Malignant pleural neoplasms
What is it?
Malignant pleural neoplasms are neoplastic diseases of the pleural sheets lining the lungs and inner surface of the chest cavity. In general, tumor involvement of the pleura is a common problem.
Malignant pleural neoplasms are distinguished into:
primary (malignant pleural mesothelioma)
secondary (malignant pleural mesothelioma), due to the spread of various tumors (especially metastases from carcinomas of the lungs, breast, ovaries, gastrointestinal tract, kidneys, etc.) through the pleura.
Which are the symptoms?
Symptoms are often insidious and nonspecific: from a clinical point of view, the most frequent manifestation (about 90%), and above all, the one that most affects the patient’s quality of life, is the occurrence of recurrent pleural effusion. This condition leads to the appearance of worsening dyspnea (i.e. “breathlessness with air hunger”).
Other signs of the disease that may manifest are lack of strength (asthenia), significant weight loss (emaciation), and dull chest pain (thoracodynia) accompanied by a “feeling of heaviness” in the chest. Less frequent symptoms may include a hoarse cough, hemoptysis, dysphagia, dystonia and fever.
- weight loss
How is it diagnosed?
The occurrence of the above symptoms makes it necessary, first of all, to perform a chest x-ray, which may or may not confirm the presence of a pleural effusion and/or pleural thickening. In the presence of a pleural effusion, the first invasive procedure to establish the diagnosis is thoracentesis or, rather, placement of a small pleural drain to suck out all the pleural fluid. This has the dual purpose of eliminating shortness of breath (dyspnea) and collecting some of the fluid to be analyzed under a microscope. Cytologic (i.e., microscopic) analysis of the pleural fluid can already allow a diagnosis, although not often. A subsequent chest CT scan may reveal more definitive solid pleural thickening/injuries and show the presence or absence of concomitant lung lesions.
However, the most important diagnostic (and often therapeutic) procedure is videothoracoscopy, both because it allows a diagnosis with certainty in almost all cases and because it provides an opportunity to determine the extent of intrathoracic spread of the disease.
How is it treated?
Treatment regimens for both primary and secondary pleural neoplasms include various combinations of surgery, chemotherapy and radiotherapy; the approach should always be multidisciplinary, involving a surgeon, oncologist, and radiotherapist simultaneously. Surgical treatment includes several types of intervention, which always depend on the spread of the disease and the patient’s general condition and should be evaluated on a case-by-case basis with fellow oncologists and radiation oncologists. These include:
Where do we treat it?
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