Treatment for fluid on the lung
When cancer affects the lungs, fluid can sometimes collect between the sheets of tissue that cover the outside of the lung and the lining of the chest cavity. These sheets of tissue are called the pleura. You can see the pleura (in red) in the diagram below
Doctors call this fluid collection a pleural effusion, as in the diagram below
The fluid stops the lung from fully expanding when you breathe. So as it builds up, the collected fluid causes shortness of breath.
You can have treatment to stop fluid from building up and help relieve symptoms. This treatment is called pleurodesis. It seals the space between the tissues covering the lung by using sterile talc to make them inflamed so they stick together. Then there is no space for the fluid to collect. You can have this done as an outpatient if you are well enough. But you may have to stay in hospital overnight if there is a lot of fluid to drain off. This can take some time and your nurses will want to keep an eye on you.
This treatment does not treat the cancer. But it should be easier for you to breathe afterwards. If it doesn't work completely the first time, then you can have it done again.
There are different ways of having this treatment, depending on whether you need to have fluid drained beforehand.
If you have no fluid to be drained, your doctor may put a tube called a thorascope into your chest until it is between the coverings of the lung (the pleura). The doctor can see through the tube so they know exactly where to put the sterile powder. They can put the powder in through the thorascope tube. This way of doing pleurodesis is called video assisted thoracoscopy.
If you need to have fluid drained from between the pleura beforehand, your doctor will first give you a small injection of local anaesthetic. When the anaesthetic has worked, the doctor puts a wide needle (cannula) into your chest, usually through your side. The tip of the needle goes into the space where the fluid is collecting – the pleural space. Once it is in the right place, the doctor attaches the needle to a drainage tube called a chest drain, which in turn is attached to a collecting bottle or bag. Your doctor puts a stitch around the tube to hold it in place. This is called a purse string suture.
As long as the drainage bottle or bag is kept lower than your chest, the fluid drains out automatically. If there is a lot of fluid, this can take several hours. It has to be done slowly, because draining a large amount of fluid too quickly can make your blood pressure drop suddenly making you feel faint. Also, the lung expanding too quickly can make you more breathless.
Once the fluid has stopped draining, the doctor injects the powder into the pleural space through the drainage tube. They then clamp the tube and leave it for an hour. To help to spread the powder around the pleural space, you have to lie in different positions on your bed – for example, on one side and then the other. After that, the drain may be attached to some suction. This helps to stick the pleura together. This part of the process can be a bit uncomfortable and you may have painkillers to take beforehand. For most people the soreness is mild and doesn't last long. But do tell your doctor or nurse if it is a problem for you.
After this, your doctor or nurse will take the tube out and pull the stitch tight to close the small opening in your chest wall. The stitch has to stay in for about a week.
A clinical trial called the TIME3 trial is looking at using a drug called urokinase to help drain fluid from around the lung. Sometimes there is more than 1 pocket of fluid between the lung and chest wall. This makes it difficult to drain all the fluid away. Urokinase may help to break down the pockets. The aim of the trial is to see if urokinase can help pleurodesis to work better in draining the fluid. The researchers hope this will help people to breathe more easily. This trial has now closed and we are waiting for the results.
The OPTIMUM trial is looking at 2 ways to treat fluid around the lung. The researchers are comparing a chest drain and pleurodesis (as described further up this page) with an indwelling pleural catheter (IPC) and pleurodesis. An IPC is a small tube that is put under the skin and into the pleural space. You can have it in place while you are at home, unlike the chest drain. A connection on the end of the IPC means a district nurse or carer can attach a bottle to drain off fluid when needed. A doctor can also use inject sterile talc through this connection. Both treatments are widely used but a trial hasn't directly compared them before. The researchers want to find out which is better at improving quality of life.
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