Malignant pleaural tumors
Which are the symptoms?
Symptoms are often insidious and nonspecific.
In 90% of cases, there is recurrent pleural effusion, leading to shortness of breath with “air hunger” – one of the signs most affecting the patient’s quality of life. In addition, asthenia (loss of strength), significant weight loss, blunt chest pain (thoracodynia) accompanied by a “feeling of heaviness” in the chest may occur.
Coughing fits, hemoptysis, dysphagia, dystonia, and fever may occur less frequently.
How is it diagnosed?
When these symptoms appear, it is recommended to undergo an examination:
· chest radiography: it may or may not confirm the presence of a pleural effusion and/or thickening;
· thoracentesis (performed in cases of pleural effusion): insertion of a small pleural drain to suck out all the pleural fluid with the dual purpose of eliminating shortness of breath (dyspnea) and collecting part of the fluid, which will be analyzed under a microscope;
· cytologic analysis: microscopic analysis of the pleural fluid, which may lead to a diagnosis, although not often;
· computed tomography of the chest: this allows a more accurate detection of solid pleural masses/injuries and demonstrates the presence or absence of concomitant pulmonary lesions;
· videothoracoscopy: a diagnostic and often therapeutic procedure that allows an accurate diagnosis in almost all cases; it allows the degree of intrathoracic spread of disease to be determined; it can be performed under local or general anesthesia, at the discretion of the physician.
How is it treated?
Treatment of pleural tumors involves various combinations of surgery, chemotherapy and radiotherapy. The approach is always multidisciplinary, involving a surgeon, an oncologist and a radiotherapist at the same time. Surgical treatment involves different types of intervention depending on the spread of the disease and the patient’s overall condition, which must be evaluated on a case-by-case basis with fellow oncologists and radiotherapists. These include:
· videothoracoscopy and pleural cavity talcage;
· pleurectomy via thoracotomy;