John Han-Chih Chang, MD and Kenneth Blank, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 1, 2001
Dear OncoLink "Ask the Experts,"
Pathology from a my right lower lung lobectomy revealed a 2cm adenocarcinoma without lymph node involvement. What is the survival rate for this cancer?
A small pleural effusion in my right chest was detected several months after surgery. Cytological examination of my pleural effusion revealed adenocarcinoma, no recurrent tumor was detected.
Can you please help me?
Kenneth Blank, MD, and John Han-Chih Chang, MD, Editorial Assistants for Oncolink, respond:
Dear OncoLink Reader:
Thank you for your question.
The lungs are surrounded by a thin sac of tissue called the pleura. Fluid continually enters and exits the space between the lungs and the sac. Pleural fluid helps lubricate the lungs and prevents friction as the lungs move up and down against the rib cage during breathing. A pleural effusion is the medical term used to describe excessive fluid buildup in the pleural space. There are many causes for a pleural effusion including; congestive heart failure, trauma, lymphoma and cancer. If the pleural fluid contains cancer cells it is termed a malignant pleural effusion. In men, lung cancer is the most common cause of a malignant pleural effusion while in females it is breast cancer.
The treatment of a malignant pleural effusion begins with determining the cause. It is important to note that only one-half of pleural effusions in patients with a diagnosis of cancer is due to the cancer. Therefore, aspiration of the fluid is necessary to determine if cancer cells are present. Once a diagnosis of malignant pleural effusion is made, treatment depends on the clinical situation and the tumor type. About 25% of malignant pleural effusions are small and asymptomatic- these cases do not mandate therapy but should be followed closely with chest X-rays and physical exams to ensure that the effusion does not enlarge or cause symptoms.
Malignant pleural effusions that are large and/or symptomatic require treatment which may be surgical or medical. The surgical options include removal of the pleura (pleurectomy) or drainage of the effusion followed by injection directly into the pleural space of substances that causes scarring (this procedure is called pleurodesis). Pleurectomy is not commonly performed as it carries a high rate of side effects. Pleurodesis, on the other hand, is often performed with minimal side effects and is effective in draining the pleural fluid and preventing a return of malignant pleural effusions in approximately three-quarters of patients. Simple aspiration of the fluid is another option and can be performed as an outpatient, but in the large majority of cases the effusion returns within a matter of weeks.
Medical therapy of pleural effusions consists of treating the underlying cancer. For example, if the effusion is caused by breast cancer tamoxifen or chemotherapy is often successful at shrinking the tumor and the effusion. However, some tumors such as non-small cell lung cancers do not typically respond to chemotherapy and pleurodesis is often necessary.