"Invisible" tumor causing pleural effusion

We met the onc today to decide our next steps.

Unfortunately in terms of curability (if any), he said my mom's condition is less favorable than visible tumor because there is no localized resectable target. Still, we have the solution that is redoing pleurodesis, which will prevent pleural fluid from accumulating IF done perfectly. He also mentioned that a perfect pleurodesis would have sort of "preventive" benefit, as it eliminates space for malignant fluid accumulation which may lead to tumor development. It certainly does not mean that the disease won't progress in other ways, but we will take it if it at least means permanent or long-term elimination of pleural effusion.

The pleurodesis will be done in weeks once X-ray shows "sufficient" accumulation of fluid -- after the fluid is drained of course. We will then take a 2-month break starting today before she undergoes the coming rounds of Irinotecan + Avastin + Xeloda. Finger crossed the cancer does not progress during the break and the new drug works better than Oxaliplatin.  I try to be optimistic. It is really tough enjoying only one month of NED and having to watch her going through the ordeal again

@Traci, my mom's PET scan from early January was 99% clear, the 1% being "inactive pleural fluid" in her left lung, according to the report. If there were mets in other places, they are probably undetectable even with PET scan. The onc said today that the fluid was most likely an early sign of my mom's current condition, and indicated that the cancer does not fully respond to Oxaliplatin.  We had to stop using Oxaliplatin anyway due to the toxicity.

Thank you again for your kind words. I really appreciate that you took the time to read and respond.

Hello friends,

i would like to give you an update on my mom:

- Pleurodesis for the left lung failed the second time. There was a faint shadowy area in left lung on X-ray. Our onc was quite certain it was tumour. First time it became visible so progression is implied. So no more chemo break now. We started chemo and wait for the fluid to naturally drain, assuming the chemo is working.

- Latest test result shows that my mom is KRAS wild type so the onc replaced Avastin with Erbitux. Xeloda is deemed ineffective so it was dropped. My mom started her first cycle of Irinotecan plus Erbitux a week ago. Tolerating it really well. No diarhhea at all with very manageable nausea, and some rash from Erbitux. 

- I would like a CT for accessing the exact size and location of the tumour but our onc advised against it. He said X-ray should be enough to access the effectiveness of chemo for now. I am a bit confused but maybe it's best to save it for after a few more chemo cycles.

-  I asked our onc a few times whether surgical resection of the tumor in pleural cavity (not on the lung itself) is possible. He said no, which is different from my research findings. So I am considering having second opinion at some point to seek possible treatment other than chemo. Other than surgery, maybe radiation? I am aware it would not be curative but hoping it at least resolve the recurrent effusion. My mom is having a hoarse voice caused by the effusion and it's sometimes depressing, constantly reminding her of the cancer.

I have been following the recent posts and I know that some among us have experienced setbacks. I believe we can beat this dreadful disease together. Stay strong.

Trubrit said:

Xray - Really?

I can't say I've heard of anyone being followed with an Xray. Most of us have CT scans and PET scans. Have you thought about getting a second opinoin?  Thats the route I would take. 

TRU

Hi Trubrit,

That's what I thought too. I will bring up the topic again next time we meet the onc.

My mom's last PET scan was done in January. Next one would be around July as our onc recommended doing a PET scan every 6 months.

Trubrit said:

OK

A PET scan in January is good. You don't want too many of those.  Still, I'm not sure why not a CT scan; even though too many of those isn't good for a body. 

I wish your mum all the best and hope she joins those of us who are NED. 

TRU

Thank you Trubrit. I decided to contact the surgeon who was in charge of the resection after my mom's stage I diagnosis five years ago. For now I would like a surgeon's point of view instead of another oncologist. I hope it will be the start of our counter attack!

Thank you Traci. Good luck to you as well.

Update: The surgeon told me surgery is not impossible but whether to perform one depends on many factors. Pleural effusion implies that the cancer cells are "all over the place" so it may not be "worth it" to resect even small nodules considering the risk, unless there is definite benefit, like debulking significant tumour mass. It is best to stick to the current attack plan that is finishing a few more rounds of chemo and see what appears on the PET scan afterwards. 

Regarding CT scan, he said yes we can do one but CT scan does not tell whether a mass is malignant. X-ray should be enough for now to tell if the chemo is working. So it seems a CT scan would not change the current plan anyway.

Shortly I may also see another surgeon who was also involved before to get one more opinion. At least for now I am a bit relieved that there still exists options other than chemo.