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Pleural Effusion Concern

Folks,

I thought I would reach out to the forum for some input on behalf of my mom. She is almost at the end of her treatment for breast cancer (ER- PR-HER2+. She started with chemotherapy last January (AC + T), surgery (lumpectomy) followed by radiation therapy. She has had a dry cough for a couple of months now and recently developed shortness of breath. We approached the oncologist who didn't find it concerning but for our peace of mind got an X-Ray done. The X-ray showed some haze, so the oncologist suggested a CT Scan, but still wasn't too concerned. The results came back last week. The haze, as per the oncologist, is most likely due to radiation and could most likely be pneumonitis. This does make sense as during her radiation therapy, they did say her lung had a slight overhang and she was asked to hold her breath during the process. She did also get a higher dosage of radiation, since the pathology reports had determined it was an aggressive form of breast cancer. They weren't too concerned by the ct-scan results and have scheduled another one in three months.


One point they didn't spend too much time on at that time was that the scan report mentioned a small pleural effusion. They did prescribe her antibiotics just in case it was an infection. She is a teacher so she is regularly exposed to students with different types of infections. Her course of antibiotics is done as of today and that has helped her a bit with shortness of breath but not really with the cough. Google is no help, since it keeps coming back to pleural effusion being probably malignant. My online search does show that Herceptin, or radiation therapy can also cause this, in addition to infections. Doctors are skeptical of it being malignancy but can't ward that off, obviously. She did have complete response to the chemo, as per the surgery. They have referred her to a lung specialist, but there doesn't appear to be any urgency. I just wanted to see if I could get advice from anyone has been through something like this before.

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Comments

  • nopink2019
    nopink2019 Member Posts: 384

    Plural effusion is how I was diagnosed with MBC. Cough, thought to be bronchial infection, wouldn't go away. Antibiotics no help. Finally ended up in ER with shortness of breath. Simple xray showed lung 4/5 full of fluid. Had thoracentisis to remove fluid. Suspected for MBC and lab results on fluid confirmed. Tumor on lung caused fluid. So if antibiotics help or shortness of breath gets better I'd take that as good sign.

  • KBeee
    KBeee Member Posts: 695

    They should be able to biopsy the fluid in the pleural effusion if it is concerning. That procedure comes with risks, but perhaps getting a second opinion from a pulmonologist could help sort it out.

  • vera66
    vera66 Member Posts: 5

    Don't google pleural effusion whatever you do. Most pleural effusions are not cancerous. I had a pleural effusion from taxotere. This is not uncommon. It took forever for the cough to go away. They did a follow up ct scan after three months and it was completely gone. From what my MO told me, malignant and non malignant pleural effusions look different on ct.

  • ag471
    ag471 Member Posts: 3

    Thank you for all the inputs so far. This forum is extremely helpful and I'm glad to have found it. We did discuss this with our GP, and he wasn't too concerned as well. We confirmed that a pulmonologist recommendation was made. They have a long wait time, so who knows when we hear back from them. My mom is scheduled for another CT scan in March following which we will meet the oncology team again. It is extremely cold where we are (-20 Celsius day time highs), so her dry cough has returned over the last couple of days, but that can be a factor of the temperature as well. They are continuing with the Herceptin, so it looks like they don't think that can be a cause.


    Vera66, yeah google is most definitely a scary place when it comes to absolutely anything cancer related, so I will try to take your advice and avoid continuing to do that.

  • MicroGirl
    MicroGirl Member Posts: 7

    I've been away from here for awhile, but I am anxious and waiting on results of a thoracentesis. Shortness of breath and dry cough (no fever) eventually sent me to the doc, antibiotics no help, then ER, no covid or other respiratory viruses, and bloodwork looked fine (so that's good). So thoracentesis as per the oncologist and a pulmonology appt on Wed. I saw the fluid that came out was red/dark pink. I'm a microbiologist and really hoping this is a weird infection, but... Still short of breath - used to run now i'm not making a mile walking and stairs wind me. Honestly I'm scared. In between my treatment ending a few years ago and now mom was diagnosed and treated for non hodgins lymphoma and dad is going through treatment for gastroesophageal cancer. I don't want to worry anyone by saying the "c" word though I'm sure they're thinking it. I know I am. I also know this could be other things...but waiting is hard. Thora was Friday and I have chemistry (looks like an exudate from what I can tell). Just venting as I know you all know this feeling. Thanks for listening. I already feel a little better...

  • minustwo
    minustwo Member Posts: 13,001

    MicroGirl - fingers crossed for you.

  • MicroGirl
    MicroGirl Member Posts: 7

    Thank you MinusTwo! Still waiting....

  • laughinggull
    laughinggull Member Posts: 509

    I had a pleural effusion when I was in my twenties, super fit and healthy. Some bug that didn't respond to any antibiotics. Cultures for TBC came negative. It landed me 10 days in the hospital. I was short of breath and with a dry cough for a month after. Never knew what it was. A pleural effusion happens when there is an infection in between the two layers that form the pleura, then it fills with infectious liquid. Right? Why do you think is cancer related? I hope I am not saying something stupid but my first thought would be you caught a bug.

