Pleural effusion (fluid around the lung) from secondary breast cancer

Hi there

I had PE but no pain at all. My only symptom was SOB. I got diagnosed via a biopsy after fluid showing up on an x-ray.

I had the Pleurodesis Procedure and that was almost 5 years ago and it hasn't come back.

Hi Branwell - good to hear that your effusion cleared up after the Pleurodesis, and that you are 5 years on from diagnosis.
The CancerResearchUK website says that effusion can cause chest pain so I'm wondering whether to ask if I could have mine drained to see if that reduces the pain. The consultant said she hoped it would 'dry up' once I start treatment, but with the shortness of breath and the pain I'm not sure how long I want to wait.
I had a liver biopsy last Thurs (2 May) and am waiting for results to see what type of cancer it is , and what the treatment will be, so it could be another couple of weeks before treatment starts.

Hi Scared2

I got told the same thing ref the drugs drying it up but I decided to go ahead with the Pleurodesis Procedure anyway. I haven't had any trouble since. I did 4.5 years on Ribociclib and I'm just finishing my 5th Cycle of Capecitabine. X

Hi

I had a pleural effusion which was drained last week.  I have secondary bc which was being managed by letrazole, but it turned out at my last scan that the cancer had found its way round the drug so I am due to start a new treatment next week  (and I also need a liver biopsy because that's where it showed up). Not fun.

I didn't get pain with PE  - just a lot of breathlessness and wheezing.  I have had it drained before, when I was first diagnosed with metastatic BC 2 years ago. I am glad that I got it done, because it reduces pressure in the chest and helps to manage my breathlessness. When I had it done 2 years ago, they drained it a first time and then had to do a second one as the meds hadn't yet taken effect but once they had, I didn't need any further drains - until now. I would think it might be worth having it done - as it may be a while before the meds start doing their job, as it might at least reduce pressure in the chest cavity? But I don't think that pain is the main symptom of PE - for me at least it was breathlessness.

All the best 

Hi VickiO - thanks for the info about your pleural effusion. A couple more queries please :
-Did the shortness of breath stop immediately you had it drained ?
-How long did the procedure take, and are you kept under observation for a while afterwards ?
-How long did it last before you had to have it redone 2 years ago?
- Did they offer you the option of a Pleurodesis like Branwell had (I think that involves draining it then putting talc in to dry it up) ?

Re your liver biopsy - I had mine last week and it was no problem ; no pain at the time and I could watch it on the ultrasound screen. It was slightly tender for the next couple of days and I now have a lovely purple&yellow bruise, but it is no problem.
The only thing to be aware of is that they may want to keep you in for 6 hours after the biopsy - possibly 2 hours laying on your side, then further 4 hours of bed rest, just so they can check there are no issues. Or that's what happened to me ! Take a good book/music.
Hope your biopsy goes smoothly, and good luck with your next line of treatment.

Hi Branwell - I hope I manage 4.5 years on my first line treatment!..that would take me to 70. And glad to hear that the Capecitabine is working for you.
My primary was ER+8, PR+7, Her2-negative so I was on Letrozole for 10 years - it stopped working after 9 years, and they now need to check whether the cancer has changed before deciding the treatment.
Just hope the fact that it seems to be all over the place (bones, liver, chest lymph nodes, pleura) doesn't make it more difficult to treat.

Hi Scared2

I wasn't given the option. My Oncologist was excited about a new drug that had only just been approved by NICE (Ribociclib) and I was started on it a few months after being put on the Letrozole. 

It depends upon the Cancer and not the location of the mets, as I've observed in my FB group. Are you having a Liquid Biopsy to see if it's mutated?

Hi Branwell - I had a liver biopsy last week to check the current cancer type. I was told it can take 2 weeks for the results, and then I guess it goes to the MDT meeting for review, so it could be a few weeks before I start treatment.

The consultant suggested they wouldn't drain the effusion (and check the fluid?) unless the breathing gets too bad, but I find I get puffed out going upstairs at the moment so it's a bit limiting.
Your suggestion has got me thinking about it now - I wish I'd asked whether they could do the drain and test the fluid rather than needing the liver biopsy. Would be interesting to know why they didn't offer that !

Hi Scared2

So to answer your queries:

• Yes it definitely eased the pressure on my lungs and I was able to breathe more easily, pretty quickly.
• The first time I had it done two years ago, there wasn't much liquid and they  were able to syringe it off. This took 30 minutes or so. The effusion came back in greater quantity (as my treatment had not fully taken effect by then) 2-3 weeks later and they took this off using a bottle and siphon (ie draining from my chest cavity through a tube into a bottle on the floor over a period of time), and I spent the whole morning in outpatients. Last week, again I had a significant amount  (1.75l!) but they used a different procedure, using a direct drain into a bag whilst still in the procedures room. The whole thing took about 40 mins from start to finish - so much quicker than the bottle method - , but I was in outpatients for while, simply because there were other people being dealt with before me.
• I wasn't offered a pleurodeisis, probably because the amount of fluid on my lungs was too great for that to be effective as a means of treatment

Thanks for the info about the biopsy - very helpful! I will dig out a good novel or two.

And I hope everything goes smoothly for you with your treatment going forwards.

Hi Scared2

Fluid showed up on my x ray and then I had a drain done and they tested the fluid straight away and that's when I got the diagnosis.

Maybe they're testing the liver separately to see if it's the same, or to see if it's a new Primary. 

Try not to worry. I know the waiting around is horrible. X