Standard therapy for malignant pleural effusions is
|A||Repeated thoracentesis with injection of a sclerosing agent|
|C||Thoracotomy with pleurectomy|
|D||Tube thoracostomy with subsequent instillation of a sclerosing agent|
a. Malignant pleural effusions secondary to metastatic disease are the second most common type of exudative pleural effusion.
b. The three tumors that cause ~75% of all malignant pleural effusions are lung carcinoma, breast carcinoma, and lymphoma. Most patients complain of dyspnea, which is frequently out of proportion to the size of the effusion.
c. The pleural fluid is an exudate, and its glucose level may be reduced if the tumor burden in the pleural space is high.
f. Patients with a malignant pleural effusion are treated symptomatically for the most part, since the presence of the effusion indicates disseminated disease and most malignancies associated with pleural effusion are not curable with chemotherapy.
g. If the patient's lifestyle is compromised by dyspnea, and if the dyspnea is relieved with a therapeutic thoracentesis, then one of the following procedures should be considered: (1) insertion of a small indwelling catheter; or (2) tube thoracostomy with the instillation of a sclerosing agent such as doxycycline, 500 mg.