Malignant Pleural Effusion
Within the chest, the lungs are placed in the pleural cavity. This cavity is filled with a sac made up of thin tissue, called the pleura, covering the outer layer of the lungs and the interior wall of the chest cavity. The lungs are normally lying in a small amount of fluid, produced by the pleura, to help them move smoothly when breathing. Sometimes, however, the amount of fluid will increase and begin to put pressure on the lungs. This is called a pleural effusion.
Such effusions can be caused by a variety of causes. When caused by cancer, they are called malignant pleural effusions. Lung and breast cancer are responsible for more than half of the malignant pleural effusions, which is why there are many lung cancer survivors with malignant pleural effusion.
Signs and Symptoms
The excess fluid in the pleural cavity press on the lungs and causes the symptoms associated with malignant pleural effusion. The most common signs and symptoms are:
- Difficult and painful breathing, characterized by shortness of breath.
- A persistent cough.
- Continuous chest pain.
To deal with malignant pleural effusion, there are generally three options available. These are pleurodesis, surgery and thoracentesis.
- Pleurodesis: this treatment involves a drainage of the excess fluid in the chest cavity. Patients will have a tube inserted, which will be used to drain the fluid. After the drainage, a ‘sclerosing agent’ is brought into the chest cavity. This will result in a inflammatory reaction which, die to the swelling, will reduce the potential space for fluid. The chest tube can be removed as soon as the drainage starts to decrease. Some side effects of this treatment are chest pain (due to the inflammation) and acute respiratory distress syndrome, which means this treatment is not without its dangers.
- Surgery: several types of surgery can be performed to deal with malignant pleural effusion. They can be relatively easy, such as freeing collections of fluid to the abdominal cavity, where the fluid can be more easily drained, with a shunt, but they can also be rather complicated, such as removing the part of the pleura that lines the chest cavity, called a pleurectomy. Complications, such as pneumonia, infection and blood clots may occur.
- Thoracentesis: this procedure involves the removal of fluid from the chest cavity through a thin tube. This may help to alleviate the symptoms on a short-term basis. A few days after the drainage, however, the fluid will begin to build up again, and repeated thoracentesis is not without its risks. Some complications of repeating this procedure may include bleeding, a collapsed lung and infection. There are at home kits available to perform thoracentesis, but it is always the safest option to consult a professional.
- Cancer Research UK: https://www.cancerhelp.org.uk/about-cancer/cancer-questions/pleurodesis-treatment#fluid
- National Cancer Institute: https://www.cancer.gov/cancertopics/pdq/supportivecare/cardiopulmonary/Patient/page3
- Robert Wood Johnson University Hospital: https://www.rwjuh.edu/medical_services/malignant_pleural_effusion_treatment.html
- Sahn, S.A. (2001) Malignant Pleural Effusions. Semin Respir Crit Care Med. 22(6).