Chapter

Pleural tumours

Robert J.O. Davies and Y.C. Gary Lee

in Oxford Textbook of Medicine

Fifth edition

Published on behalf of Oxford University Press

ISBN: 9780199204854
Published online May 2012 | e-ISBN: 9780199570973 | DOI: http://dx.doi.org/10.1093/med/9780199204854.003.181903

Series: Oxford Textbooks

Pleural tumours

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Benign tumours are rare in the pleural cavity, with solitary fibrous tumour of the pleura, the most frequent of these rarities.

Malignant pleural tumours are common and can arise from the pleura (most commonly mesothelioma) or as metastases from extrapleural malignancies (especially lung and breast cancer). They typically present with breathlessness, chest pain, and a pleural effusion. Diagnosis requires histocytological confirmation of malignant cells from pleural fluid and/or pleural biopsies.

Mesothelioma—most cases are due to asbestos exposure, characteristically after a latent period of more than 20 years, with risk related to the duration and intensity of asbestos exposure and the fibre type (worst with needle-like amphiboles). The condition is incurable, with overall median survival of about 9 months. Care involves control of pain and pleural effusion, chemotherapy with multitargeted antifolate agents in combination with cisplatin, and radiotherapy for symptom palliation.

Metastatic pleural malignancy—most tumours that have spread to the pleura are incurable. For tumours that are highly responsive to chemotherapy (e.g. lymphoma or small cell carcinoma) treatment may control pleural fluid re-accumulation. Definitive treatment for fluid control (e.g. pleurodesis) should be performed in patients with symptomatic recurrence of malignant pleural effusions. Indwelling pleural catheters (IPCs) provide an effective alternative to pleurodesis or when the latter fails. Surgical pleurodesis may be considered in selected patients.

Chapter.  4224 words.  Illustrated.

Subjects: Respiratory Medicine and Pulmonology

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