  • MicroGirl
    MicroGirl Member Posts: 7

    Hi LaughingGull, wow what a crummy experience :-( Not stupid at all! This is my understanding ...

    Pleural effusions happen when fluid builds up between the lining (pleura) of the lung and lining (pleura) of the chest cavity. Normally there's a little fluid there, but when things go awry you can get more (much more apparently, I was reading up to 2L plus, yikes). Anyway this presses on the lungs and leads to shortness of breath and a dry cough. There are lots of things that can cause them, primarily bacterial infection in exudates (which are effusions high in protein; the other kind, transudates, are primarily caused by congestive heart failure, also, yikes and sometimes pulmonary embolism). I think this could still be a bacterial infection- some don't respond to first round drugs, like you said TB. Waiting on those cultures now. Sometimes viral infections like sars-cov-2 can cause this, but I had a panel done and negative for all including sars-cov-2.

    Another major cause of pulmonary effusions is maligancy, either a primary lung cancer or a metastasis from breast (or a few other main types). So they're checking the pleural fluid for atypical/malignant cells too. And like yours, some are never solved but resolve. Heck, I'd be happy for that result. X-ray today, pulmonologist televisit tomorrow, and hopefully pathology before Friday!

  • laughinggull
    laughinggull Member Posts: 509

    Thanks for this great explanation MicroGirl.

    I will keep my fingers crossed, and I hope it is an infection, which sounds like the most common, and simplest explanation. In my case, my bug did not respond to any antibiotics whatsoever. While waiting for my TB cultures, they started me on the TB treatment (on top of removing fluid, which was also dark pink); I started to slowly improve, and was eventually discharged with the TB treatment (lasting 6m), although my TB cultures came back negative. They said maybe some baccillum related to the Koch baccillum (which would explain why I was "responding" to TB treatment, although nobody knows if I was really responding or if I was slowly improving as part of the natural course of the disease, after being sick for weeks); in retrospect, years later, other doctors told me I didn't have TB, because TB leaves some scarring marks in your lungs, visible in x-rays, that I don't have. As I said, I was young, athletic and the picture of health, and I was in that hospital wondering how I got there. Every day the pulmonologist would visit, and every day I asked how in hell I caught that bug, and everyday he answered "because you came close to someone who was coughing and you inhaled some bug".

    Best of luck and keep us posted.



  • MicroGirl
    MicroGirl Member Posts: 7

    LaughingGull you're giving me some hope here! I put the TB or related as a possible cause and what. the chances of this spontaneously resolving on my list of questions for the pulmonologist tomorrow. There are at least a few other related to TB that cause lung disease, so there's that and some grow really slowly, so maybe I picked it up before we were taking all these pandemic precautions. Will definitely keep you updated and thanks again! I may not be in my 20s but I was in pretty decent shape (running and hiking regularly).

  • MicroGirl
    MicroGirl Member Posts: 7

    Just got an updated test result from cytology as I wait on the pulmonologist, "Diagnosis: Metastatic carcinoma, consistent with spread from a breast primary."

    I'm waiting to hear from the oncologist; pulmonologist was wonderful and has lots of plans to keep the effusion under control. Time to fight this bastard again. Thanks to all who responded or sent positive wishes, LaughingGull & MinusTwo particularly.

  • minustwo
    minustwo Member Posts: 13,001

    MicroGirl - so sorry to hear this diagnosis. Sending you strength and I'll keep you in my thoughts.

  • moth
    moth Member Posts: 3,293

    MicroGirl, well, that is crap news :(

    Btw, there is s stage 4 lung met thread which is probably the closest related thread.

    Hugs

  • MicroGirl
    MicroGirl Member Posts: 7

    Thanks Minus Two and thanks for the heads up moth. I'll head over there.

  • laughinggull
    laughinggull Member Posts: 509

    Sorry to hear those news Microgirl. Much, much love to you, sister Heart

  • gr4c1e
    gr4c1e Member Posts: 124

    Just had a chest x-ray and now I'm being sent for CT scan for a pleural effusion with, what the doctor described as two spots in my right lung. Thank you, LaugingGull. I never thought about anything but mets until now. I also think this is the first time I've ever hoped I had TB. My CT scan is next Wednesday. I'm hating the wait, but I'm a little less worried.

  • gr4c1e
    gr4c1e Member Posts: 124

    Okay, now I'm panicking. I just received the paper copy of my prescription for the CT scan. My doctor wrote "3 masses + pleural effusion" with a note about my previous breast cancer diagnosis.

    The "3 masses" thing came as a shock. I did NOT know that. She said a couple of spots, which I took to mean "no big deal". I guess the word "masses" threw me for a loop. I'm starting feel like this is a very big deal. On the CT portion of the script she crossed out "with contrast" and "lung cancer screening" so its going to be a CT without contrast. I'll try to assign some positive meaning to that.



