Malignant Pleural Effusion: Causes and Treatment

Pleural effusion is a condition that occurs when excess fluid accumulates between the layers of membrane (pleura) around the lung. Also known as "water on the lungs", pleural effusion is quite common. The area between the layers that cover the lungs is called pleural space or cavity. The membrane produces a fluid which plays an important role in maintaining the normal breathing process. Normally the fluid is present in small amounts. However, when the formation of the fluid is more than required, it causes a difficulty in breathing. If pleural effusion is caused by cancer (uncontrolled growth of cells), then it is known as malignant pleural effusion. The fluid collected contains a large number of malignant cells. Patients diagnosed with advanced cancer, are likely to develop malignant pleural effusion.

Causes of Malignant Pleural Effusion

Malignant effusion is a common complication that develops in patients suffering from cancer. Prolonged use of chemotherapy drugs or radiation therapy, can lead to this condition. Medical conditions that are known to cause malignant pleural effusions are as follows:

• Breast cancer
• Leukemia (blood cancer)
• Lymphoma (cancer that damages the immune system)
• Lung cancer

Symptoms of Malignant Pleural Effusion

Malignant pleural effusion makes it difficult for a person to breath. The abnormal formation of fluid puts undue pressure on the lungs. As a result the lungs are not able to expand fully. In some cases, the part of the lung collapses (the space between the lung and the wall of chest cavity fills with air) that leads to shortness of breath. In general, the most common symptoms of malignant pleural effusion are as follows:

• Trouble breathing
• Pain while inhaling
• Chest pain
• Cough

Treatment for Malignant Pleural Effusion

There are 3 major treatment options that can help manage malignant pleural. Treatment involves slowing down the rate of fluid build up and draining it to decrease the severity of symptoms.

Thoracentesis: In this procedure the fluid is drained from the pleural activity using a needle and a hollow plastic tube. This method of removing the fluid, can ease the discomfort of the patient to a certain extent as it relieves severe symptoms for a short period. This method provides an immediate improvement in the breathing process, thus allowing the patients to continue with daily activities. However, after the treatment of thoracentesis, the fluid may start collecting again. Repeated thoracentesis is not recommended as it can cause bleeding, infection and low blood pressure. This procedure is helpful only if the rate of excess fluid build up is very slow.

Pleurodesis: In this procedure the pleural sac is closed to avoid repeated fluid build up. Fluid is first drained by thoracentesis using a chest tube. A chemical or a drug, is then administered through the chest tube in order to close the sac. Chemical agents that cause the sac to close are talc, doxycycline and bleomycin. The chest tube is removed from the body, only after a sufficient amount of fluid is drained. In most cases, the patient is admitted in the hospital for 6-7 days.

Surgery: The surgical procedure involves implanting a shunt (tube) to bring the accumulated fluid to the abdominal activity. Removing the fluid from the pleural activity can be a bit tough, whereas the fluid can be drained easily, if it is in the abdominal activity. This procedure is highly effective for alleviating symptoms of malignant pleural effusion.

As soon as malignant pleural effusion is diagnosed, immediate treatment is required to avoid disastrous complications. Effective treatment will help bring the condition under control.