Management of Pleural Burden in Metastatic Lung Cancer and Malignant Pleural Mesothelioma
The burden of malignant pleural disease continues to rise, and the discovery of a malignant pleural effusion is a common problem in patients with lung cancer and malignant pleural mesothelioma. Symptomatic pleural involvement can present clinicians with a number of diagnostic and therapeutic challenges. Radiologically apparent pleural involvement requires thorough investigation and its discovery commonly represents metastatic disease across many tumour types. Histopathological pleural molecular subtyping has dramatically increased the availability of novel targeted therapies in advanced thoracic malignancy, and modern pleural intervention strategies can offer patients timely evidence-based fluid management. The impact of modern pleural research has reshaped the way in which patients are managed, shifting from what was historically a more surgical and radiological domain to the more medically focused approach. Developing pleural teams are in an excellent position to influence change in the current economically challenging environment by providing this group of patients with advanced disease, rapid management in an ambulatory setting. The use of validated prognostication tools and image-guided symptom control strategies help us to offer our patients more individualised pleural management. The chapter aims to summarise the available data around the pathophysiological mechanisms of pleural fluid production whilst considering methods of investigation, tumour staging and prognostication through to patient focused, therapeutic intervention strategies.
KeywordsPleural disease Malignant pleural effusion Tumour staging Lung cancer Malignant pleural mesothelioma Prognostication Pleural aspiration Intercostal chest drain Thoracoscopy Indwelling pleural catheter
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