Malignant Pleurisy

Malignant Pleurisy

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Malignant pleural effusion is a complication that occurs in 30% of lung cancers. The condition may also occur in other cancers such as lymphoma and breast cancer. In lung cancer malignant pleurisy may be the first clinical manifestation of neoplasia or can develop as a late complication of the disease advanced.
Malignant Pleurisy is defined as an abnormal amount of fluid accumulated in the pleural space between the foils of tissue lining the lung. If tumor cells are present in the liquid condition is called malignant pleural effusion.
Almost all types of cancer can cause pleural metastases if chest shows. Most common are lymphomas and breast cancer. Malignant pleurisy symptoms can cause patient discomfort and include dyspnea, chest pain, coughing and irritating.
Proper diagnosis is important because the prognosis and treatment of malignant pleurisy are different than for non-malignant pleurisy. Even in cancer, up to 50% of pleurisy are benign. Malignant pleurisy is suspected because of symptoms or elements initially detected at CT or radiography. It will toracenteza practice, the procedure to punctioneaza pleural space to remove a sample of liquid. The fluid is sent to cytology to check for cancer cells. If toracenteza is inefficient to sample indicate thoracoscopy and biopsy to diagnose malignant pleurisy.
Malignant pleurisy palliative treatment is the patient's life by improving quality and reducing symptoms. If pleurisy is small quantity can be medically supervised. Toracenteza is performed to remove a part of the fluid, which will move refece most times. To prevent fluid pleurodeza practiced the procedure by which a chemical such as talc is inserted between the two pleural foil to prevent pasting them build up. The procedure has a success rate of 60-90%. If you persist indicate malignant pleurisy surgery to drain fluid in the abdomen or pleurectomie. Chemotherapy can help pleurisy due to small cell lung cancer but does not seem to be helpful in case of non-small cell. Unfortunately, life expectancy for lung cancer with malignant pleural effusion is less than 6 months. Average survival was 4 months.
Pathogenesis and causes of malignant pleural effusion: Pleural cavity normally contains a small amount of liquid, about 10 ml on each side. Pleurisy occurs when an imbalance occurs between the production rate and the result having the absorption of excess pleural fluid accumulation. Pleurisy occurs because the imbalance of p [roducere and absorption of about 5-10 liters of fluid in the pleural cavity traverses 24 hours, exceeding the 5 to 20 ml of fluid are normally preenti into the pleural space at any time.
There are differences in the pathogenesis of the types of malignant pleurisy. In type I increased permeability of capillaries developed pleural inflammatory response of tumor invasion of the pleural effusion leads to extravasation of fluid rich in protein (exudate). This fluid can accumulate in large quantities as a result of blocked lymphatic drainage of the pleural space by the neoplastic process. Lymphatic blockage can be done at any level of the stoma until the parietal pleura mediastinal and internal mammary lymph nodes. There are studies showing that impaired pleural lymphatic drainage is probably the most important mechanism responsible for large volumes of fluid accumulation in cancer.
The appearance of these were described paramaligne pleurisy causes disruption of production-absorption balance: -Lymphatic obstruction Airway obstruction with atelectasis, By pneumonia, bronchial obstruction Superior vena cava syndrome, Heart-lung -Decompensated heart failure -Constrictive pericarditis, ascites Paraneoplazic-nephrotic syndrome Late-radiotherapy -Chemotherapy with cyclophosphamide.
Developed physiological phenomena are variable depending on the amount of accumulated fluid and fast installation. The progressive installation of pleurisy can cause physiological disorders by: Lung collapse, pulmonary compression leads to decreased ventilation and hypoxemia after infusion through the right-left are With contralateral mediastinal shift insuficeinta-respiratory, circulatory disorders decreased with returning venous -Metabolic disorder caused by loss of protein, fat and fat-soluble vitamins in advanced stages can lead to malnutrition and death, immunological disorders as a result of loss of lymphocytes and antibodies with increased risk of infection. When fluid accumulation is fast phenomena with cardiopulmonary Sudden onset dyspnea and tachypnea, tachycardia, hypotension with rapid evolution into shock.