Home > Cancer information > Living with and after cancer > Symptoms & side effects

> Other symptoms &

side effects > Pleural effusion
Pleural effusion
Pleural effusions can be a symptom of cancer.
On this page
Pleural effusions
Causes of a pleural effusion
Signs and symptoms of a pleural effusion
How a pleural effusion is diagnosed
Drainage of a pleural effusion
Pleurodesis
Medical thoracoscopy
References and thanks
We hope this information answers your questions. If you have any further questions, you can ask your
doctor or nurse at the hospital where you are having your treatment.
Pleural effusions
The lungs are covered by a membrane, or lining, called the pleura, which has an inner and outer layer. The
inner layer covers the lungs. The outer layer lines the rib cage and diaphragm, which is a sheet of muscle
that separates the chest from the abdomen.
The pleura produces a fluid that acts as a lubricant that helps you to breathe easily, allowing the lungs to
move in and out smoothly. Sometimes too much of this fluid can build up between the two layers of the
pleura; this is called a pleural effusion.
A pleural effusion
Causes of a pleural effusion
Pleural effusions are quite common and are often due to infections such as pneumonia or heart failure, which
is when the heart is not pumping the blood efficiently around the body. A pleural effusion can also be a
symptom of several types of cancer. The effusion can develop if cancer cells have spread into the pleura,
where they can lead to irritation and cause fluid to build up. The types of cancer that are more likely to
cause a pleural effusion are:
lung cancer
breast cancer
ovarian cancer
lymphomas
mesothelioma (cancer of the pleura).
Signs and symptoms of a pleural effusion
The build-up of fluid presses on the lung, making it difficult for the lung to expand fully. In some situations,
part or all of the lung will collapse. This can make you increasingly breathless, not only when youre active,
but also when youre resting. You may also get some chest pain and a cough.
How a pleural effusion is diagnosed
A chest x-ray and/or an ultrasound scan may be used to diagnose a pleural effusion. Sometimes other tests
may be needed to confirm the diagnosis and the cause of the effusion.
Drainage of a pleural effusion
The initial treatment of a pleural effusion involves draining it to relieve the symptoms.
Draining a pleural effusion with a chest drain
A pleural effusion is usually drained by putting a tube, known as a chest drain, into the chest. This
procedure is carried out by a doctor. You will be asked to sit either on a chair or on the edge of the bed.
Someone will then help you lean forward over a table with a pillow on it so that your back is exposed.
Your doctor will decide where to insert the drain - usually in the side of the chest. The skin over the area
where the drain is to be inserted is cleaned with an antiseptic solution to prevent the area from becoming
infected. You will then be given an injection of local anaesthetic to numb the area so you wont feel any pain
during the procedure.
Your doctor will then make a very small cut in the chest and insert the chest drain into the space where the
fluid is collecting. Sometimes an ultrasound scan is used to help guide the tube into the correct position.
Once in position, the chest drain is attached to a bag or bottle for the fluid to drain into. The fluid that drains
may be bloodstained.
Usually the fluid will be drained off fairly slowly, as a sudden release of pressure in the chest can cause a
drop in blood pressure. A litre of fluid may be drained safely as soon as the drain has been inserted. After
this, drainage will be carried out more slowly. Your blood pressure will be checked during the procedure. You
should let your doctor or nurse know if you feel dizzy, sick or light-headed.
You will usually need to stay in hospital for a couple of days after the procedure. You may have some pain
when the local anaesthetic wears off. Let your doctor or nurse know if this happens so that they can
prescribe painkillers. The drainage tube will be held in place with a small stitch until all the fluid has drained.
If your drainage tube is attached to a bottle, you will be able to walk about with it. It's important to be careful
with the bottle; it shouldn't be raised above the level of the chest as the fluid could go back into your lungs.
Once the drainage has slowed down and the doctors think that most of the fluid has drained, you will have a
chest x-ray to see how well your lung has re-expanded. If it has, the drain will be removed.
It's possible for the fluid to collect again, so drainage may need to be carried out more than once. To prevent
the fluid from building up again you may be prescribed chemotherapy or hormonal therapy to treat the
cancer. Your doctor may also advise you to have a pleurodesis or a medical thoracoscopy.
