Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentSurvival
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Survival
A malignant pleural effusion is a common but serious complication of cancer in which fluid collects between the membranes lining the lungs, called thepleura. It occurs in between 7% and 23% oflung cancersbut can also occur withbreast cancers,lymphomas, and other malignancies (cancers).
In all, malignant pleural effusion affects around 15% of people with cancer and is generally associated with a poor outlook.Symptoms include difficulty breathing, chest pressure, and an inability to lie flat. The various treatments are focused on removing the fluids either directly or indirectly.
The article describes the symptoms and causes of malignant pleural effusion, including how it is diagnosed and treated. It also explains the impact malignant pleural infusion has on survival.
What Is a Pleural Effusion?
What Are the Characteristics of Malignant Pleural Effusion?
What Stages Does Malignant Pleural Effusion Occur?
Malignant pleural effusion most often occurs with advancedstage 4 (metastatic) cancer. However, with lung cancer, it can sometimes occur before stage 4 and be the very first sign of cancer.
Similarly, pleural effusion can occur at any stage of lymphoma. This is because lymphoma is not a solid tumor cancer but one that spreads through fluids and vessels of thelymphatic system. While nearly half of all pleural effusions occur with stage 4 lymphoma, the rest are distributed almost equally among stages 1, 2, and 3.
Verywell / Cindy Chung
How Malignant Pleural Effusion Is Diagnosed
A malignant pleural effusion is often first suspected because of symptoms or findings on a chest X-ray orcomputed tomography (CT)scan.
If your doctor suspects a malignant pleural effusion, the next step is usually a thoracentesis. This is a procedure in which a needle is inserted through the chest wall into the pleural space to get a sample of 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, apleuroscopymay be ordered. This is a more invasive procedure in which a scope is inserted into the chest through an incision to access the pleural space.
How Is Malignant Pleural Effusion Treated?
Because pleural effusion usually occurs with stage 4 disease, the aim is not to cure the cancer but rather to manage symptoms and improve the person’s quality of life (known aspalliativeor comfort care).
Thoracentesis
Although thoracentesis is generally safe, complications such as infection,pneumothorax(a collapsed lung), chest wall bleeding, blood clots, andpulmonary edema(“water in the lungs”) are possible.
Pleurodesis
Another procedure that works in roughly 60% to 90% of cases ispleurodesis. In this procedure, a tube is inserted into the pleural space, and a substance (commonly talc) is injected between the membranes. The chemicals trigger inflammation which causes the two linings to stick together and effectively press the fluid out of the pleural space.
The complications of pleurodesis are similar to those of thoracentesis.
Indwelling Pleural Catheters
Another procedure used for a malignant pleural effusion is an indwelling pleural catheter (IPC). In this procedure, a small tube (catheter) is inserted into the pleural space via an incision between the ribs. The end of the tube is attached to a replaceable vacuum container that draws out and collects the fluid.
An IPC is effective if the effusion is bilateral or there are large volumes of fluid. The procedure is often considered less invasive than pleurodesis and is effective in over 80% of cases. Many researchers feel that IPCs should be the first-line option for all people with malignant pleural effusion.
Additional Treatment Options
If a malignant pleural effusion persists despite these treatments, surgery may be used to drain the fluid into the abdomen, or apleurectomymay be performed to remove part of the pleura.
Chemotherapymay help with malignant pleural effusions due tosmall cell lung cancerbut is not usually very effective withnon-small cell lung cancer.
Is Treatment Always Needed?A malignant pleural effusion is not always needed if the effusion is small and the risks of the treatment outweigh the benefits. It is not necessary to remove fluid just because it is there, rather, only if it is causing problems such as shortness of breath.
Is Treatment Always Needed?
A malignant pleural effusion is not always needed if the effusion is small and the risks of the treatment outweigh the benefits. It is not necessary to remove fluid just because it is there, rather, only if it is causing problems such as shortness of breath.
How Long Can Someone Live With Malignant Pleural Effusion?
