Symptom Control

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=200 BGCOLOR="#003333" TEXT="#F7F7FF" background="067d8c00dduajq.jpg"> <div> <A HREF="id206.htm" TARGET="_top" TITLE="Death And Dying"><U>Death And Dying</U></A></div> <div> <A HREF="id207.htm" TARGET="_top" TITLE="Carers"><U>Carers</U></A></div> <div> <B>Symptom Control</B></div> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> Click on the question to go to the answer</div> <div> Click on the Top link (at bottom of answers) to return to the questions</div> </td> <td valign="top" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#0066FF" FACE="Arial" ><B>Don't Say That Word</B></FONT><FONT SIZE="1" COLOR="#333399" FACE="Arial" >   </FONT>  |     <A HREF="index.htm" TARGET="_top" TITLE="Dont Say That Word"><U>home</U></A></div> <div> back to  <A HREF="id166.htm" TARGET="_top" TITLE="Living With Cancer QA"><U><B>Living With Cancer Q&A</B></U></A></div> <div> Symptom Control</div> <div> <B> <A NAME="top"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>Questions:</B></div> <bR> <div> <A HREF="#1___cancer_can_spread_from_one_part_of" TITLE="Symptom Control"><U><U>1. I am very breathless and my doctor says this is because I've got bowel cancer in my lungs. That sounds very strange. Have I got lung cancer or not.? Can you explain and tell me how this will be treated? </U></U></A></div> <bR> <div> <A HREF="#2____the_lungs_are_wrapped_in_a_filmy" TITLE="Symptom Control"><U><U>2. My father has been told he has fluid on the lungs, because of his cancer, and this must be drained. They have written down that he has a 'pleural effusion'. Can you explain this please?</U></U></A></div> <bR> <div> <A HREF="#3__ascites_is_an_abnormal_build_up_of" TITLE="Symptom Control"><U><U>3. My aunt has ovarian cancer and has developed fluid in her tummy (I think they called it ascites). A friend has told me there is an operation to help this. Is this true?</U></U></A></div> <bR> <div> <A HREF="#4___brain_tumours_like_most_cancers" TITLE="Symptom Control"><U><U>4. My father has a brain tumour. He has had radiotherapy and chemotherapy but these are no longer helping. The doctors have suggested 'steroids'. How can these help?</U></U></A></div> <bR> <bR> <div> <B>Answers:</B></div> <bR> <div> <B> <A NAME="1___cancer_can_spread_from_one_part_of"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>1.  </B>Cancer can spread from one part of the body to other areas. Where the cancer started is called the primary cancer and where it spreads to is called the secondary cancer. Your doctor has told you that you have a primary bowel cancer that has spread to your lungs. </div> <bR> <div> This is one of the commonest areas in the body for a bowel cancer to spread. Cancer cells have broken away from the primary bowel cancer and travelled round your body through the bloodstream. This probably happened some time ago, before your primary cancer was diagnosed and treated. These bowel cancer cells have lodged in your lungs and started to grow so the cancer in your lungs is secondary to your bowel cancer. This is different to a primary lung cancer where the cancer originates in the lung.</div> <bR> <div> As the cancer in your lungs is made up of bowel cancer cells, it will respond to treatment that is designed for bowel cancer. The most common treatment for bowel cancer that has spread is chemotherapy. This may be with 5-FU and Folinic acid or, if you have had 5-FU before, with one of the newer chemotherapy drugs used for bowel cancer. Radiotherapy can also be used, but is less commonly given. CancerBACUP has online booklets on colon cancer and chemotherapy, and a factsheet on secondary lung cancer.</div> <bR> <div> You mention that you are very breathless. Secondary cancer in the lungs can sometimes cause fluid to collect in the chest cavity, reducing the space available for the lungs to expand during normal breathing. It is possible to have this fluid drained off and this should relieve breathlessness almost immediately. If the fluid continues to collect, it is possible to have treatment to prevent or reduce it. This involves having an injection into the pleural cavity (the space surrounding the lungs). The injection irritates the two linings covering the lung and causes them to stick together. Once this has happened, there is no longer a space between the linings in which the fluid can collect.</div> <bR> <div> <A HREF="#top" TITLE="Symptom Control"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="2____the_lungs_are_wrapped_in_a_filmy"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>2.   </B>The lungs are wrapped in a filmy membrane, which is called the pleura. The pleura is made up of two layers, the one encloses the lungs, the other lines the inside of the chest wall and ribcage. The pleura produces small amounts of fluid which lubricate the two layers so that they slide easily over one another as we breathe in and out.</div> <bR> <div> When they spread, some cancers will form little seedlings, or plaques, of secondary cancer (also called, metastases) on the surface of the pleura. These seedlings irritate the pleural membrane and make it inflamed. To try and soothe this inflammation the pleura produces more of its lubricant fluid. </div> <div> This pleural fluid is then trapped between the two layers of the membrane. As more fluid builds up so it will begin to press on the lungs. As it increases this pressure will gradually lead to symptoms of breathlessness, chest pain and cough. </div> <bR> <div> This accumulation of fluid in the pleural lining of the chest is called a pleural effusion. </div> <div> Any condition which causes irritation of the pleura can lead to the formation of a pleural effusion. So pleural effusions can occur in people who do not have cancer.