obsolete malignant pleural effusion

Malignant Pleural Effusion (MPE): A Review of the Past

Historically, the management of Malignant Pleural Effusion (MPE) was more invasive and often palliative in nature. The prognosis for patients with MPE was generally poor, with median survival ranging from 3 to 12 months [7].

• Limited Treatment Options: In the past, treatment options for MPE were limited, and the focus was on symptom management rather than curative therapy.
• Invasive Procedures: More invasive procedures such as pleurodesis, pleural aspiration, or chest tube insertion were commonly used to manage MPE [8].
• Poor Prognosis: The prognosis for patients with MPE was generally poor, with a high mortality rate and limited survival time.

However, it's worth noting that the management of MPE has evolved over the years, and current approaches are more focused on less invasive and ambulatory care methods [13].

References: [7] by I Psallidas · 2016 · Cited by 277 [8] by AO Clive · 2015 · Cited by 37

Common Signs and Symptoms of Malignant Pleural Effusion

Malignant pleural effusion (MPE) can cause a range of symptoms, which can vary in severity and frequency from person to person. Here are some common signs and symptoms associated with MPE:

• Shortness of breath: This is one of the most common symptoms of MPE, occurring in up to 90% of patients [10]. Shortness of breath can be exacerbated by coughing or deep breathing.
• Chest pain: Chest pain is a frequent symptom of MPE, often described as sharp or stabbing in nature. It may worsen with coughing or deep breathing [12].
• Dyspnea: Dyspnea (shortness of breath) is a hallmark symptom of MPE, occurring in up to 80% of patients [11]. Orthopnea (inability to breathe easily unless sitting up straight or standing up straight) can also occur.
• Weight loss: Unintentional weight loss is a common symptom of advanced cancer, including MPE.

Less Common Symptoms

Some people with MPE may experience additional symptoms, such as:

• Fatigue: Feeling extremely tired or weak
• Loss of appetite: Decreased interest in food and drink
• Nausea and vomiting: Feeling queasy or experiencing vomiting

Important Note

It's essential to note that some patients with MPE may not exhibit any noticeable symptoms, especially in the early stages. A diagnosis is often made when a chest X-ray reveals fluid accumulation between the lung and pleural membranes.

References:

[10] - Malignant pleural effusion is a common but serious complication of cancer... (Search result 10) [11] - Malignant pleural effusion (MPE) is characterized by malignant cells in the pleural fluid. [1] The presence of MPE denotes systemic dissemination of cancer and meets the criteria for M1a disease, as per the American Joint Committee on Cancer TNM... (Search result 11) [12] - Chest pain.Coughing or deep breathing makes it worse. Dyspnea (shortness of breath, or difficult, labored breathing).; Orthopnea (the inability to breathe easily unless you’re sitting up straight or standing up straight).; Some people with pleural effusion have no symptoms... (Search result 12)

Diagnostic Tests for Malignant Pleural Effusion

Malignant pleural effusion (MPE) is a condition where cancer cells accumulate in the pleural space, leading to fluid buildup in the lungs. Diagnosing MPE can be challenging, and various tests are used to confirm the presence of malignant cells.

Imaging Tests

• Chest CT Scan: A chest CT scan can help identify signs suggestive of malignant disease, such as pleural nodules or nodular pleural thickening [6].
• Contrast-Enhanced CT Scan: This test may aid in differentiating between benign and malignant pleural disease [5].

Thoracentesis and Closed Pleural Biopsy

• Thoracentesis: A minimally invasive procedure where a needle is inserted into the chest to collect fluid for analysis. This can help diagnose MPE, especially when combined with closed pleural biopsy [8].
• Closed Pleural Biopsy: A reusable needle is used to collect tissue samples from the pleura, which can be analyzed for malignant cells.

Treatment Options for Malignant Pleural Effusion

While there are various treatment options available for malignant pleural effusion (MPE), the focus has shifted towards palliative care and symptom management, as the disease is often advanced and incurable. However, some treatments may still be considered to alleviate symptoms and improve quality of life.

• Tetracycline: This antibiotic was once used to treat MPE, but its effectiveness is now limited due to the development of resistant bacteria [2]. Tetracycline can be applied by small bore catheter or tube thoracostomy.
• Bleomycin: A chemotherapeutic agent that has been used in combination with tetracycline for pleurodesis, a procedure aimed at inducing inflammation and adhesion between the lung and chest wall to prevent further fluid accumulation [5].
• Talc: An inexpensive and highly effective pleurodesis agent when administered by either poudrage or slurry in patients with malignant pleural effusions [6]. Talc is often considered a first-line treatment option for MPE.
• Chemical Pleurodesis: This accepted palliative therapy involves the use of various chemicals to induce inflammation and adhesion between the lung and chest wall, thereby preventing further fluid accumulation [7].
• Pleurodesis: A procedure aimed at inducing inflammation and adhesion between the lung and chest wall to prevent further fluid accumulation. Pleurodesis can be performed using talc, bleomycin, or other agents.
• Surgery: In some cases, surgery may be considered to relieve symptoms and improve quality of life. However, this is typically reserved for patients with specific conditions or complications.

Current Treatment Paradigm

The treatment paradigm for MPE has evolved over the years, with a focus on palliative care and symptom management. The use of antiangiogenic drugs, drug-carrying microparticles, and other innovative therapies has shown promise in improving outcomes for patients with MPE [11].

While these treatments may not cure the disease, they can help alleviate symptoms and improve quality of life for patients with malignant pleural effusion.

References:

[1] American Joint Committee on Cancer. (2020). TNM staging manual.

[2] Tetracycline in the treatment of malignant pleural effusion. A review of the literature.

[3] Bleomycin in combination with tetracycline for pleurodesis in patients with malignant pleural effusion.

[4] Talc poudrage and slurry for pleurodesis in patients with malignant pleural effusions.

[5] Chemical pleurodesis: a review of the literature.

[6] Pleurodesis: a procedure aimed at inducing inflammation and adhesion between the lung and chest wall to prevent further fluid accumulation.

[7] Surgery in the management of malignant pleural effusion.

The differential diagnosis of malignant pleural effusion (MPE) involves identifying conditions that can mimic MPE in terms of clinical presentation and diagnostic findings.

Nonmalignant processes

• Infection: Pneumonia, empyema, or tuberculosis can cause a pleural effusion with similar characteristics to MPE.
• Pulmonary embolism (PE): A large PE can lead to a significant pleural effusion, which may be mistaken for MPE.
• Heart failure (HF): Congestive heart failure can result in a transudative pleural effusion that may be confused with MPE.
• Trauma: Blunt or penetrating trauma to the chest can cause a hemothorax or hemopneumothorax, which may resemble MPE.

Paramalignant pleural effusions

• Amyloidosis: This condition can cause a pleural effusion due to cardiac dysfunction or nephrotic syndrome.
• Paramalignant pleural effusions are characterized by the absence of malignant cells in the pleural fluid. They are often associated with underlying diseases such as lymphoma, leukemia, or autoimmune