The occurrence of malignant pleural effusion is generally a sign of poorer outcomes. With lung cancer, the average life expectancy is less than six months, while the mediansurvival time(the time during which 50% of people will have died) is four months.
When all cancer types are factored in, the median survival can be anywhere from three to 12 months.The only exception is pleura effusion with ovarian cancer, which has a median survival time of 21 months.
Summary
Malignant pleural effusion is a complication of cancer that causes the build-up of fluid in the membrane surrounding the lungs. It most often occurs with advanced stage 4 cancer, including lung and breast cancer. Symptoms include shortness of breath and chest pain or pressure.
Malignant pleural effusion is usually a sign of a poorer outcome and shortened life expectancy. Treatments can help control the complication, including indwelling catheters which drain fluid from the pleural space, or pleurodesis which uses chemicals to press fluids out of the pleural space.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Zamboni MM, da Silva CT Jr, Baretta R, Cunha ET, Cardoso GP.Important prognostic factors for survival in patients with malignant pleural effusion.BMC Pulm Med. 2015;15:29. doi:10.1186/s12890-015-0025-zDesai NR, Lee HJ.Diagnosis and management of malignant pleural effusions: state of the art in 2017.J Thorac Dis. 2017;9(Suppl 10):S1111–S1122. doi:10.21037/jtd.2017.07.79Yang L, Wang Y.Malignant pleural effusion diagnosis and therapy.Open Life Sci.2023;18(1):20220575. doi:10.1515/biol-2022-0575Hunter BD, Dhakal S, Voci S, Goldstein NPN, Constine LS.Pleural effusions in patients with Hodgkin lymphoma: clinical predictors and associations with outcome.Leuk Lymphoma.2014 Aug;55(8):1822-6. doi:10.3109/10428194.2013.836599National Heart, Lung, and Blood Institute.Thoracentesis.Clive AO, Jones HE, Bhatnagar R, Preston NJ, Maskell N.Interventions for the management of malignant pleural effusions: a network meta-analysis.Cochrane Database Syst Rev. 2016;2016(5):CD010529. doi:10.1002/14651858.CD010529.pub2Kheir F, Shawwa K, Alokla K, Omballi M, Alraiyes AH.Tunneled pleural catheter for the treatment of malignant pleural effusion: a systematic review and meta-analysis.Am J Ther. 2016;23(6):e1300-e1306. doi:10.1097/MJT.0000000000000197Zamboni MM, da Silva CT, Baretta R, Cunha ET, Cardosa GP.Important prognostic factors for survival in patients with malignant pleural effusion.BMC Pulm Med. 2015;15:29. doi:10.1186/s12890-015-0025-z
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Zamboni MM, da Silva CT Jr, Baretta R, Cunha ET, Cardoso GP.Important prognostic factors for survival in patients with malignant pleural effusion.BMC Pulm Med. 2015;15:29. doi:10.1186/s12890-015-0025-zDesai NR, Lee HJ.Diagnosis and management of malignant pleural effusions: state of the art in 2017.J Thorac Dis. 2017;9(Suppl 10):S1111–S1122. doi:10.21037/jtd.2017.07.79Yang L, Wang Y.Malignant pleural effusion diagnosis and therapy.Open Life Sci.2023;18(1):20220575. doi:10.1515/biol-2022-0575Hunter BD, Dhakal S, Voci S, Goldstein NPN, Constine LS.Pleural effusions in patients with Hodgkin lymphoma: clinical predictors and associations with outcome.Leuk Lymphoma.2014 Aug;55(8):1822-6. doi:10.3109/10428194.2013.836599National Heart, Lung, and Blood Institute.Thoracentesis.Clive AO, Jones HE, Bhatnagar R, Preston NJ, Maskell N.Interventions for the management of malignant pleural effusions: a network meta-analysis.Cochrane Database Syst Rev. 2016;2016(5):CD010529. doi:10.1002/14651858.CD010529.pub2Kheir F, Shawwa K, Alokla K, Omballi M, Alraiyes AH.Tunneled pleural catheter for the treatment of malignant pleural effusion: a systematic review and meta-analysis.Am J Ther. 2016;23(6):e1300-e1306. doi:10.1097/MJT.0000000000000197Zamboni MM, da Silva CT, Baretta R, Cunha ET, Cardosa GP.Important prognostic factors for survival in patients with malignant pleural effusion.BMC Pulm Med. 2015;15:29. doi:10.1186/s12890-015-0025-z
