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Cardiopulmonary Syndromes (PDQ®)

Patient Version
Last Modified: 08/19/2011

Malignant Pleural Effusion

Key Points for This Section


Pleural effusion is extra fluid around the lungs.

The pleural cavity is the space between the pleura (thin layer of tissue) that covers the outer surface of each lung and lines the inner wall of the chest cavity. Pleural tissue usually makes a small amount of fluid that helps the lungs move smoothly in the chest while a person is breathing. A pleural effusion is extra fluid in the pleural cavity. The fluid presses on the lungs and makes it hard to breathe.

Pleural effusion may be caused by cancer, cancer treatment, or other conditions.

A pleural effusion may be malignant (caused by cancer) or nonmalignant (caused by a condition that is not cancer). Malignant pleural effusion is a common problem for patients who have certain cancers. Lung cancer, breast cancer, lymphoma, and leukemia cause most malignant effusions. An effusion also may be caused by cancer treatment, such as radiation therapy or chemotherapy. Some cancer patients have conditions such as congestive heart failure, pneumonia, blood clot in the lung, and poor nutrition that may lead to a pleural effusion.

A diagnosis of the cause of pleural effusion is important in planning treatment.

These and other symptoms may be caused by a pleural effusion. Talk to your doctor if you have any of the following problems:

  • Dyspnea (shortness of breath).
  • Cough.
  • An uncomfortable feeling or pain in the chest.

Treatment for a malignant pleural effusion is different from treatment for a nonmalignant effusion, so the right diagnosis is important. Diagnostic tests 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 space between the lining of the chest and the lung, using a needle. A pathologist views the fluid under a microscope to look for cancer cells. This procedure may be used to reduce pressure on the lungs.

  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If thoracentesis is not possible, a biopsy may be done during a thoracoscopy. A thoracoscopy is a 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 with a lens for viewing) is inserted into the chest. A cutting tool at the end of the thoracoscope is used to remove a sample of tissue.

The type of cancer, previous treatment for cancer, and the patient's wishes also are important in planning treatment.

Treatment may be to control symptoms of pleural effusion and improve quality of life.

A malignant pleural effusion often occurs in cancer that is advanced , cannot be removed by surgery, or continues to grow or spread during treatment. It is also common during the last few weeks of life. The goal of treatment is usually palliative, to relieve symptoms and improve quality of life.

Treatment of the symptoms of malignant pleural effusion includes the following:

  • Thoracentesis

    Thoracentesis is a procedure to remove extra fluid from the pleural cavity using a needle and/or a thin, hollow plastic tube. Removal of the fluid may help to relieve severe symptoms for a short time. A few days after the extra fluid is removed it is likely it will begin to come back. The risk of a thoracentesis includes bleeding, infection, collapsed lung, fluid in the lungs, and low blood pressure.

  • Pleurodesis

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

  • Surgery

    Surgery may be done to put in a shunt (tube) to carry the fluid from the pleural cavity to the abdominal cavity, where the fluid is easier to remove. Pleurectomy is another type of surgery that may be used. In this procedure, the part of the pleura that lines the chest cavity is removed.



