Plueral effusion treatment

I have posted you in the past. Diagnosed 3c May 06. $ ip cisplatin/taxol/ then 4 iv to finish. I had remission 7 month and ca125 started rising. Two months later I had an adhesion causing a  lower intestine blockage, and my gyn/onc did surgery. No visible cancer but positive slides, ca125 169. Started gemzar/carbo the next month (Last Nov.). In late Nov. My friend, who is a pulmonologist, xrayed me for shortness of breath. Since I have a 220 mile trip to Memphis, he drained plueral fluid in my right lung. I had a reaction to carbo after 4 treatments and went on gemzar/cytoxin iv.. My ca125 went to 23, then after 2 or 3 treatments of the cytoxin/gemzar went to 33 the 125, then 376. I had my first doxil 3 weeks ago. ! week after it, I could not breathe good, my lung dr. drained off 100cc again. I go back the 9th for doxil. The lung dr. is out at my house golfing today, and wants me to get another xray this coming week before I see the onc and have mynext doxil. I talked to my onc on the phone and she said if it was back she would drain it 1 more time to try to give the doxil time to work. She said if it continued, she usually had a thoracic (sp) surgeon go in and check for scar tissue and the do a tube. I am wondering if I should change to a faster acting chemo. I don't want this fluid to attach somewhere. My ct a week after doxil was clear. I think she went with doxil because of all the low counts and bone pain I had been having.I am still having bone pain and fatigue. What do you think about all this. Just worriyng again. Thank you so much for your time...Donna ( My ca125 on original dx was only 175.)

[Annekathryn Goodman, M.D.]

Dear Donna,
I am so sorry to hear about your suffering. it sounds really rough!

You have had lots of good therapy choices. I completely agree with what your doctor has been doing.
I also agree with your question about what is the best next thing to do.

Doxil does take 3 to 4 cycles to see a response. It is a very reasonable choice after a platinum drug.

There are several ways to manage a pleural effusion (fluid in the lungs)
-drain it
-drain it and leave a chest tube in. The chest tube goes in the space between the chest wall and the lung (the pleural space). Once the fluid is completely drained dry, a medicine such as bleomycin or talc or tetracycline is instilled. this medicine causes the pleural space to seal down. That prevents new fluid from forming. This procedure is called pleurodesis.
-do a minor surgical procedure called a VATs (video assisted thoracoscopy). Under general anesthesia, a scope is inserted into the pleural space. Biopsies can be taken. Then talc is placed in the space just as with a pleurodesis
-finally a small tube (PLEURX® catheter) can be inserted into the pleural space. Thsi tube is tunneled under the skin and comes out at a distance from where it goes into the pleural space. this tube can be attached to a small, plastic  container. people with chronic pleural effusions can go home with this device. here is a link with a picture of this:
http://www.rwjuh.edu/medical_services/malignant_pleural_effusion_treatment.html

Here is a link with alot of information on pleural effusions :  
http://www.emedicine.com/emerg/topic462.htm

take care

[msjazz]

Sorry, that should be 4 IP chemo. Also why would I have scar tisue in the plueral cavity, and what happens if they put in a tube> Does it shunt through or is it some kind of outside access? Why is the fluid there instead of the abdomen? I didn't ask, I really didn't feel up to knowing that day.  Donna