General Information about Malignant Pleural Effusions
Causes of Malignant Pleural Effusions
Diagnosis of Malignant Pleural Effusion
Managing Malignant Pleural Effusions

General Information about Malignant Pleural Effusions

The pleural cavity is the space surrounding each lung in the chest. The pleura is the thin layer of tissue that covers the outer surface of each lung and lines the interior wall of the chest cavity, creating a sac that encloses the pleural cavity. Pleural tissue normally produces a small amount of fluid that helps the lungs move smoothly in the chest while a person is breathing. A pleural effusion is an increased amount of fluid in the pleural cavity, which then presses on the lungs and makes breathing difficult.

Pleural effusions may be malignant (caused by cancer) or nonmalignant (caused by a condition that is not cancer). Malignant effusions are a common complication of cancer. Lung cancer, breast cancer, lymphoma, and leukemia cause most malignant effusions. Effusions caused by cancer treatment, such as radiation therapy or chemotherapy, are called paramalignant effusions.

Not all pleural effusions found in cancer patients are malignant. Cancer patients often develop conditions such as congestive heart failure, pneumonia, pulmonary embolism, and malnutrition, and these conditions may cause pleural effusions to occur.

The following symptoms may be caused by malignant pleural effusion:

• Dyspnea.
• Cough.
• Chest pain.

The management of a malignant pleural effusion is different from the management of a nonmalignant effusion, so an accurate diagnosis is important. Diagnostic tests may include the following:

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.



• CT scan: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.



• Thoracentesis: The removal of fluid from the pleural cavity using a needle inserted between the ribs. This procedure may be used to reduce pressure on the lungs and/or to check the fluid under a microscope to see if cancer cells are present.



• Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. If thoracentesis is not possible, a biopsy may be done during a thoracoscopy, a surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope (a thin, lighted tube) is inserted into the chest. Samples are then taken for biopsy.

Malignant pleural effusions often occur in advanced or unresectable cancer or in the last few weeks of life. The goal of treatment is usually palliative, to relieve the symptoms and improve the quality of life. The goals of therapy will depend on a number of factors, including the following:

• The prognosis (chance of recovery).
• The patient's preferences in regard to the risks and benefits of treatment.
• The patient's ability to perform activities of daily living.
• The type of primary cancer.
• The number and type of previous treatments. For example, patients whose cancer has not responded to chemotherapy are unlikely to obtain symptom relief with additional chemotherapy.

Treatment of the symptoms of malignant pleural effusion may include the following:

• Thoracentesis

  (See Diagnosis of Malignant Pleural Effusion ¹.) Removal of fluid from the pleural cavity using a needle may help to alleviate severe symptoms in the short-term. A few days after thoracentesis, the effusion will begin to reform. Repeated thoracentesis has risks, however, including bleeding, infection, collapsed lung, fluid in the lungs, and low blood pressure.




• Pleurodesis

  This is a procedure to close the pleural sac so that fluid cannot collect there. Fluid is first removed by thoracentesis. A drug or chemical that causes the sac to close is then inserted into the space through a chest tube. Chemical agents such as bleomycin or talc may be used.




• Surgery

  Surgery may be done to implant a shunt (tube) to transfer the fluid from the pleural cavity to the peritoneal (abdominal) cavity, where the fluid can be more easily removed. Another option is pleurectomy, removal of the part of the pleura that lines the chest.

Glossary Terms

Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Not normal. An abnormal lesion or growth may be cancerous, premalignant (likely to become cancer), or benign.

ADL. The tasks of everyday life. These activities include eating, dressing, getting into or out of a bed or chair, taking a bath or shower, and using the toilet. Instrumental activities of daily living are activities related to independent living and include preparing meals, managing money, shopping, doing housework, and using a telephone. Also called ADL.

The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

An anticancer drug that belongs to the family of drugs called antitumor antibiotics.

Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

Treatment with drugs that kill cancer cells.

An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.

Weakness of the heart muscle that leads to a buildup of fluid in body tissues.

A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.

Computed tomography scan. A series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computed tomography scan, computerized tomography, computerized axial tomography scan, and CAT scan.

The process of identifying a disease by the signs and symptoms.

A method used to identify a disease.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

Difficult, painful breathing or shortness of breath.

A block in an artery caused by blood clots or other substances, such as fat globules, infected tissue, or cancer cells.

Liquid.

A substance or object that is put in the body as a prosthesis, or for treatment or diagnosis.

A cut made in the body to perform surgery.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One kind is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer.

Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.

A disorder caused by a lack of proper nutrition or an inability to absorb nutrients from food.

Not cancerous.

A part of the body that performs a specific function. For example, the heart is an organ.

Treatment given to relieve the symptoms and reduce the suffering caused by cancer and other life-threatening diseases. Palliative cancer therapies are given together with other cancer treatments, from the time of diagnosis, through treatment, survivorship, recurrent or advanced disease, and at the end of life.

Having to do with the parietal peritoneum (the tissue that lines the abdominal wall and pelvic cavity) and visceral peritoneum (the tissue that covers most of the organs in the abdomen, including the intestines).

A thin layer of tissue that covers the lungs and lines the interior wall of the chest cavity. It protects and cushions the lungs. This tissue secretes a small amount of fluid that acts as a lubricant, allowing the lungs to move smoothly in the chest cavity while breathing.

The space enclosed by the pleura, which is a thin layer of tissue that covers the lungs and lines the interior wall of the chest cavity.

An abnormal collection of fluid between the thin layers of tissue (pleura) lining the lung and the wall of the chest cavity.

A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may cause a decrease in the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia is usually caused by infection but may also be caused by radiation therapy, allergy, or irritation of lung tissue by inhaled substances. It may involve part or all of the lungs.

The original tumor.

The likely outcome or course of a disease; the chance of recovery or recurrence.

Having to do with the lungs.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called radiotherapy and irradiation.

In medicine, a passage that is made to allow blood or other fluid to move from one part of the body to another. For example, a surgeon may implant a tube to drain cerebrospinal fluid from the brain to the abdomen. A surgeon may also change normal blood flow by making a passage that leads from one blood vessel to another.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

Removal of fluid from the pleural cavity through a needle inserted between the ribs.

Examination of the inside of the chest, using a thoracoscope. A thoracoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

A group or layer of cells that work together to perform a specific function.

Unable to be removed with surgery.