Malignant Pleural Effusions and Malignant Pleural Mesothelioma Flashcards
Most common causes of malignant pleural effusions (MPE)
- Lung cancer (40%)
- Breast cancer (25%)
- Lymphoma (10%)
- Ovarian cancer (5%)
- Gastric cancer (5%)
MOA of MPE
Pleural seeding (direct tumor extension, hematgoenous spread, lymphatic spread) accompanied by accumulation of pleural fluid.
- Angiogenic factors
- Increased vascular permiability
- Lymphatic obstruction
- disrupts normal absorption of 2-3L of pleural fluid per day
- Direct production of fluid by tumor
Median survival for most patients with MPE after diagnosis
4-6 months
MC symptoms of MPE
Dyspnea
Systemic therapy for MPE
Malignancy specific chemotherapry and XRT to primary lung lesions (small effusions.
(not effective for moderate to large MPE)
All cancer patients with a pleural effusion should undergo _
Thoracocentesis
- Diagnosis
- Weight contribution of the effusion to the patient’s symptoms
Radiographic assessment after thoracocentesis importnat to determine what
- Extent of disease
- Degree of lung entrapment
T/F
Repeat thoracocentesis is an acceptable managment strategy for patients with an extremely short life expectancy (<2 months)
True
Surgical options for recurrent effusions
- Pleurodesis (talc or doxycycline)
- Indwelling pleural catheter
Essential for success of pleurodesis
Lung inflation with pleural apposition
Chemical sclerosants used for pleurodesis
Talc
Doxycycline
Bleomycin
*Patients must be medically fit to tolerate the systemic inflammatory reponse that occurs after chemical pleurodesis (especially after talc)
Success rate of talc pleurodesis
80-95% at 90 days
Potential serious complications associated with talc as a sclerosant for pleurodesis
ARDS
(Extreme caution in medically comprimised and elderly patients)
Surgical options for pleurodesis
- VATS drainage of effusion and installation of sclerosant
- Thoracostomy tube placement with sclerosant instillation
- Indwelling pleural catheter placement followed by sclerosant instillation
MC indications for indwelling pleural catheter placement
Patients with trapped lung (d/t chronic fibropurulent effusion and fibrin peels) following thoracocentesis for MPE
*Pleural apposition is not possible
Techniques for indwelling pleural catheter placement
- VATS
- Open
- Percutaneous (Seldinger technique)
MC primary pleural tumor
Malignant pleural mesothelioma (MPM)
Peak incidence of MPM occurs in what patient population
Sixth decade
Males (5:1 ratio)
Asbestos exposure (85%)
Exposure to asbestos accounts for __% of patients with MPM
85%
Latency period from exposure to development of MPM
15-50 years