It is quite common for people with lung cancer to develop a collection of fluid between the sheets of tissue covering the lung (the pleura). This is called a Pleural Effusion. It is potentially life threatening, because it takes up space in your chest - space that your lung would normally fill when you breathe in. A pleural effusion can make you quite breathless because the affected lung doesn't have enough space to expand properly. Untreated, it may ultimately lead to suffocation. Also, the liquid can contain cancer cells and, in effect, become a "cancer soup" residing up against the lower outer lining of the lung. Even effective chemotherapy will have no impact on the cancer cells in this soup, which will continue to subject the lower lobes of the lung to contact with cancer cells.
The
initial treatment is to drain off the fluid. This is called a thoracentesis
(thora - sen - tee - sis) and despite the name, is fairly simple. First, you will have a local anaesthetic injection in one
side of your back, where the drain will go in. When this has had time
to work, the doctor will make a small cut and put in a larger needle called a
cannula. This hollow needle is attached to a tube with a drainage bottle
or bag on the end. If you have more than a litre of fluid inside your
chest, it will have to be drained off slowly. So the doctor will put in a
stitch to hold the cannula in place. Once it is secure, you can walk
around carrying the drainage bottle. You will have to stay in hospital for
a day or two while the fluid drains.
Remember- if your
tube is connected to a bag or bottle, don't raise it above the level where
the tube goes into your chest. If you do, you could allow the fluid back
in.
If there is not much fluid, the needle won't have to be in long and you may just
have a dressing put over it temporarily. Once the drainage has stopped,
you will have a chest X-ray to make sure it has all gone and then the drain can
come out. This only takes a second. Your nurse will put a dressing
over the small wound site and then you can go home. If you had a stitch to
hold the drain in, this will need to come out in about a week.
To
keep the fluid from coming back, (which otherwise can lead to fatal
complications):
Unfortunately, the fluid can build up again. You can have it drained
more than once. But it isn't a good idea to keep on doing it, as you are
likely to get an infection there in the end, and a return might also lead to
suffocation and/or the proliferation of cancer cells.
A treatment exists to try to stop the fluid from collecting. This is called a pleurodesis
(ploo-ro-dee-sis). Because the fluid collects between the two pleural
membranes that cover the lung, the idea of this treatment is to stick the
two pleura together, so there is no space for the fluid to collect. This
won't hurt your breathing in any way.
The procedure is the same as above, except that after the fluid has drained off,
your doctor will give an injection into the chest drain. The injection
will be something to irritate the pleura and make them stick together. It
could be plain talc, or an antibiotic, or a chemotherapy drug called bleomycin*.
Once the talc or drug is in, the doctor will clamp off the tube for an hour or
so. Your doctor may ask you to shift position every 10 minutes or so (side
to side and front to back). This helps to move the drug or talc around
inside so that it coats the pleura all over. After the hour is up, your
doctor may connect a suction tube, which helps to encourage the pleura to stick
to each other.
Then the tube can come out, the
stitch pulled together and a dressing put on. Once again, the stitch will
need to come out after about a week.
A fluid under the heart is called a Pericardial Effusion, and must also be drained, followed by the tissue below the heart being surgically treated via a relatively simple procedure to eliminate future fluid build-up.
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From the Web Site administrator:
* Talc, which has the highest success rate at about 97%, can only be administered if the production of fluid stops for at least 90 minutes. Wait no more than 2 days to see if the fluid will stop. Otherwise the various alternatives, such as Bleomycin, should be tried immediately. (note: it is not acceptable to "wait" until the problem becomes more severe before taking action). If any given drug fails to obtain the desired result, others can still be tried. Talc costs a few dollars; Bleomycin costs many thousands. Some oncologists and/or specialists may resist performing this procedure with patients who have advanced cancer. However in order for the patient to have a shot at being one of those fortunate few who are long-term survivors, these fluids must not be ignored.
This is an excerpt from an e-mail sent to this site that describes one person's experiences:
I am a breast cancer survivor (it has metastasized to the liver, but I am now in remission after an additional 7 rounds of chemo). I am very lucky with the oncology team I have found and the support team I have bumped into after the initial 'terminal' diagnosis. In my observation, you are absolutely correct in the way cancer seems to be approached by a majority of care givers. As they are used to dealing with elderly patients they have a fatalistic & minimal intervention approach to 'terminal' patients. It seems to be the younger patient's responsibility to remind them that we (FYI, I will be 40 this year) *want* to live and are not willing to give up as readily as someone of advanced years might. I wish Cecily had had more time, she seemed like a neat girl. I am sorry for your loss. Odile
[The opinions expressed above are strictly those of this website creator, based on his personal experience. They do not represent the opinions of anyone else. There may be patients, especially of advanced age, who wish for exactly the opposite. They may not wish to endure the pain of additional treatment. Or they may be very satisfied with the long and wonderful lives that they have lived, and may not want an aggressive effort and an uncomfortable fight during their later years. But the system of treating late stage cancer patients MUST respond to the distinction, and offer treatment accordingly.]
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