer itself and irritation from either chemotherapeutic agents or radiation. My husband had huge issues with pleural effusion, but his were mostly due to chemo irritation. He had multiple thoracentesis procedures done, but most people have pleurodesis for recurring effusion. He also had effusion that did go away on it's own following a successful chemo regimen (Navelbine). Alimta brought back the effusion. He had very touchy and compromised lungs, so it didn't take much to set off his effusion.

Remember, we aren't in the medical field here, just passing on our personal experiences. It's a great place for information gathering, but every case is so very different. I hope for nothing but the best for you Mom following her next visit.

Good luck!
PBJ
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Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

michael916

Mommysgirl and PBJ, thank you both very much for your help and please accept my apologies for getting back to you both so late. Partly overwhelmed and partly not wanting to log in for a while. Sometimes it's too easy to let your own life distract you just enough so as to feel like everything is fine and coming here just brings you back to reality. Well enough of that, I hope things are going well on your end. It's been three weeks or so post op and we have an apt with onco next week to discuss options moving forward. What's strange is the onco she has seen at UCSF on advisory terms only mentioned would not combine avastin with tarceva, yet most of what I read does suggest the results of that combo are very promising. We might be going to UCDMC for other options.

Thank you again for all of the positive thoughts and insight.

Best regards,

Michael

pbj11 · Site Admin Joined: 12 May 2007 Posts: 1035

Hi Michael,

I have no Avastin experience as my husband wasn't a candidate due to bleeding issues. I don't know that I've seen this mix in a first line treatment though. Usually they go with something like Carbo/Taxol and maybe add Avastin to the mix. After 4-6+ cycles they may just leave the patient on Avastin. I don't see Tarceva used too much in first line treatment, but I've seen some discussions on this. One of my friend's husband is in a Tarceva/Avastin trial for second line therapy. This was following radiation and Carbo/Taxol.

As for not checking in and living your life --- I say go for it! As parents, my husband and I truly wanted our adult children to continue moving ahead with their lives and we tried to maintain as much normalcy for them as possible. I didn't want their Dad's cancer to become the be all and end all of their lives. It shouldn't be. If an adult child is not in the primary caregiver role, there is no need for a huge hands-on approach to your parent's cancer. (Unless your parent is single.) My kids knew we were capable of handling all the treatment, appointments, etc. and of course all treatment decisions were strictly up to my husband. They were kept informed and visited as usual. This was our perspective and what we wished for their lives.

Just drop by every now and then to let us know how she is doing. We're here when you need us.

Take care,
PBJ
_________________
Husband diagnosed with NSCLC Stage IV. (Non-Small Cell Lung Cancer) Fought & lived 2 1/2 years with multiple lines of treatment.

Post describing our battle: http://cancerforums.net/viewtopic.php?t=7026&postdays=0&postorder=asc&start=0

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