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Chapter 077. Approach to the Patient with Cancer (Part 11)

Effusions Fluid may accumulate abnormally in the pleural cavity, pericardium, or peritoneum. Asymptomatic malignant effusions may not require treatment. Symptomatic effusions occurring in tumors responsive to systemic therapy usually do not require local treatment but respond to the treatment for the underlying tumor. Symptomatic effusions occurring in tumors unresponsive to systemic therapy may require local treatment in patients with a life expectancy of at least 6 months. Pleural effusions due to tumors may or may not contain malignant cells. Lung cancer, breast cancer, and lymphomas account for ~75% of malignant pleural effusions. Their exudative nature is usually gauged by an effusion/serum. | Chapter 077. Approach to the Patient with Cancer Part 11 Effusions Fluid may accumulate abnormally in the pleural cavity pericardium or peritoneum. Asymptomatic malignant effusions may not require treatment. Symptomatic effusions occurring in tumors responsive to systemic therapy usually do not require local treatment but respond to the treatment for the underlying tumor. Symptomatic effusions occurring in tumors unresponsive to systemic therapy may require local treatment in patients with a life expectancy of at least 6 months. Pleural effusions due to tumors may or may not contain malignant cells. Lung cancer breast cancer and lymphomas account for 75 of malignant pleural effusions. Their exudative nature is usually gauged by an effusion serum protein ratio of 0.5 or an effusion serum lactate dehydrogenase ratio of 0.6. When the condition is symptomatic thoracentesis is usually performed first. In most cases symptomatic improvement occurs for 1 month. Chest tube drainage is required if symptoms recur within 2 weeks. Fluid is aspirated until the flow rate is 100 mL in 24 h. Then either 60 units of bleomycin or 1 g of doxycycline is infused into the chest tube in 50 mL of 5 dextrose in water the tube is clamped the patient is rotated on four sides spending 15 min in each position and after 12 h the tube is again attached to suction for another 24 h. The tube is then disconnected from suction and allowed to drain by gravity. If 100 mL drains over the next 24 h the chest tube is pulled and a radiograph taken 24 h later. If the chest tube continues to drain fluid at an unacceptably high rate sclerosis can be repeated. Bleomycin may be somewhat more effective than doxycycline but is very expensive. Doxycycline is usually the drug of first choice. If neither doxycycline nor bleomycin is effective talc can be used. Symptomatic pericardial effusions are usually treated by creating a pericardial window or by stripping the pericardium. If the patient s condition does not .