</div> <bR> <div> A simple physical examination and an ordinary chest x-ray are often all that are needed to diagnose a pleural effusion. </div> <bR> <div> The usual treatment for a pleural effusion caused by a cancer is to drain the fluid, as this gives very rapid relief from troublesome symptoms like shortness of breath. </div> <bR> <div> In contrast to some other conditions, taking water tablets, or diuretics, which can remove excess fluid from the body, does not help to clear pleural effusions.</div> <bR> <div> The drainage procedure is quite simple. A local anaesthetic is given into the skin of the chest and a small tube inserted between the ribs. The fluid is then drawn off with a syringe or a drainage bottle. Depending on the amount of fluid present this may take anywhere from minutes to hours, or occasionally a day or so. Depending on the time it takes the drainage may be done as a day -patient or might need a short stay in hospital. The procedure is a bit uncomfortable but not usually painful. </div> <bR> <div> Sometimes the drainage tube is inserted in the x-ray department, using an ultrasound scanner, to increase the accuracy of its positioning. </div> <bR> <div> Often when the pleural fluid has finished draining a drug is instilled through the drainage tube, into the pleural lining, to try and stop the fluid coming back. These drugs work by sticking the two layers of the pleura together, so there is no space for fluid to form. This may cause some temporary chest pain and patients often need pain killers for a day or two to ease this.</div> <bR> <div> A chest x-ray will usually be done to check that the fluid has cleared and the lung has not been damaged. </div> <div> Often the drainage procedure (which is called a thoracentesis) may be followed by other treatment, such as chemotherapy, to help control the cancer. </div> <bR> <div> Sometimes, despite all these measures, pleural effusions can come back. If this does happen the drainage procedure can often be repeated.</div> <bR> <div> <A HREF="#top" TITLE="Symptom Control"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="3__ascites_is_an_abnormal_build_up_of"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>3. </B>Ascites is an abnormal build up of fluid in the abdominal cavity which leads to progressive swelling of the abdomen. It has many different causes but is an occasional complication of some types of cancer. </div> <bR> <div> When ascites occurs as a result of an underlying cancer the usual treatment is to put a fine tube through the muscle wall of the abdomen (using a local anaesthetic) and slowly drain off the excess fluid over a day or two. This fluid drainage, which is called paracentesis, can be repeated at intervals. Sometimes paracentesis is combined with chemotherapy to try and control the cancer and so prevent further fluid forming.</div> <bR> <div> A peritoneo-venous shunt, also known as a Le Veen shunt, is another approach to the treatment of ascites. This involves an operation, under a general anaesthetic. During the operation a long perforated tube is placed inside the abdomen. This is then connected to a valve which leads to another tube which is tunnelled up, under the skin, over the chest. The end of this tube is fixed into one of the main veins in the neck, the internal jugular vein.</div> <bR> <div> The way the shunt works is that as you breath in your diaphragm (the muscle which separates the chest and the abdomen) moves down and this will push fluid through the holes in the perforated tube. As you breath out the valve will stop the fluid going back into the abdomen and it will be sucked into the vein. From there it will pass into the blood stream and the excess fluid will be removed by the kidneys.</div> <bR> <div> Although this sounds fairly straightforward the shunts often do not work very well. They also have quite a high risk of complications like the leakage of fluid, infections and bleeding as well as causing circulatory problems.</div> <div> For these reasons a shunt would usually only be considered for a very carefully selected group of people whose ascites could not be controlled by the usual treatment of fluid drainage by paracentesis.</div> <bR> <div> <A HREF="#top" TITLE="Symptom Control"><U><B>[Top]</B></U></A></div> <bR> <div> <B> <A NAME="4___brain_tumours_like_most_cancers"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A></B><B>4.  </B>Brain tumours, like most cancers, are usually covered by a rim of inflammation, where the tumour meets the surrounding normal tissue. This area of inflammation is found with both primary brain tumours (those which start off in the brain) and secondary tumours which have spread to the brain from a cancer elsewhere in the body. </div> <div> The layer of inflammatory tissue makes the tumour seem larger than it actually is. It also causes pressure on the surrounding normal tissue. Because the brain fits quite tightly into the bony framework of the skull this means that the normal tissue is squeezed between the swelling caused by the tumour and inflammation and the rigid structure of the skull. The pressure this causes on the normal brain tissue leads to unpleasant symptoms like headache and sickness. </div> <bR> <div> Steroids are drugs which can reduce inflammation in the body. One steroid in particular, called dexamethasone, is very effective in easing the inflammation caused by brain tumours. </div> <bR> <div> Taking dexamethasone tablets can shrink the area of inflamed tissue surrounding tumours in the brain. This reduces the volume of abnormal tissue and so eases pressure and relieves symptoms. </div> <bR> <div> Unfortunately dexamethasone does not have any effect on the cancer itself and so the benefit that it gives is only temporary. But very often taking dexamethsaone can give a very valuable respite from problems like headache and sickness for some weeks or even months. In addition the steroid does have other benefits, like increasing appetite and energy levels, which can lead to an overall improvement in quality of life. </div> <bR> <div> <A HREF="#top" TITLE="Symptom Control"><U><B>[Top]</B></U></A></div> <bR> <bR> </td> </tr></table></body>