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Almost 2 years NED now suspicious cells in fluid


Concernedson

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My dad had stage iiia squamous cell nsclc in fall 2016....surgery to remove upper left lobe, one positive lymph node nov 16. January 17 multiple radiation/chemo treatments. Clean Ct scans since every 4 months. Had plueral effusion drained in summer 17 clean fluid with no cancer cells. Plueral effusion returned aug 18. Drained last week now doctor says "suspicious cells" wants PET scan. Dad also had afib and had cardiac ablation procedure in early Sept 18 where he had multiple chest CT scans in addition to regular 4 month scans....no tumors present. What could be causing a malignant effusion when no tumors on CT scan? If PET shows active areas what's next? Do they do chemo again?

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Concernedson,

Welcome here. 

I would think the effusion cells would be more conclusive. At least, that was my experience. The diagnosis standard is visual ID under a microscope and I would think a pathologist could be more specific. 

Perhaps his docs are looking for distant metastasis and therefore his PET. My only idea is a tumor or nodule growing in the scar tissue from his resection that is too small to distinguish on a CT. 

If the PET shows a single met, perhaps more surgery or precision radiation followed up by chemo. If the PET shows multiple mets, then likely chemo. Perhaps Taxol and Carboplatin or some derivation of these followed by immunotherapy. Or, maybe just immunotherapy if his PD-L1 marker indicates suitability. 

Hope I’ve answered your question. Hope the PET shows nothing. 

Stay the course. 

Tom

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  • 4 weeks later...

Thanks LexieCat. I’m so relieved to find you all here for support. I will post back as soon as we have her results on a Thursday. She’s having the Aspira catheter indwelling put in tmrw to relieve her lungs of the fluid. My mom was a happy, healthy 67 year old woman before this all started about a month ago. 

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Dads PET showed no cancer....his Oncologist mentioned a biopsy but wants to consult with others. Seems leaning toward just monitoring things and having him do an out of cycle CT in January...not even sure what they'd biopsy given clean PET. So far positive news....whatever might be there has to be extremely small for it not to show up on regular CT or PET....

DAD was in the hospital with AFIB in August and had cardiac ablation intravenous..... then the pleural fluid was drawn about 3 weeks later....I just wonder if that didn't mess with the cytology results....shouldn't make a difference but just have to wonder.

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Doc seems perplexed about the effusion and the cytology results --

Dad did NOT have an effusion before his surgery in Nov 16 -- it only appeared after the surgery and more importantly after radiation and chemo. Surgery removed upper portion of left lung and 1 positive mediastianal lymph node (so he was Stage IIIa at diagnosis). Had small effusion Summer 17 -- Onco said likely from radiation -- drained -- cytology clean (no cancer cells).

Effusion came back Spring 18 ....  still small  -- it was monitored -- when he had Afib and cardioablation in Aug 18 they decided to drain the fluid again.... this time cytology "suspicious" (though they are not entirely clear on that -- didn't say positive for cancer just suspicious). Set up PET scan - Late Oct had PET -- which shows no active cancer areas. Onco said he was "surprised" by the initial fluid result himself given every regular CT (every 4 months) plus the extra CT scans they did during AFIB showed no tumors anywhere.

Anyway -- Onco said he might/might biopsy but was going to conference with other Onco's in the field first -- said it was more likely they'd just have him come back for an "out of cycle" CT scan in January. He was about to move to only twice a year CT's -- their normal practice once you are 2 years out with clean CT's every 4 months. Like I said I am not sure what they'd biopsy (pleural space?) given clean PET.

Doc seemed positive -- said if anything is there it is so tiny it can't be detected on scans (thus I think the decision to monitor). Dad's "type" is Squamous Cell which I understand is slower growing than the more common Adenicarcinoma. Also less likely to mets outside of thoracic region.

Doing my own research seems to be a lot of papers linking disruption of mediastianal lymph nodes to fluid production -- given they removed one positive node at surgery and then blasted that area with a ton of radiation post surgery I feel fairly sure at least the initial pleural effusion was caused by that. Not sure why it keeps coming back. He does have the ongoing cardiac issues (hardening of the arteries etc) and has an ultrasound of his heart scheduled in December. Pleural effusion caused by heart failure however is usually bilateral and his is only on the same side as the lung that was operated on -- blasted with radiation...

Dad's only symptoms have ever been (again only post surgery and radiation) coughing up a little clear fluid every once in a while (maybe once a day).... Pleural fluid has had NO blood in it.

 

 

 

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  • 2 weeks later...

So ONCO conferenced with surgical team and they decided to be safe they should do a biopsy of the tissue likely near his resection from 2016. Dad met with ONCO and surgeon and both said we can NOT say your cancer is back but want to look and sample nonetheless. As I noted PET scan was clean...so if something is there it's very small. They are going to do it after xmas and said unless they found something unexpected requiring more significant operation hed probably send him home on same day. He was leaning toward inserting a drain for the plueral fluid so Dad wouldn't have to have repeated needle drains....again said that was up to Dad. Seemed optimistic that whatever might be there is so small they could get it....and confident that given PET result it was unlikely to be anywhere but in the original diseased lung.

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Concernedson,

It seems like you've got a plan.  I wonder what tissue is the target also but have read that disruption of the mediastinal nodes leads to fluid production also.  Perhaps a plural fluid drain is a good idea.  Let us know the outcome.

Stay the course.

Tom

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