Unexplained Left Hand Swelling and Pleural Effusion: A Tumor Case Study

Q: Unexplained Left Hand Swelling and Pleural Effusion: A Tumor Case Study

Ms. <br>Su： If the doctor at National Taiwan University confirms that it is not lymphedema, it is possible that cancer has caused a deep vein thrombosis in the left arm that has progressed to the left subclavian vein. <br>You may want to ask the doctor if a venography is necessar

Unexplained swelling of the left hand leading to pleural effusion in the left lung?

1.
Five years ago, my sister underwent an endoscopic surgery to remove a tumor approximately 5 centimeters in size from her stomach.
However, after the biopsy, cancer cells were detected, leading to a subsequent open surgery to remove half of her stomach.
She did not receive chemotherapy or follow-up care afterward.

2.
About a year ago, my sister's left hand began to swell.
Initially, she thought it was a sprain and did not pay much attention to it.
After three months of increasing swelling from her palm to her shoulder, she sensed something was wrong and began a series of examinations from her left hand to her left chest, including ultrasound and MRI, but no cause could be identified, so she turned to traditional Chinese medicine.
3.
Earlier this year, my sister had a blood test for cancer markers, and the results were alarmingly high.
She was urgently referred to National Taiwan University Hospital for a PET scan, which revealed that cancer cells had metastasized to her bones (spine, sternum, and leg bones).
The doctor speculated that it was stage IV bone cancer originating from a primary cancer, but the primary site could not be identified, as there was no recurrence in the stomach.
It was ultimately presumed that the primary cancer was still in the stomach but had not recurred and had directly metastasized, so chemotherapy was initiated specifically for the bone cancer.
4.
Strangely, the cause of the left hand's swelling remains unknown.
The PET scan did not show any issues with the bones, blood, or lymph nodes in the left hand, but the swelling has extended from the left hand to the left chest.
During a breast ultrasound, a large mass was suspected, but the biopsy results were normal.
5.
The doctors could only state that the cause of the left hand's condition was unknown.
My sister has been very compliant, undergoing chemotherapy while waiting for a breakthrough.
There has been some improvement in the bone condition; she has not needed pain medication for a long time, and her cancer marker levels have dropped from over 3000 to several hundred.
However, the CA 19-9 marker has consistently remained above 10,000, and last week it surged to 70,000.
Additionally, due to acute shortness of breath (initially thought to be due to low hemoglobin), an X-ray revealed pleural effusion in the left chest, leading to the removal of 1000 cc of fluid, and chemotherapy has been temporarily halted.
We are all very frustrated.
6.
My sister is very young and has a strong will to live; she cooperates well with the doctors.
However, the situation of having an unknown cause is truly tormenting.
We do not believe that stage IV bone cancer means she should give up hope.
We are willing to treat any manageable pain.
In fact, if it were solely bone cancer, my sister's quality of life would still be quite good; she can still go shopping, dining, and enjoy outings as usual.
However, her left hand has swollen to twice the size of her right hand, making dressing a challenge, which is truly heartbreaking.
7.
Just as her condition took a turn for the worse, her doctor informed us that he would be going abroad for a year.
This is incredibly frustrating.
Given the complexity of my sister's condition, we truly need a physician who can provide insight and direction.
We are immensely grateful for any assistance in finding a feasible path forward.

Su, 30~39 year old female. Ask Date: 2005/10/16

Dr. Fan Sheng reply Oncology

Ms.
Su: If the doctor at National Taiwan University confirms that it is not lymphedema, it is possible that cancer has caused a deep vein thrombosis in the left arm that has progressed to the left subclavian vein.
You may want to ask the doctor if a venography is necessary for diagnosis.
If this is the case, treatment with anticoagulants will be required.
Keep it up!

Reply Date: 2005/10/16

More Info

I'm truly sorry to hear about your sister's challenging medical situation. It sounds like she has been through a lot, and the uncertainty surrounding her condition can be incredibly stressful for both her and your family. Based on the details you've provided, it appears that your sister's case is complex, involving a history of cancer and current unexplained symptoms.

Firstly, the swelling in her left hand and the pleural effusion (fluid accumulation in the chest cavity) could potentially be linked to her previous cancer diagnosis. In cases of metastatic cancer, where cancer cells spread from the original site (in this case, possibly the stomach) to other parts of the body, symptoms can manifest in various ways. The fact that she has a history of gastric cancer and is now experiencing bone metastases suggests that the cancer may have spread, but the source of the original tumor remains elusive.

The swelling in her left hand could be due to several factors. One possibility is lymphedema, which occurs when lymph fluid does not adequately drain, often due to damage or obstruction of the lymphatic system, potentially caused by cancer or its treatment. Another consideration is that the swelling could be a result of inflammation or a reaction to the chemotherapy she is undergoing. It’s also important to rule out any vascular issues that could be contributing to the swelling.

Given that imaging studies have not revealed any clear cause for the swelling, it may be beneficial to consider a multidisciplinary approach. This could involve consultations with various specialists, including an oncologist, a hematologist, and possibly a vascular surgeon or a lymphedema specialist. They may be able to provide insights into the swelling and pleural effusion, and whether they are related to her cancer treatment or if they indicate a separate issue.

As for the pleural effusion, it is essential to monitor this closely. The fact that she had 1000cc of fluid drained is significant, and the underlying cause of the effusion should be investigated further. It could be due to cancer, infection, or other conditions. If her cancer is causing the effusion, addressing the cancer itself may help alleviate this symptom.

Regarding her cancer treatment, it’s crucial to maintain open communication with her healthcare team. If her oncologist is going to be unavailable for an extended period, it may be wise to seek a second opinion or consult another oncologist who can provide continuity of care. This is especially important given the rapid changes in her condition and the high CA19-9 levels, which indicate a potential issue that needs to be addressed.

In terms of managing her quality of life, supportive care is vital. This includes pain management, nutritional support, and possibly physical therapy to help with mobility and function in her left hand. Engaging with palliative care services can also provide additional support, focusing on symptom management and improving her overall quality of life.

Lastly, it’s important to remain hopeful and proactive. Cancer treatment can be unpredictable, and while the situation may seem dire, there are often options available that can help manage symptoms and improve quality of life. Encourage your sister to continue advocating for herself and to seek out healthcare providers who are willing to explore all avenues for her care.

In summary, your sister's case requires a comprehensive approach, involving multiple specialists to address the various symptoms and underlying issues. Continued monitoring, supportive care, and open communication with her healthcare team will be crucial as she navigates this challenging journey.

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