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sara k

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I am wondering how they determine whether or not to operate, use radiation etc. My husband has stage 3b adeno. The cancer is in the pluera. The doctor has said this is inoperable but I have read about similar situations where they do operate.

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Please make sure you speak with a general thoracic surgeon whose clinical interests include pleural effusion. You said 3B, and I could be wrong but I imagine there is fluid buildup, so make sure you ask about a pleurodesis. That is where they adhere the lung to the chest wall with talc, to prevent any further fluid buildup. I learned the hard way that oncologists usually only want to use chemo because it is their forte. And whether it works or not, they will use it on a trial and error basis because it is extremely lucrative. My mom's cancer was in the pleura as well. They called it cancer of unknown primary, but have been treating it as lung cancer. No tumors or mets were found, so they figured cancer cells just settled in the pleura. The consensus among most oncologists is that if the cancer has spread to the pleura, then it is inoperable.

Does he have a pleural effusion(fluid buildup around the lung?) If he does(my mom did), the logic behind the word 'inoperable' in my mom's and your husband case is that the fluid serves as a conduit for spread. If there is no discernable tumor mass, then an operation would not be curative. That means, even if they were to remove the pleura, or entire lung for that matter, the chest wall would still be infected with microscopic cancer cells. So chemo is the only way to get to all the cancer cells because it goes thru the entire system. However, I also learned the hard way that there are surgeons who will operate on cancer that is metastatic to the pleura. We found one near Chicago.

I don't want to scare you, but whether surgically or medically, if there is pleural effusion get it taken care of quick. Because my mom waited until her entire right chest cavity filled up with fluid, and later developed a trapped lung. This happens in 10-30% of cases with malignant pleural effusion. This is where the lung becomes encased with fibrous tissue that prevents the lung from re-expanding. At this point, the oncologist sent her home with a do-it-yourself chest drainage kit called a Pleurx. We later found out from our new surgeon that that was a mistake because it can be a means of developing infection. The good news is, all her recent tests on her fluid have come back negative for cancer cells, so the chemo worked. Also, her CT and PET scans are clean. My mom just needed a surgery to re-expand her trapped lung, which she had this week and is doing fine.

Most doctors say that rather than treat the effusion itself, you have to treat the underlying cause, namely the cancer. I would tend to agree in some cases, but as was the case with my mom, pleural effusion can be hard to treat with chemo and the fluid buildup just got worse and worse. The point is, make sure you talk to a general thoracic surgeon who knows about the minimally invasive video-assisted procedures for lung cancer. My mom's new oncologist admitted he wasn't a lung specialist, and didn't even understand the severity of a trapped lung, but at least he was man enough to admit it, and encouraged us to seek a second opinion with this surgeon. I even asked the surgeon why the first doctors didn't do the pleurodesis first, and she said it was because we didn't talk to a surgeon, only oncologists and pulmonologists, and what do they know about surgery??? As you can imagine, I am not very fond of my mom's local hospitals and have let them know.

Sorry about rambling on but I feel obligated to share all my extensive research with you to give you guys the best chance of beating this. Also, I don't want you and your husband to go thru the frustrations and late revelations we went thru. I could become a doctor with all the research I've done. Also, make sure your husband gets a PET scan so that they can single out the primary site if there is one.

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