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[ Post a Response | Breast Cancer Recurrences Board ]
Posted by Diane C.-TX on 5/19/2008, 11:17 am, in reply to "dr's want to stop chemo??"
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I can feel the desperation in your words. Maybe I can explain some of it. Once the diagnosis of malignant pleural effusion has been made, the treatment will depend on the tumor type and prior chemotherapy. Generally, when these effusions are stable, about 25% of them do not require any treatment. Repeated percutaneous draining of effusions are avoided because they may lead to tumor growth along the needle track and through the chest wall. Since your mom has received extensive prior systemic therapy(and sounds like she has some chemotherapy-resistant tumors), her cancer, at this time, is not likely to respond to systemic therapy. Palliative approaches to the management of malignant pleural effusions are necessary in such patients. By this I mean that her cancer treatments will coincide with her symptom management care. Since she is currently asymptomatic, no treatment is necessary. When she does become symptomatic, there are two general approaches to take. One is to insert a chest tube in order to instill a sclerosing agent. The second one is to do a thoracoscopic drainage of the pleural effusion under local or general anesthesia with intraoperative sclerosis of the pleural space. If none of these treatments is an option, or they are tried and do not work, then a pleuroperitoneal shunt is inserted. This shunt helps with decreasing the shortness of breath associated with malignant pleural effusions; however,one out of four shunts usually become occluded from the cancer cells that continue to grow. Xeloda converts to 5-FU inside the cancer cells and interferes with the RNA processing and protein synthesis that is needed by the tumor to progress--thus holding the cancer at bay. Quality and Quantity of life are two topics to discuss openly with your mom now. I am not a physician, nor do I give medical advice. With my experience as an oncology nurse, however, I have seen patients extend their quantity of life, with reasonable quality. It is important though for your mom to know that if and when quality becomes harder to attain, that she let her oncologist what SHE wants to do. I hope this helps. Love, Di
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