What You Should Know About Malignant Pleural Efflusion

By Health & Medical Last updated Tuesday, April/02/2024

Updated August 12, 2015.

A malignant pleural effusion is a complication that occurs in 30% of lung cancers. It can also occur with other cancers, such as breast cancers and lymphomas. With lung cancer, a malignant pleural effusion may be the first sign of cancer, or it can occur as a late complication of advanced disease.

What Is a Malignant Pleural Effusion?

A pleural effusion is defined as an abnormal amount of fluid in the space between the layers of tissue (the pleura) that line the lungs.

If cancer cells are present in this fluid (the pleural cavity), it is called a malignant (cancerous) pleural effusion.

Causes

Almost any type of cancer can cause a pleural effusion if it is present in or spreads (metastasizes) to the chest area. The most common are those mentioned above.

Symptoms

The symptoms of a malignant pleural effusion can be very uncomfortable. Shortness of breath is the most common symptom. A cough may be present, and this is often positional, meaning it may be worse in certain positions such as with leaning forward or lying on one side. Chest pressure may also occur.

Diagnosis

It is important to make an accurate diagnosis of a malignant pleural effusion, since the prognosis and treatment are much different than for non-malignant (benign) pleural effusions. It's important to note that even with cancer, up to 50% of pleural effusions are benign.

A malignant pleural effusion is often first suspected because of symptoms or findings seen on a chest x-ray or CT scan. If your doctor suspects a malignant pleural effusion, the next step is usually a thoracentesis, a procedure in which a needle is inserted into the pleural space to get a sample of the fluid.

This fluid is then examined under a microscope to see if cancer cells are present.

If a thoracentesis cannot be done, or if the results are inconclusive, further procedures may need to be done to get an accurate diagnosis. In some cases, a thoracoscopy (a procedure in which a thorascope is inserted into the chest) may need to be done to obtain a biopsy to diagnose a malignant pleural effusion.

Treatment

The goal in treating a malignant pleural effusion is palliative, that is, to improve quality of life and reduce symptoms but not to cure the cancer.

If the effusion is very small, it can sometimes be left alone. Thoracentesis can be performed to remove the fluid, but it frequently returns.

For malignant pleural effusions which recur, there are several options for treating the fluid and relieving shortness of breath. One procedure that works in roughly 80% of people is called a pleurodesis. In this procedure, a tube is inserted into the pleural space and a substance, most commonly talcum powder, is inserted between the 2 membranes lining the lungs. This causes inflammation which in turn causes the 2 linings to stick together (fuse,) preventing fluid from again accumulating in the pleural space. Another procedure is a tunneled pleural catheter. In this procedure a small tube is inserted into the pleural space and tunneled beneath the skin, with a small opening on your side which can be covered with a bandage. This allows patients to drain their own fluid (with the help of a loved one) by attaching a vacuum container to the opening at the skin. Before a pleurodesis or tunneled pleural catheter are recommended a few things are necessary. First, your doctor will want to confirm that you have a malignant pleural effusion and that your symptoms are not due to another cause. Secondly, you should have a pleural effusion that recurs (comes back) after a thoracentesis. And most importantly, the draining of the fluid from your pleural space should help with your symptoms of shortness of breath. It is not necessary to remove fluid just because it is there, but only if it is causing problems such as shortness of breath.

If a malignant pleural effusion persists despite these other techniques, surgery may be done to drain the fluid into the abdomen, or a pleurectomy (a procedure that removes part of the pleura) may be performed. New treatments (such as medical pleuroscopy) are emerging to treat malignant pleural effusions as well. Chemotherapy may help with malignant pleural effusions due to small cell lung cancer, but it does not seem to help with those due to non-small cell lung cancer.

Prognosis

Sadly, the average life expectancy for lung cancer with a malignant pleural effusion is less than 6 months. The median survival time (the time at which 50% of people have died and 50% are still living) is 4 months.

Coping

The discomfort from a malignant pleural effusion can be considerable. Pair that with learning of the diagnosis and its poor prognosis, and the experience can be distressing for anyone -- particularly those who already have a malignant pleural effusion when they are first diagnosed with cancer. Ask questions. Ask for help from others, and allow them to give it. Talk to your doctor about managing pain from lung cancer. Consider joining a support group. Your emotions may span the spectrum from anger, to disbelief, to depression. That is normal. Seek out friends and loved ones who are willing to truly listen and support you.

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