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gardenmama’s journal

Cancer questions

· 🌡️ 39°F

I have a friend who is battling esophageal cancer. Her sister sent me the following update, which I received today:

A few weeks ago she had a lung drained and they were going to drain the other the following week. After a week's delay due to the stomach flu she went in to have the procedure done. They determined the same lung had filled up again (worse than the lung they hadn't touched yet) and drained it again. As per (patient), they have no intention of draining the untouched lung. They stopped chemo (fluid in lung is side effect of chemo) and don't plan on resuming it until after Thanksgiving. They're keeping an eye on her lungs and she'll have a CAT scan just before Thanksgiving to determine how to proceed with chemo so that her lungs don't continue to fill with fluid (other side effects are tearing eyes, which (patient) says are much less teary since stopping chemo and thick crusty nails which she is grateful it's glove weather so she can hide her hands now, and also total exhaustion which she hopes, with these weeks off, will help her regain some strength).

I am curious as to why they wouldn’t drain the second lung, especially if it’s causing her pain, as is my understanding. Also, is this really a side effect of chemo (I don’t remember this being a problem with my husband)? Does anyone know?

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💬 10 comments

  1. tinypliny ·

    Did she have esophagectomy - surgery dissecting out the cancer + lymph nodes before chemo? Pulmonary edema is the #1 postop complication after esophagectomy for thoracic (lower-part which is in the chest cavity) esophageal cancer.

  2. tinypliny ·

    And to answer your other question, yes, it's possible that pulmonary oedema is a side-effect of chemotherapy (neo-adjuvant/or otherwise) but no, it doesn't always occur is all patients.

    With regards to your question about why they are not attempting lung drainage again or even in the other lung, I don't really know. Maybe the bonafide surgeon (I am looking at you, @jenks) could give us some insights of postop/post-chemo edema management?

  3. gardenmama ·

    No Tiny, no surgery. I'm not sure of all the details but when she was diagnosed it was stage 4 and she had a tumor the size of a golf ball. Also, there's something about the "type" of cancer that it is that's not the "usual". I could have this messed up but I believe it involves something with there actually being cancer in her saliva/her saliva being cancerous? Anyway, she's been through radiation and was in some type of chemo study but then had to stop it because she became too ill. So they went to a different type of chemo.

  4. tinypliny ·

    If she didn't have surgery, it does sound like she was receiving neoadjuvant (to shrink the tumour to a manageable size) before surgery. I am not really familiar with the treatment protocol for advanced stage esophageal ca so I need to read before I say anything completely inaccurate.

    Hmmmm.... were the cancer cells shedding in her saliva? I need to read up about this.

    @jenks?

  5. tinypliny ·

    Some more questions - was she a smoker? Did the lung have any traces of cancer? Sometimes malignant cells can be detected in the saliva when you carry out a PCR (Polymerase Chain Reaction) assay on the saliva. But this technique picks up small number of malignant cells in the saliva.

    :/ I need to read up about this!

  6. tinypliny ·

    What I meant was PCR is very sensitive and picks up EVEN small number of malignant cells in the saliva.

    Based on what you are saying, it would seem that this patient had large number of shed malignant cells in the saliva. So PCR may not have been necessary.

  7. jenks ·

    I must have felt you calling my name tiny, after four months away, I'm baaaack....

    minor correction tiny- fluid in the lung like that (technically in the pleural space, between the lung and the chest wall) is called pleural effusion. Pulmonary edema is a little different. But nonetheless...

    I don't know side effects of all chemo all that well, but effusions (malignant effusions) are unfortunately pretty common in advanced cancers (particularly breast). May well also be due to chemo. Usually they will tap the fluid a few times, but if it keeps reaccumulating, they will try a procedure called pleurodesis, in which they put a chemical irritant (usually talc, or sometime doxycycline or bleomycin) in the pleural space- it makes the lung 'stick' to the chest wall, so the fluid can't accumulate. If that doesn't work (it doesn't alway) they may have to do surgery to accomplish the same thing, or if surgery isn't an option for whatever reason (patient too sick etc) they may just leave a tube in to drain the fluid.

    As far as only doing one side... Any time you stick anything into the chest, there's a risk of collapsing the lung. Which is bad enough, but collapsing both is even worse, so usually they'll only do one at a time, just in case. But if they really have "no intention" of EVER tapping the other side... I'm not sure why that would be.

    But side effects depend on the specific chemo regimen- which may be why her husband's experience was different. Nausea/vomiting/fatigue are pretty universal, though.

    And one last comment, effusions aren't usually PAINFUL per se, but cause (sometimes severe) shortness of breath.

    Hope that helps!

  8. jenks ·

    p.s. I've never heard of cancer cells in the saliva, unless I suppose it was cancer of the salivary glands...
    Won't say it's impossible, but i haven't heard of it.

    Unfortunately, esophageal ca is a 'bad actor'.

    And stage IV anything is usually inoperable. I'd have to check the guidelines, but even chemo/radiation is usually more palliative than curative at that point.

    Even if surgery were an option, an esophagectomy is no joke.

    I'm sorry you're having to deal with this... best wishes to everyone.

  9. tinypliny ·

    Thanks for clearing stuff up, @jenks.

    Good luck to your friend @gardenmama. She will be in my prayers.

  10. gardenmama ·

    Thank you both for all the info. Tiny, yes, she used to be a smoker, but not an everyday smoker, usually only an occasional social smoker. Whatever her form of cancer, the dr.s said it was some rare type and that she doesn't really fit the demographic for it at all. Yes, the treatment has been primarily pallative and trying to buy some time. She has a teenage daughter whom she's pretty determined to see graduate from H.S. next June; though she has already surpassed what they initially expected - I'm guessing out of sheer stubbornness.

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