  • laughinggull
    laughinggull Member Posts: 509

    Hi Gr4c1e,

    Don't panic. I send you strength and hope. Even if it turns out to be the bad news you are fearing, you will be able to handle it. Others, who are (or have been) in whatever the situation turns out to be, will give you guidance and advice and hope. The sun will be out tomorrow and you will still make breakfast. TB, masses or spots, you will deal with them.

    Best,

    LaughingGullHeart

  • gr4c1e
    gr4c1e Member Posts: 124

    Thanks for your kind words, Laughing Gull.


  • gr4c1e
    gr4c1e Member Posts: 124

    My doc just called. CT scan results apparently not good. He just kept saying "I'm so sorry" over and over, then told me to contact my oncologist ASAP. I have an appointment on Monday. Fingers crossed this is treatable.

  • MicroGirl
    MicroGirl Member Posts: 7

    Hi GR4C1E. I am so sorry you are dealing with this, and I hope there is an alternative explanation. But if not, as LaughingGull said, there is still hope on this side! Sending love and hugs. <3

  • laughinggull
    laughinggull Member Posts: 509

    Hi Gr4c1e,

    Crummy news for sure Devil

    BUT

    Now that you found this, good treatment will be on the way. Here is hoping for effective treatment that obliterates those bastard spots soon. Did you get the thoracocentesis? It brings relief quickly. We are rooting for you, sister. You can deal with this.

    That doctor who called you to say I am so sorry over and over and over...is is just me feeling that such reaction is not helpful? No doubt is not good news but that sounds terrifying and...alienating right?

    And how’s your week going otherwise?

    Heart

  • gr4c1e
    gr4c1e Member Posts: 124

    I met with my oncologist yesterday. He said "we'll this looks weird". He said that the masses in my lungs present like that of a HER2+ mets, but I was diagnosed TNBC so - that makes no sense. He sent my CT & xrays to a thoracic surgeon for review. He's trying to fast track a thoracentesis and hoping we can schedule something by tomorrow. He said it looks like cancer - but it doesn't look like the same cancer. Have you ever heard of such a thing?

    And, yes, you're right. The "I'm so sorry doctors" did not help! Seeing my oncologist was awesome! I forgot how awesome he is. I actually have run four 5Ks this year all while growing something "weird" in my chest. I told him I was tired and not able to run right now. His last words to me during the consultation were: "I'm gonna get you back on that treadmill, don't you worry about that."

    I was definitely getting sucked into the gloom and doom talk of others, but I'm feeling much more optimistic. I'm actually looking forward to the thoracentesis. Doc said it will relieve the pressure in my chest and I can eventually start running again. Baby steps.

    I'm super curious about what is going on, more than being afraid like before. I thought all cancer after breast cancer is still breast cancer, and maybe that's the case here, but maybe it isn't. Maybe I grew a new cancer! We'll obviously know more after the thoracentesis. I do love a good mystery.


  • laughinggull
    laughinggull Member Posts: 509

    Hi Gr4c1e,

    Thank you for coming to post the update! Good to hear you are in the capable, compassionate, reassuring hands of your MO. Sounds like the "I am so sorry" doctor was incapable of putting himself in your shoes, and sent you straight to the other side of the glass, where you are doomed, and he is fine, and he is sorry for you. He will be sick one day, too! It's very sad when doctors (and other people, too) react like that, because they make you feel so alone and out of their reach. It reflects their own fears rather than your situation.

    Who would have said HER2+ mets have a specific presentation. But that would be good news right? HER2+ has more treatment options than TN. And TN is not supposed to recur that far out right? Maybe a mutation explains why it's back. But if that mutation gives you more treatments, that would be great.

    The thoracentesis will do wonders and so will going back to the treadmill, I am sure. Let us know about the resolution of the mystery.

    LaughingGull Heart


  • gr4c1e
    gr4c1e Member Posts: 124

    I had the thoracentesis last Wednesday before the holiday. The nurse practitioner was amazing. It was practically painless, little discomfort but super easy and fast! She said that the CT was deceiving because it showed a small pleural effusion but they got 400 cc's of fluid and she was surprised. I had hoped to feel much better afterward, but I'm actually feeling more tired, dizzy and I'm coughing more. The radiating shoulder pain is gone and I can sleep on my side again so that's a plus. The results are supposed to be ready today but I haven't heard from my MO yet.

  • gr4c1e
    gr4c1e Member Posts: 124

    Still waiting for test results. Lab is backed up. MO said he will call again today for the cytology report.


  • gr4c1e
    gr4c1e Member Posts: 124

    Still waiting for test results.

  • sunshine99
    sunshine99 Member Posts: 2,477

    GR4C1E, I'm sorry you're still waiting. I sincerely hope that "No News is Good News". Thanks for letting us know.

    (((hugs)))

    Carol

  • laughinggull
    laughinggull Member Posts: 509

    We will be here for you! Thanks for posting