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Pleural Tumors

What are Pleural Tumors?

Pleural tumors are found in the pleural space—the cavity between the lungs and chest wall that contains lubricating pleural fluid. A pleural tumor is almost always metastatic (cancerous) and difficult to operate on. The prognosis is seldom encouraging. One type of tumor—called a localized fibrous tumor of the pleura (LFTP)—is the exception to the rule. Only about one in eight LFTPs is cancerous, and recovery after surgical removal is quite high despite their typically large size.

A cancerous pleural tumor is most often a secondary cancer, triggered by cancer cells that have spread to the pleural space from somewhere else in the body (usually the lungs). It is extremely unlikely that people who have never had cancer before will develop a metastatic pleural tumor. But patients who have had cancer are at risk, especially if treatment of that cancer was not totally successful in controlling it. Even so, the incidence of these tumors is rare, affecting perhaps one in 2,000 cancer patients.

The Mechanics of Pleural Tumors

Cancer cells can be transferred to the pleural space through the bloodstream or the lymph system. They also can develop due to the pleura’s direct contact with cancer tissue pressing in from the lungs. Once there, these cells can produce one or more tumors.

Metastatic pleural tumors usually cause a pleural effusion—the accumulation of an abnormal amount of pleural fluid in the chest cavity space. The fluid, which is often bloody, can provide accurate diagnostic information, so doctors commonly extract and analyze a sample of pleural fluid to help pinpoint the patient’s condition.

Symptoms of Pleural Tumors

LFTPs might not have any symptoms. They’re most often found when the patient’s chest is being x-rayed for other purposes. But metastatic pleural tumors produce symptoms similar to those of lung cancer or other serious chest ailments. They include:

  • Shortness of breath when active
  • Chest pain
  • General discomfort or uneasiness
  • Cough
  • Unintended weight loss

Causes of Pleural Tumors

One of the primary underlying causes of metastatic pleural tumors has been complications from mesothelioma—that is, lung cancer related to asbestos exposure. But other cancers can metastasize to the pleural space as well.

Very little is known about the cause of LFPTs, particularly the majority of these tumors that are benign. There seems to be some connection between cancerous LFPTs and either asbestos exposure or smoking.

Diagnosing Pleural Tumors

There are numerous procedures at a doctor’s disposal to develop a diagnosis. They include:

  • Listening to the sound of the patient’s breathing with a stethoscope
  • Tapping on the patient’s chest and listening for a dull sound (indicating a fluid build-up)
  • Taking an x-ray to reveal the make-up and condition of the chest area
  • Performing a CT (computed tomography) scan to obtain additional “internal” details
  • Drawing fluid from the chest cavity by needle (thoracentesis) and analyzing its contents
  • Viewing the pleural space using a thoracoscope to examine its characteristics

The most preferred diagnostic test is obtaining and analyzing a sample of the fluid in the pleural cavity. That’s because it’s relatively simple for both doctor and patient, and the results are highly reliable. Occasionally, there are cases in which a surgical biopsy procedure is performed to obtain actual tissue from the tumor.

Treating Pleural Tumors

Many LFPTs can be surgically removed and the prognosis is generally good. Metastatic pleural tumors, however, usually cannot be surgically removed. Treatment therefore focuses on the underlying cancer, relying as appropriate on such well-known regimens as chemotherapy and radiation therapy. Any progress made with respect to the underlying cancer can extend to the pleural tumor.

Aid and Comfort
There’s no way around it. Metastatic pleural tumors are life threatening. Fewer than one in four patients survives more than five years after diagnosis. The stress and anxiety that accompany this ailment can often be lessened by joining a support group. The health care providers and fellow patients who participate can make a difficult situation a bit less so.