Malignant pleural effusions often occur in advanced or unresectable cancer or in the last few weeks of life. The goal of treatment is usually palliative, to relieve the symptoms and improve the quality of life. The goals of therapy will depend on a number of factors, including the following:
Treatment of the symptoms of malignant pleural effusion may include the following:
Removal of fluid from the pleural cavity using a needle and/or a thin, hollow plastic tube may help to alleviate severe symptoms in the short-term. A few days after thoracentesis, the effusion will begin to reform. Repeated thoracentesis has risks, however, including bleeding, infection, collapsed lung, fluid in the lungs, and low blood pressure.
This is a procedure to close the pleural sac so that fluid cannot collect there. Fluid is first removed by thoracentesis, using a chest tube. A drug or chemical that causes the sac to close is then inserted into the space through a chest tube. Chemical agents such as bleomycin or talc may be used.
Surgery may be done to implant a shunt (tube) to transfer the fluid from the pleural cavity to the peritoneal (abdominal) cavity, where the fluid can be more easily removed. Another option is pleurectomy, removal of the part of the pleura that lines the chest.