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

General Information about Malignant Pericardial Effusions

Pericardial effusion is an increased amount of fluid inside the pericardium, the thin layer of tissue that forms a sac surrounding the heart. The excess fluid causes pressure on the heart, which prevents it from pumping blood normally. Lymph vessels may also be blocked, and bacterial or viral infections often develop. If fluid builds up very quickly, a condition called cardiac tamponade may occur, in which the pressure on the heart becomes life-threatening and must be treated promptly.

Pericardial effusions may be malignant or nonmalignant. Malignant pericardial effusions are caused by cancer that begins in the pericardium or the heart muscle, or by cancer that has spread there from the lung, esophagus, thymus, or lymph system. Malignant pericardial effusions are commonly caused by lung cancer in males and breast cancer in females. Nonmalignant causes include infection of the pericardium, heart attack, underactive thyroid gland, lupus, injury, surgery, and AIDS. Infection of the pericardium is a possible side effect of radiation therapy or chemotherapy.

The following symptoms may be caused by malignant pericardial effusions:

• Dyspnea.
• Cough.
• Chest pain.
• Difficulty breathing while lying flat.
• Swelling in the upper abdomen.
• Hiccups.
• Extreme tiredness and weakness.

Because pericardial effusions usually occur in advanced cancer or in the last few weeks of life, extensive diagnostic testing may be less important than relief of symptoms. The following tests and procedure may be used to diagnose pericardial effusion:

• 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.
• Echocardiography: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs of the chest. The echoes form a picture of the heart's position, motion of the walls, and internal parts such as the valves.
• Electrocardiogram (EKG or ECG): A recording of the heart's electrical activity to evaluate its rate and rhythm. A number of small pads (electrodes) are placed on the patient’s chest, arms, and legs, and are connected by wires to the electrocardiograph machine. Heart activity is then recorded as a line graph on paper. Electrical activity that is faster or slower than normal may be a sign of heart disease or damage.
• Pericardiocentesis: The removal of fluid from the pericardium using a needle inserted through the chest wall. The physician may use an echocardiogram to view the movement of the needle inside the chest. This procedure can be used to drain fluid from an effusion and reduce pressure on the heart. To diagnose malignant pericardial effusion, the fluid is examined under a microscope to check for cancer cells. The fluid may also be checked for signs of infection.

Large malignant pericardial effusions are managed by draining the fluid, unless the goals of therapy are to use a less invasive approach that may improve quality of life but not help the patient live longer. The goals of therapy depend on a number of factors, including the following:

• The patient's prognosis.
• The cost, risks, and invasiveness of treatment.
• Whether treatment will relieve symptoms and improve the patient's quality of life.
• Whether treatment will shorten the patient's hospital stay.

Treatment options include the following:

• Pericardiocentesis

  (See Diagnosis of Malignant Pericardial Effusion ¹.) In some patients, fluid may again collect in the pericardium after pericardiocentesis. A catheter may be inserted and left in place to allow continued drainage. This procedure may be used for patients with advanced cancer instead of more invasive surgery.

• Pericardial sclerosis

  A procedure to close the pericardium so fluid cannot collect in the cavity. Fluid is first removed by pericardiocentesis. A drug or chemical that causes the pericardium to close is then injected through a catheter into the pericardial space. Three or more treatments may be needed to completely close the pericardium.

• Pericardotomy

  A surgical incision is made in the chest and then in the pericardium to insert a drainage tube. This increases the quantity of fluid that can be drained from the pericardium.

• Pericardiectomy

  Surgery to remove part of the pericardium. This may be done when there are chronic infections of the pericardium or to drain fluid quickly when cardiac tamponade occurs. This surgery is also called pericardial window.

• Balloon pericardiostomy

  A catheter with a balloon tip is inserted through the chest and into the pericardium. The balloon is then inflated to enlarge the pericardial opening and allow fluid to drain into the pleural cavity. This may be used when an effusion has recurred (come back) after pericardiocentesis or as an alternative to more invasive surgery.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment.

A disease caused by the human immunodeficiency virus (HIV). People with AIDS are at an increased risk for developing certain cancers and for infections that usually occur only in individuals with a weak immune system. Also called acquired immunodeficiency syndrome.

A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

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 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.

Having to do with the heart.

A flexible tube used to deliver fluids into or withdraw fluids from the body.

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.

The muscles, bones, and joints that make up the area of the body between the neck and the abdomen.

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.

A disease or condition that persists or progresses over a long period of time.

The process of identifying a disease, such as cancer, from its signs and symptoms.

A specific test or series of steps done to help diagnose a disease or condition. Mammograms and colonscopies are examples of diagnostic procedures.

In medicine, to remove fluid as it collects; or, a tube or wick-like device used to remove fluid from a body cavity, wound, or infected area.

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 procedure that uses ultrasonic waves directed over the chest wall to obtain a graphic record of the heart's position, motion of the walls, or internal parts such as the valves.

In medicine, a device such as a small metal plate or needle that carries electricity from an instrument to a patient for treatment or surgery. Electrodes can also carry electrical signals from muscles, brain, heart, skin, or other body parts to recording devices to help diagnose certain conditions.

The muscular tube through which food passes from the throat to the stomach.

A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.

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."

A medical procedure that invades (enters) the body, usually by cutting or puncturing the skin or by inserting instruments into the body.

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

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.

A chronic, inflammatory, connective tissue disease that can affect the joints and many organs, including the skin, heart, lungs, kidneys, and nervous system. It can cause many different symptoms; however, not everyone with lupus has all of the symptoms. Also called SLE and systemic lupus erythematosus.

A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.

The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.

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

Not cancerous. Nonmalignant tumors may grow larger but do not spread to other parts of the body. Also called benign.

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

An abnormal collection of fluid inside the sac that covers the heart.

Medical doctor.

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.

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

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 irradiation and radiotherapy.

To come back or to return.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

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.

An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone.

A gland located beneath the larynx (voice box) that makes thyroid hormone and calcitonin. The thyroid gland helps regulate growth and metabolism. Also called thyroid.

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

A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Also called ultrasonography.

Having to do with a virus.

A type of high-energy radiation. 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.