Plural Effusion- Artistes in the Lung (left)

We have followed this forum for several years, reading and commenting when we thought we could help. Now we need your input. Violet my wife has been fighting this since 2001, (see mobydick original name), she has taken most of the normal chemo as well as radiation, and has been managing her cancer reasonable well. However, 6 days ago, due to just feeling unwell, shortness of breath, she asked to be taken to hospital, we found Vi was in critical condition with her left lung collapsed being full of fluid. Vi’s consultants are great, phone calls were made and within 3 hours 6 top consultants were by her side. They drained 400ml of fluid, tested it and found that CA was present, so confirming this is from the Ovarian primary. Question: we realize this is very serious, but is the ‘beginning of the end’, as what we overheard, if so, what timings are we looking at, is there any one of you strong ladies/care givers that know of cases, their out come whether positive or negative. Over the past 6 days, having careful monitoring, X rays and cat scans, no fluid has returned as yet. She is feeling a lot better, apart from tiredness and a general feeling of weakness, Thanks Steve.

[medresc]

I don't think it's the beginning of the end...I guess the answer is it is not 'uncommon'.  like anything everyone's situation is different so her physicians would be best able to tell if this is something to further worry about or if the condition in the lung(s) is improving (this may take time for them to determine)

[Kimchi]

Prior to being diagnosed, I had breathing difficulties and ended up seeing a lung specialist who discovered that I had pleural effusion in the left lung,,,Had it drained and tests confirmed OC.  Since being on chemo, have not had this problem again.  What chemo was she on when she developed this problem? If she was on chemo meds, doctor will probably change the meds.  Don't see where this is the beginning of the end, to me , this is part of having OC.  

[YvonneS]

The plural effusion is caused by the ovarian cancer.  Check it out on the internet.  I had mine drained about 11 weeks ago and it is reaaly borthering me again.  Doctor had hoped the chemo (topotecan) would take care of it, but it doesn't seem to be helping.  I felt so much better after they drained my lung.  However, it is risky and they don't like to drain it unless it is full of fluid. (Or in this case, the fluid is on the outside of the lung)  I am coughing real bad and it feel like in the next few weeks we willhave to have it drained again.  I don't necessarily think this is the "beginning of the end".  There are so many side effects from other stuff and this is just one of them.  Other than the cough, I feel great.  Yet, the cancer has mestazied into the abdomeum, on (but not in) the kidneys and liver.  And this lung stuff.  Just hang in there and good luck.  Yvonne

[dian07]

Hey Steve....dian here.....I've been here since '05 and have listened and watched you and Vi so courageously battle this beast.  I have no advice or info but I do want to speak up to tell you two how I respect you both and I just want to say she is such a brave woman and I hold her up as an example to all of us dealing with this disease.  Please give her my best....I admire you tremendously and wish you both the very best....my heart and love to you both.
Peace.
dian

[Steve H]

Hi, sorry not to have replied sooner but been with Vi at hopspital most of the time, here in Jordan, there is no such thing as visiting hours, so have 'moved in' and slep there with her. Vi has progressed well, amazing her doctors at her recovery, to date there has been not reoccurence, but they are keeping her in to monitor her, she is getting board as she slowly get better, more strength etc, so hopefully they will let her go home soon. Thanks for your thoughts. To recap, treatments so far: Carb/Taxol sept 2001 to March 2002. Remission to April 2004. July 2004 to Jan 2005 Taxol/Carb, remission 9 months. Nov 2005 to Feb 2006 Genzar, 6 sessions, CA from 2500 to 34, but started to rise almost imediately. 6 month break (our choice) Sept 2005 Toptigan, CA from 4500 to 125, then started to rise, switched to Doxil (Calex) 5 session, CA static at 250. Switched to Oxiplatin from Mid 2007, CA slowly rising, to reached 2500. Now had 2 session taxol with Amimex, CA static for 2 sessions, but rose to 3500 in 3 weeks. CAT Scan showed tumers reduced apprt from in neck, started Radiation (spot treatment) CA static, but developed pleral effusion, no chemo for 6 weeks, CA reduced, neck almost gone, 2 in left lung reduced from 11mm to 7.2 mm, lesion in liver no change for 9 months at 20mm. Any ideas where we should look now. Tks Steve

[karikay]

If the pleural effusion does come back, you may want to investigate if your wife is a candidate for having some talc injected into the lining of her lung, which can help ease the symptoms and MAY even stunt the growth of lung tumors (see here: http://www.ufscc.ufl.edu/patient/content.aspx?section=ufscc&specialnews=true&id=39928 )
As for other drugs to try, I am not sure what is available in Jordan. Do you have any way of getting Avastin (bevacizumab)? It is approved for breast cancer, but has shown some benefits for ovarian patients in trials here in the US. Here's an excerpt from a paper about new treatments:
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Bevacizumab, a recombinant humanized antibody against the vascular endothelial growth factor (VEGF), has been shown to potentiate the activity of cytotoxic chemotherapy in cancers of the lung, colon, and breast. The Gynecologic Oncology Group[4] examined the agent administered alone, as a second-line treatment strategy in women with recurrent or persistent ovarian cancer. Objective tumor shrinkage was observed in this trial with the drug administered alone, in contrast to experience in other disease sites (eg, colon), where minimal activity was noted with single-agent bevacizumab. Toxic effects were similar to those documented in other disease sites (eg, cardiovascular, gastrointestinal). Based on the results of this trial, the Gynecologic Oncology Group has initiated a randomized phase 3 trial comparing the standard primary chemotherapy regimen of carboplatin/paclitaxel vs either carboplatin/paclitaxel/bevacizumab, where bevacizumab is discontinued at the completion of chemotherapy, or carboplatin/paclitaxel/bevacizumab, where bevacizumab is continued for approximately 1 year following the completion of chemotherapy. This important trial will not only explore the potential benefits of adding bevacizumab to carboplatin/paclitaxel chemotherapy, but will also examine the highly clinically relevant issue of a maintenance strategy with this class of agents in this setting.
A second study,[5] conducted by the California Cancer Consortium, examined a potential role for bevacizumab in ovarian cancer by combining the agent with low-dose oral cyclophosphamide in the treatment of recurrent disease. All patients (n = 29) entered into this trial had previously received a platinum agent and paclitaxel, with a large percentage also having been treated with a second cytotoxic agent prior to study entry. An objective response rate of 21% was observed. A number of toxicities previously described for bevacizumab, including pain and hypertension, were noted. This trial, along with the previously noted Gynecologic Oncology Group study, demonstrates the potential favorable effects of therapy designed to have an impact on both the normal and tumor vasculature in ovarian cancer.
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full article here: http://www.medscape.com/viewarticle/506519

All the best to you and your wife. :)