Significance of a Pleural Fluid Accumulation in a Patient with a Localized Lung Cancer

Description

A malignant pleural effusion in a patient with localized lung cancer is a poor prognostic finding and usually excludes the patient from a definitive surgical resection. On the other hand a patient with non-malignant pleural fluid may make a good surgical candidate.

Goal: To determine if a patient with a localized lung cancer and pleural fluid accumulation is a candidate for surgical resection of the lung cancer.

Parameters:

(1) type of fluid (transudate, non-bloody exudates, bloody exudates)

(2) probable cause (metastatic cancer, heart failure, other)

(3) results of pleural cytology (based on at least 2 examinations if the first is negative)

The presence of a bloody exudates is usually indicative of a malignant pleural effusion although there may be other explanations.

Type of Fluid	Probable Cause	Cytology	Surgical Candidate
transudate	other than cancer	negative	good
bloody exudates	lung cancer	positive	very poor
exudate	other than cancer	negative	fair
transudate	lung cancer	negative	fair
NA	NA	positive	poor
other	other	other	guarded

It is important not to deny surgery to a patient with lung cancer who may benefit from it. On the other hand one should not put a patient through the trauma of surgery if there will be no benefit.

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Significance of a Pleural Fluid Accumulation in a Patient with a Localized Lung Cancer

Description

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