Side effects from Esphagectomy

LorettaMarshall said:

Keyzj~Origin of pleural effusion needs 2B determined quickly

Dear Keyzj:

It’s so kind of you to try to find some help for your cousin’s present condition.  An Esophageal Cancer diagnosis is devastating and it affects all the members of our family.  Even after a successful surgery, we can never rest easy that it will not recur since it forever remains a possibility, although the earlier the diagnosis the better the outcome, as a rule.  So it would be quite natural to wonder if this pleural effusion indicative of a recurrence, so your cousin must be tested conclusively in this regard. 

It’s my usual practice to see if I can find some useful information that will help our cancer brothers/sisters find some helpful solutions.  I’m all for making myself aware of possibilities and then consulting with my oncologist and asking very pointed questions.  It is my belief that first we must “own” our diagnosis and not depend on someone else to tell me what’s going on in my life.  Having followed this link for the last 14 years, I don’t recall a multitude of survivors that experienced a fluid buildup in the lungs.  That’s not to say there aren’t any, but I haven’t noticed it to be a repetitive condition for post-surgical EC patients.

As for me, since my diagnosis in 2012 with both Peritoneal Carcinomatosis and Ovarian Cancer Stage IV, I have had what seemed to be almost half a liter of fluid drained from my lungs during my hospitalization for Cytoreductive Surgery.  Since then, there has been no recurrence.  So I just attributed it to my ongoing cancer.  The surgery was never intended to be “curative” but rather a “pre-emptive strike” against further metastasis to other organs in my abdomen.   

Far be it from me to know what might be the cause of your cousin’s fluid buildup, but I did find a link that talks about being able to test the pleural effusion that I find interesting.  As is often the case, there are some very beneficial sites but often they require a subscription or are limited to medical professionals.  That is the case for this site, but it seems to suggest that “With “UpToDate”, you can look up a specific question — anything from a symptom you're concerned about to a condition or treatment you've been discussing with your healthcare provider.” If I subscribed to every site that has useful information, I would be broke, as well as totally confounded.  So I’m not suggesting that you pay money to any of them.  However, when they give abstracts of information contained therein, I find that helpful.  With that in mind, I will give you a few links that may give you a hint as to the way doctors will seek to decide the cause of your cousin’s condition.  It requires immediate attention.  And as always, it is wise to secure a SECOND opinion, when one is not absolutely convinced that they are receiving the very best treatment from their current physician’s group.

As a note of encouragement, I always like to share with Esophageal Cancer patients that there are long-term survivors.  My husband William is now into his 14^th year of survival after his initial diagnosis of Adenocarcinoma at the GastroEsophageal (GE) junction in November of 2002.  He has not suffered any setbacks along the way.  His thoracic surgeon was Dr. James D. Luketich, the pioneer of the Ivor Lewis Minimally Invasive Esophagectomy (MIE) at the University of Pittsburgh Medical Center (UPMC).  We always suggest finding a facility that majors in the latest laparoscopic procedures for Esophageal Cancer. This is definitely MAJOR surgery and outcomes will vary depending on one’s choice of doctors!  While I can’t offer you any conclusions with certainty, I note that a PET/CT scan seems to be very beneficial in determining the cause and makeup of the fluid.  From what I have read, it seems that an analysis of the fluid can be rendered quite quickly with great accuracy. However, I’m not giving you a piece of professional advice.  That’s beyond my paygrade.  Perhaps someone else will read your letter, and offer a different perspective.  I’m just always curious as to the outcome when an EC patient is having difficulties of any kind.

It is my prayer that your cousin is not going to be found as having a recurrence.  And the sooner that is ruled out as a cause, the better. 

Sincere best wishes for your cousin,

Loretta

1.  http://medical-dictionary.thefreedictionary.com/thoracentesis

(Definition of “THORACENTESIS)-  “Also known as pleural fluid analysis, thoracentesis is a procedure that removes fluid or air from the chest through a needle or tube…”

2.  http://www.medicinenet.com/image-collection/pleural_effusion_picture/picture.htm

Here is an understandable illustration of pleural effusion –  “Pleural effusion: Excess fluid between the two membranes that cover the lungs (the visceral and parietal pleurae) separating the lungs from the chest wall. A small quantity of fluid is normally spread thinly over the visceral and parietal pleurae and acts as a lubricant between the two membranes. Any significant increase in the quantity of pleural fluid is a pleural effusion…”

3.  http://www.uptodate.com/contents/diagnostic-evaluation-of-a-pleural-effusion-in-adults-initial-testing

“Diagnostic evaluation of a pleural effusion in adults: Initial testing…determining the cause of a pleural effusion is greatly facilitated by analysis of the pleural fluid. Thoracentesis is a simple bedside procedure with imaging guidance that permits fluid to be rapidly sampled, visualized, examined microscopically, and quantified for chemical and cellular content. A systematic approach to analysis of the fluid in conjunction with the clinical presentation should allow the clinician to diagnose the cause of an effusion in about 75 percent of patients at the first clinical evaluation [1]:

●A definitive diagnosis, provided by the finding of malignant cells or specific organisms in the pleural fluid, can be established in approximately 25 percent of patients.

●A presumptive diagnosis, based on the pre-thoracentesis clinical impression, can be substantiated by pleural fluid analysis in an additional 50 percent of patients.

Even with a non-diagnostic thoracentesis, pleural fluid analysis can be useful in excluding other possible causes, such as infection, or guiding subsequent diagnostic studies. Thus, clinical decision-making information can be gained from pleural fluid analysis in over 90 percent of patients [1]…”

4.  http://www.uptodate.com/contents/diagnostic-thoracentesis?source=see_link

“Diagnostic thoracentesis …Thoracentesis is a percutaneous procedure during which a needle is inserted into the pleural space and pleural fluid is removed either through the needle… "Diagnostic thoracentesis" refers to removal of a small volume of pleural fluid for analysis, while "therapeutic thoracentesis" refers to removal of a large volume of pleural fluid for relief of symptoms…”

5.  http://www.uptodate.com/contents/diagnostic-evaluation-of-pleural-effusion-in-adults-additional-tests-for-undetermined-etiology/abstract/25?utdPopup=true

“Medline ® Abstract for Reference 25 - of 'Diagnostic evaluation of pleural effusion in adults: Additional tests for undetermined etiology'… CONCLUSIONS: On PET-CT, the presence of concomitant pleural abnormalities is the most accurate criterion in determining the malignant nature of pleural effusion. -

AD- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.”

_____________________End of references_________________

Thanks Loretta for your info.

Regards,

Joel