Possible complications of chest drains
The chest drain can become blocked, but this is rare. It can sometimes be cleared by changing your
position or sitting upright. Occasionally the drain may need to be replaced.
The drain can become infected. You will have your temperature checked for any sign that you may be
developing an infection.
Sometimes the drain causes air to become trapped between the lung and the chest wall. This is
called a pneumothorax. You may become more breathless and have a sharp pain in your chest. If it's
a small pneumothorax, you may not need any treatment and it's likely to clear over a few days. You
may need to have an x-ray to check that it's gone. If it's a larger pneumothorax, you may need
another drainage tube to remove the air.
Draining a pleural effusion at home
Occasionally, it may be possible to have your pleural effusion drained while youre at home using a catheter,
which acts in a very similar way to a chest drain. The catheter will be put in while youre in the hospital and
then you will be able to go home. Your doctor or specialist nurse will explain more about this method of
drainage if its suitable for you.
Draining a small pleural effusion
If there is only a small amount of pleural fluid in the chest, the doctor may insert a small needle or cannula
into the chest rather than a chest drain. This is removed immediately after the fluid has been drained off and
the area is covered with a dressing.
Pleurodesis
If the lung re-inflates after the fluid has been drained, it may be possible to seal the two layers of the pleura
together to prevent the fluid from building up again. This is known as pleurodesis. It is usually done using a
sterile talc that is injected through the drain.
The doctor injects the drug through the drain and then leaves the drain clamped for about an hour. You will
be asked to lie in various positions in the bed (on your back, your front, and your left and right sides) to help
the drug circulate around the lining of the lungs. The drain may then be attached to a suction machine to
apply a small amount of pressure, which encourages the pleura to seal together. After a pleurodesis, the
drain will usually remain in place for 24 hours.
If there is a stitch that has been holding the drain in, it can be pulled together when the drain is removed,
sealing the hole that is then covered with a dressing. The stitch is usually removed about a week later.
Sometimes just a dressing is used to cover the area where the drain has been. After a pleurodesis, you may
get chest pain for a day or so and you may need to take painkillers.
If youre advised to have a pleurodesis, your doctor or nurse will give you more information about it.
Medical thoracoscopy
It may be possible to drain a pleural effusion and to do a pleurodesis using a procedure called medical
thoracoscopy. A flexible tube (thorascope) is put into your chest through a small cut made in your chest
wall. The tube has a light and a camera at the end so that the doctor can see the area clearly.
You will be asked to lie on your side and given an injection of a sedative to make you feel drowsy. A local
anaesthetic will be given to numb the area where the doctor will make one or two small cuts. The thorascope
is then put into the chest. Any fluid can be drained, and the doctor can spray sterile talc through the
thoracoscopy tube to help the layers of the pleura stick together. The procedure takes about 40-60 minutes.
After the thoracoscopy, a plastic tube (chest drain) will be put through the cut to drain any remaining fluid.
The drain will be attached to a bottle or bag and secured in place with a stitch. You will usually be able to go
home 2-5 days after a thoracoscopy. Your hospital team will be able to give you more information about this
procedure.
References and thanks
This section has been compiled using information from a number of reliable sources, including:
Doherty L, Lister S. The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th edition
2008. Wiley-Blackwell.
Heffner J. Management of malignant pleural effusions. 2012. UpToDate (accessed August 2012)
Souhami, Hochhaser. Cancer and its management. 6th edition. 2010. Wiley-Blackwell.
Twycross et al. Symptom Management in Advanced Cancer. 4th edition. 2009. Palliativedrugs.com
Ltd.
Thanks
With thanks to Dr David Gilligan, Consultant Oncologist, and the people affected by cancer who reviewed
this edition.
Reviewing information is just one of the ways you could help when you join our Cancer Voices network.
Content last reviewed: 1 January 2013
Next planned review: 2015
We make every effort to ensure that the information we provide is accurate and up-to-date but it should not be
relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by
law, Macmillan does not accept liability in relation to the use of any information contained in this publication or
third party information or websites included or referred to in it.
Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the
Isle of Man (604). A company limited by guarantee, registered in England and Wales company number
2400969. Isle of Man company number 4694F. Registered office: 89 Albert Embankment, London SE1 7UQ.