Mesothelioma and Pleural Effusions

Pleural effusion refers to a buildup in fluid within the pleura (the space between the lungs, chest wall and the pleura). Pleural effusions may be an indicator of lung cancer, such as mesothelioma and lung cancer. A malignant pleural effusion is treatable.

What is a Pleural Effusion?

Fluid between the chest wall, and the lung is called pleural effusion. A small amount of fluid fills the pleural cavity, which allows the lungs to glide in the chest while we breathe. A pleural effusion is when excess fluids build up in the pleural cavity due to mesothelioma, or other conditions.

The extra fluid surrounding the lungs takes up space, and fills the cavity. This causes the lungs to become compressed and makes breathing difficult. Nonexpandable lung refers to a compressed lung due to fluid or tumor.

A 2019 study of 229 mesothelioma patients found that 83% had a present pleural effusion, while 33% had nonexpandable lungs.

Pleural effusions could indicate a developing asbestos-related disease and may contribute to its progression.

Pleural thickening occurs when there is an accumulation of scar tissue in the pleura. It can also spread after each episode.

Uncomplicated pleural effusions can be treated on their own and are not considered life-threatening. They usually resolve themselves in a matter of months, without the need for medical intervention. A person with pleural effusions is more likely to have them again.

Pleural Effusions: Symptoms

Patients with nonexpandable lungs had the most frequent symptoms of pleural effusion, which included cough and breathlessness. Patients with mesothelioma without pleural effusions experienced more chest pain.

The symptoms of pleural effusion may vary from mild to severe. Some people experience no symptoms. The severity and type of symptoms can often be correlated with the fluid level and any underlying conditions or infections.

COMMON PLEURAL EFFUSION SYSMPTOMS

  • Dry cough
  • Breathing difficulties
  • Deep breathing or cough can cause severe chest pain.
  • Malaise (general feeling or discomfort)
  • Fatigue
  • Hiccups
  • Rapid and shallow breathing
  • If fluid becomes infected, you will get fever.

Pleural effusions are usually self-limiting and can be resolved. However, it is important to seek medical attention if you experience breathing difficulties or new symptoms such as shortness of breathe. A pleural effusion can lead to a collapse of the lung due to pressure.

If you don’t seek immediate treatment, pleural fluid may become infected. Emphyema is a condition that results in the infection of the pleural fluid.

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What causes Pleural Effusions

Although there are many causes of pleural effusions, they often accompany asbestos-related diseases such as mesothelioma and lung cancer.

Inhaled asbestos fibers can cause inflammation and swelling in the pleura after exposure to asbestos. This can increase the likelihood of fluid leaking from blood vessels, which can lead to pleural effusions.

Malignant effusions are those that are caused by cancer. Effusions that are not malignant can be caused by benign, non-cancerous conditions.

The condition can also be caused by non-malignant conditions such as pneumonia, tuberculosis and congestive cardiac failure. Other cancers may cause pleural effusions, too.

Your doctor will take fluid from the pleural effusion to diagnose the cause. The cause of fluid accumulation will determine the best treatment.

Diagnoses of Mesothelioma & Pleural Effusion

Once the fluid has accumulated to approximately 300ml, or 1.25 cups, an X-ray can diagnose pleural effusion. The effusion might not be visible on chest radiographs if it is smaller than that.

Pleural effusion is a common symptom in mesothelioma, and other asbestos-related diseases. This condition can become more severe as the disease progresses.

To diagnose this condition, your doctor may also look for other signs. A pleural effusion can be identified by a decreased ability to breathe and a decrease in chest movement on one side of your body. A decrease in vocal resonance may also be a sign of pleural effusion.

Your doctor may order additional tests to confirm your diagnosis. Doctors can identify pleural effusion as possible causes by looking for mesothelioma-related cancer cells in the pleural fluid.

Diagnostic Thoracentesis

If the doctor suspects that there is fluid in the pleural cavity they will collect a sample to be evaluated using a technique called Thoracentesis. A doctor will insert a thin needle or a plastic tube into the area where fluid is being collected.

The fluid is taken out and sent to the laboratory for further testing. About 75% of the cases in which cancer cells are found in pleural fluid include lung cancer, mesothelioma or breast cancer.

The results of this test are usually not sufficient to diagnose mesothelioma. They can often identify the root cause of fluid buildup. Doctors will do a biopsy to confirm if mesothelioma is the cause.

2021 research looked at the diagnostic accuracy for malignant pleural melanoma biomarkers. Scientists suggest that a machine-learning algorithm could be used to identify diagnostic biomarkers like soluble mesothelin related peptide (SMRP), cytokeratin fragment (CYFRA 21-1), or carcinoembryonic antibody (CEA).

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