Glossary Terms

abdominal (ab-DAH-mih-nul)
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.
abnormal (ab-NOR-mul)
Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
biopsy (BY-op-see)
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.
bleomycin (blee-oh-MY-sin)
The active ingredient in a drug that is used to treat many types of cancer and is being studied in the treatment of other types of cancer. It comes from the bacterium Streptomyces verticillus. Bleomycin damages DNA and may kill rapidly growing cancer cells. It is a type of antineoplastic antibiotic.
blood clot (blud klot)
A mass of blood that forms when blood platelets, proteins, and cells stick together. When a blood clot is attached to the wall of a blood vessel, it is called a thrombus. When it moves through the bloodstream and blocks the flow of blood in another part of the body, it is called an embolus.
blood pressure (blud PREH-sher)
The force of circulating blood on the walls of the arteries. Blood pressure is taken using two measurements: systolic (measured when the heart beats, when blood pressure is at its highest) and diastolic (measured between heart beats, when blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed by the diastolic blood pressure (for example 120/80).
breast cancer (brest KAN-ser)
Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a 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. Also called malignancy.
cavity (KA-vih-tee)
A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.
cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chemotherapy (KEE-moh-THAYR-uh-pee)
Treatment with drugs that kill cancer cells.
chest x-ray (chest EX-ray)
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.
condition (kun-DIH-shun)
In medicine, a health problem with certain characteristics or symptoms.
congestive heart failure (kun-JES-tiv hart FAYL-yer)
Weakness of the heart muscle that leads to a buildup of fluid in body tissues.
CT scan (… skan)
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 CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
diagnostic procedure (DY-ug-NAH-stik proh-SEE-jer)
A type of test used to help diagnose a disease or condition. Mammograms and colonoscopies are examples of diagnostic procedures. Also called diagnostic test.
drug (drug)
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.
dyspnea (DISP-nee-uh)
Difficult, painful breathing or shortness of breath.
fluid (FLOO-id)
A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
incision (in-SIH-zhun)
A cut made in the body to perform surgery.
infection (in-FEK-shun)
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.
injection (in-JEK-shun)
Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
lens (lenz)
A clear disk that focuses light, as in a camera or microscope. In the eye, the lens is a clear, curved structure at the front of the eye behind the pupil. It focuses light rays that enter the eye through the pupil, making an image on the retina (light-sensitive layers of nerve tissue at the back of the eye).
leukemia (loo-KEE-mee-uh)
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.
lung (lung)
One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
lung cancer (lung KAN-ser)
Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.
lymphoma (lim-FOH-muh)
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.
malignant (muh-LIG-nunt)
Cancerous. Malignant cells can invade and destroy nearby tissue and spread to other parts of the body.
malignant pleural effusion (muh-LIG-nunt PLOOR-ul eh-FYOO-zhun)
A condition in which cancer causes an abnormal amount of fluid to collect between the thin layers of tissue (pleura) lining the outside of the lung and the wall of the chest cavity. Lung cancer, breast cancer, lymphoma, and leukemia cause most malignant pleural effusions.
microscope (MY-kroh-SKOPE)
An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
nonmalignant (non-muh-LIG-nunt)
Not cancerous. Nonmalignant tumors may grow larger but do not spread to other parts of the body. Also called benign.
nutrition (noo-TRIH-shun)
The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.
organ (OR-gun)
A part of the body that performs a specific function. For example, the heart is an organ.
palliative therapy (PA-lee-uh-tiv THAYR-uh-pee)
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.
pathologist (puh-THAH-loh-jist)
A doctor who identifies diseases by studying cells and tissues under a microscope.
pleura (PLOOR-uh)
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.
pleural cavity (PLOOR-ul KA-vuh-tee)
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.
pleural effusion (PLOOR-ul eh-FYOO-zhun)
An abnormal collection of fluid between the thin layers of tissue (pleura) lining the lung and the wall of the chest cavity.
pleurectomy (ploo-REK-toh-mee)
Surgery to remove part of the pleura (a thin layer of tissue that covers the interior wall of the chest cavity).
pneumonia (noo-MOH-nyuh)
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.
quality of life (KWAH-lih-tee ... life)
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.
radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)
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 irradiation and radiotherapy.
shunt (shunt)
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.
surgery (SER-juh-ree)
A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
symptom (SIMP-tum)
An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
talc
A mineral, usually used in a powdered form. In cancer treatment, sterile talc is used to prevent pleural effusions (an abnormal collection of fluid in the space between the lungs and the chest wall). Talc is inserted into the space, causing it to close up, so fluid cannot collect there. Also called sterile talc powder.
thoracentesis (THOR-uh-sen-TEE-sis)
Removal of fluid from the pleural cavity through a needle inserted between the ribs.
thoracoscope (thor-A-koh-skope)
A thin tube-like instrument used to examine the inside of the chest. A thoracoscope has a light and a lens for viewing and may have tool to remove tissue.
thoracoscopy (THOR-uh-KOS-koh-pee)
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.
tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
vein (vayn)
A blood vessel that carries blood to the heart from tissues and organs in the body.
x-ray (EX-ray)
A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.