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Definition

Metastatic pleural tumor is a type of cancer that has spread from another organ to the thin membrane (pleura) surrounding the lungs.

Causes

The blood and lymph systems can carry cancer cells to other organs in the body. There, they can produce new growths or tumors.

Almost any type of cancer can spread to the lungs and involve the pleura.

Symptoms

Symptoms may include any of the following:

• Chest pain, especially when taking a deep breath
• Cough
• Wheezing
• Coughing up blood (hemoptysis)
• General discomfort, uneasiness, or ill feeling (malaise)
• Shortness of breath
• Weight loss
• Loss of appetite

Exams and Tests

The health care provider will examine you and ask about your medical history and symptoms. Tests that may be done include:

• Chest x-ray
• CT or MRI scan of the chest
• Procedure to remove and examine the pleura (open pleural biopsy)
• Test that examines a sample of fluid that has collected in the pleural space (pleural fluid analysis)
• Procedure that uses a needle to remove a sample of the pleura (pleural needle biopsy)
• Removal of fluid from around the lungs (thoracentesis)

Treatment

Pleural tumors usually can't be removed with surgery. The original (primary) cancer should be treated. Chemotherapy and radiation therapy may be used, depending on the type of primary cancer.

Your provider may recommend thoracentesis if you have a lot of fluid collecting around your lungs and you have shortness of breath or low blood oxygen levels. After the fluid is removed, your lung will be able to expand more. This allows you to breathe easier.

To prevent the fluid from collecting again, medicine may be placed directly into your chest space through a tube, called a catheter. Or, your surgeon may spray a medicine or talc on the lung surface during the procedure. This helps seal the space around your lungs to prevent the fluid from returning.

Support Groups

You can ease the stress of illness by joining a support group where members share common experiences and problems.

Outlook (Prognosis)

The survival time varies greatly from several months to several years. Outlook depends on:

• The location of pleural tumors
• The cell type of pleural tumors
• The stage of the tumor
• The person's age and general health
• Whether surgery is an option
• The person's response to treatment

You and your family may want to start thinking about end-of-life planning, such as:

• Palliative care
• Hospice care
• Advance care directives
• Health care agents

The 5-year survival rate (number of people who live for more than 5 years after diagnosis) is less than 25% for people with pleural tumors that have spread from other parts of the body.

Possible Complications

Health problems that may result include:

• Side effects of chemotherapy or radiation therapy
• Continued spread of the cancer

Prevention

Early detection and treatment of primary cancers may prevent metastatic pleural tumors in some people.

References

Arenberg DA, Reddy RM. Metastatic malignant tumors. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 79.

Davies HE, Sterman D, Gary Lee YC. Pleural malignancy. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 114.

Wald O, Izhar U, Sugarbaker DJ. Lung, chest wall, pleura, and mediastinum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 58.

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