Malignant pleural effusion
From Standard of Care
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May be the initial presentation of cancer, as a delayed finding in a known neoplasm or as a manifestation of recurrent cancer.
Defined by the presence of malignant cells in the pleural space.
Causes dyspnea in more than 1 million people worlwide annualy and prevalence increasing.
Can arise from primary malignancy of the pleura or from intra or extra thoracic cancers.
Cancer cells reach the pleural fluid by contiguous spread, the blood or lymphatics.
More than 75% of cases related to lung, breast, ovary or lymphoma malignancies.
Metastatic adenocarcinoma the most common tissue type.
Can be due to mesotheliomas.
Median survival from findings of a malignant pleural effusion is 4 months.
When established tumors spread in the pleural space along parietal pleural membranes obstructing lymphatic vessels that drain the intrapleural fluid.
Pleural involvement by tumors stimulate release of chemokines that increase pleural and vascular membrane permeability resulting in further accumulation of pleural fluid.
Patients typically present with low glucose (<60mg/dL), cell counts less than 5000/µL, and positive cytology.
Grossly bloody fluid and eosinophilia are common.
Aim of treatent is palliation.
Treatment recommendation is chest tube insertion and pleurodesis as first line treatment.
Talc most effective pleurodesis agent.
Median hospitalization 7 days for talc pleurodesis is 7 days.
30 day failure rate for talc pleurodesis with recurrent pleural fluid requiring further management is approximately 30%.