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Zamboni MM, da Silva CT Jr, Baretta R, Cunha ET, Cardoso GP.Important prognostic factors for survival in patients with malignant pleural effusion.BMC Pulm Med. 2015;15:29. doi:10.1186/s12890-015-0025-zDesai NR, Lee HJ.Diagnosis and management of malignant pleural effusions: state of the art in 2017.J Thorac Dis. 2017;9(Suppl 10):S1111–S1122. doi:10.21037/jtd.2017.07.79Yang L, Wang Y.Malignant pleural effusion diagnosis and therapy.Open Life Sci.2023;18(1):20220575. doi:10.1515/biol-2022-0575Hunter BD, Dhakal S, Voci S, Goldstein NPN, Constine LS.Pleural effusions in patients with Hodgkin lymphoma: clinical predictors and associations with outcome.Leuk Lymphoma.2014 Aug;55(8):1822-6. doi:10.3109/10428194.2013.836599National Heart, Lung, and Blood Institute.Thoracentesis.Clive AO, Jones HE, Bhatnagar R, Preston NJ, Maskell N.Interventions for the management of malignant pleural effusions: a network meta-analysis.Cochrane Database Syst Rev. 2016;2016(5):CD010529. doi:10.1002/14651858.CD010529.pub2Kheir F, Shawwa K, Alokla K, Omballi M, Alraiyes AH.Tunneled pleural catheter for the treatment of malignant pleural effusion: a systematic review and meta-analysis.Am J Ther. 2016;23(6):e1300-e1306. doi:10.1097/MJT.0000000000000197Zamboni MM, da Silva CT, Baretta R, Cunha ET, Cardosa GP.Important prognostic factors for survival in patients with malignant pleural effusion.BMC Pulm Med. 2015;15:29. doi:10.1186/s12890-015-0025-z
Zamboni MM, da Silva CT Jr, Baretta R, Cunha ET, Cardoso GP.Important prognostic factors for survival in patients with malignant pleural effusion.BMC Pulm Med. 2015;15:29. doi:10.1186/s12890-015-0025-z
Desai NR, Lee HJ.Diagnosis and management of malignant pleural effusions: state of the art in 2017.J Thorac Dis. 2017;9(Suppl 10):S1111–S1122. doi:10.21037/jtd.2017.07.79
Yang L, Wang Y.Malignant pleural effusion diagnosis and therapy.Open Life Sci.2023;18(1):20220575. doi:10.1515/biol-2022-0575
Hunter BD, Dhakal S, Voci S, Goldstein NPN, Constine LS.Pleural effusions in patients with Hodgkin lymphoma: clinical predictors and associations with outcome.Leuk Lymphoma.2014 Aug;55(8):1822-6. doi:10.3109/10428194.2013.836599
National Heart, Lung, and Blood Institute.Thoracentesis.
Clive AO, Jones HE, Bhatnagar R, Preston NJ, Maskell N.Interventions for the management of malignant pleural effusions: a network meta-analysis.Cochrane Database Syst Rev. 2016;2016(5):CD010529. doi:10.1002/14651858.CD010529.pub2
Kheir F, Shawwa K, Alokla K, Omballi M, Alraiyes AH.Tunneled pleural catheter for the treatment of malignant pleural effusion: a systematic review and meta-analysis.Am J Ther. 2016;23(6):e1300-e1306. doi:10.1097/MJT.0000000000000197
Zamboni MM, da Silva CT, Baretta R, Cunha ET, Cardosa GP.Important prognostic factors for survival in patients with malignant pleural effusion.BMC Pulm Med. 2015;15:29. doi:10.1186/s12890-015-0025-z
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
