Non-Small Cell Lung Cancer and Pleural Effusion (2024)

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer in the United States. It can cause a buildup of fluid around the lungs, known as pleural effusion.

Roughly 80-85% of all lung cancer cases are NSCLC. It’s also usually less aggressive than small-cell lung cancer (SCLC).

As well as NSCLC, several other lung conditions and even injuries to your chest can cause pleural effusion.

When due to NSCLC, pleural effusion is associated with cancer spread and decreased survival odds. This is known as malignant pleural effusion.

But new research shows that, with aggressive treatment, people with NSCLC and pleural effusion might have a better outlook than was previously believed.

Pleural effusion is the buildup of fluid between the layers of membranes that line your lungs and the inside of your chest cavity. These membranes are called pleura. There’s always a small amount of fluid in the pleura that acts as a lubricant to help you take in and expel air.

Pleural effusion is when too much fluid builds up in the pleura. It’s also sometimes called “water on the lungs.”

Pleural effusion can lead to symptoms such as:

  • shortness of breath
  • pain with breathing or a cough
  • fever

Doctors often check for pleural effusion during NSCLC diagnosis. Doctors can do a few different tests to check for pleural effusion. These tests include:

  • Chest X-ray: A chest X-ray can take images of the lungs to look for fluid buildup.
  • Chest CT scan or ultrasound: An imaging test such as a chest CT scan or ultrasound can create detailed images of the lungs.
  • Thoracentesis: Thoracentesis uses a needle between the ribs to remove a sample of fluid for examination in a lab.
  • Thoracoscopy: A thoracoscopy uses tiny cameras to allow doctors to see and treat the effusion at the same time. You’ll be under general anesthesia during the procedure.

Pleural effusion can be a sign that NSCLC has spread beyond the original tumor location. People whose NSCLC is at a higher stage are more likely to experience pleural effusion. In many cases, the presence of pleural effusion at diagnosis means the NSCLC has already advanced to stage 4.

But this isn’t always true. Pleural effusion can sometimes be the first symptom of lung cancer. It can also be due to complications of lung cancer.

To determine the exact stage of your cancer when pleural effusion is present, your doctor will need to identify the underlying cause of the pleural effusion.

If the underlying cause is NSCLC, meaning the pleural effusion contains cancer cells, the cancer is stage 4. If the underlying cause is something other than NSCLC, your stage will depend on factors such as tumor size and whether it has spread to your lymph nodes or surrounding tissues.

Doctors typically consider pleural effusion to be a sign of a poor outlook for people with NSCLC. But studies published in 2019 and 2020 suggest that more aggressive treatment of NSCLC with pleural effusion can help improve the survival odds of people with otherwise minimal disease (when cancer hasn’t spread beyond the chest).

Your exact treatments will depend on other factors and when pleural effusion develops. Options generally include:

  • Thoracentesis: Doctors use this procedure both to diagnose and treat pleural effusion.
  • Tube thoracostomy: In a thoracostomy, doctors insert a tube into your chest for a day or more to drain fluid.
  • Catheter: Doctors can place a catheter into your chest to drain fluid. They may use this option when fluid drainage needs to be ongoing.
  • Shunt: A shunt is a surgically inserted tube doctors use to move fluid from one area of your body to another.
  • Chemotherapy: In some cases, treating NSCLC with chemotherapy is also the best treatment for pleural effusion.

Until recently, doctors didn’t consider people with NSCLC and pleural effusion as candidates for tumor removal surgeries.

But research has found that surgery can benefit some people with NSCLC and pleural effusion after receiving standard care. A 2019 study found that surgery improved the survival rate for people with minimal disease, meaning cancer that hasn’t spread beyond their chest.

More research on this topic is still needed, but initial results are promising.

Doctors typically consider pleural effusion a sign of advanced NSCLC, and the outlook can be challenging. Once NSCLC is in later stages, the 5-year survival rate is 9%.

But survival rates are based on old data. That figure represents data collected between 2012 and 2018. With advances in treatment, it’s likely that the current number is higher and will continue to rise.

If you have pleural effusion and NSCLC, your doctor might talk with you about palliative care. Palliative care can help you manage your NSCLC.

Palliative care isn’t the same as hospice, and it doesn’t mean your doctor expects you to die quickly. Palliative care is a program that provides you with extra medical, social, and mental health support while you manage your NSCLC.

If you have questions about pleural effusion and NSCLC, you can learn more by reading the answers to some commonly asked questions.

How common is pleural effusion in NSCLC?

About 8% to 15% of people with NSCLC have pleural effusion at the time of NSCLC diagnosis. About 40% to 50% of people with NSCLC will develop pleural effusion.

What increases my risk for pleural effusion?

The biggest risk factors for pleural effusion are also the biggest risk factors for NSCLC itself. These include:

  • smoking
  • exposure to secondhand smoke
  • environmental factors
  • contact with asbestos

Is pleural effusion more common with some types of lung cancer?

Pleural effusion is more common in people with adenocarcinoma than in other types of NSCLC.

How long can you live with pleural effusion and lung cancer?

The presence of pleural effusion with lung cancer usually signifies an advanced stage of disease. Survival is generally less than 12 months since the time pleural fluid is first detected.

Pleural effusion is a buildup of fluid in the membranes between your lungs and chest wall. When pleural effusion occurs with NSCLC, it can indicate that cancer has spread and progressed to a late stage.

Doctors consider this a sign of a poor outlook for people with NSCLC and often eliminate surgery as a treatment option.

But if cancer hasn’t yet spread beyond your chest, new research suggests that more aggressive treatment may be possible. More research is needed to determine whether surgery can be an option for this subset of people with NSCLC and pleural effusion.

Talk with your doctor to learn more about options specific to you.

Non-Small Cell Lung Cancer and Pleural Effusion (2024)

FAQs

What stage of NSCLC is pleural effusion? ›

Stage IV cancer also includes people who have a fluid collection around the lung (called a malignant pleural effusion) caused by the cancer. Stage IV NSCLC cannot be cured, but treatment can reduce pain, ease breathing, and extend and improve quality of life.

Does non-small cell lung cancer cause pleural effusion? ›

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer in the United States. It can cause a buildup of fluid around the lungs, known as pleural effusion. Roughly 80-85% of all lung cancer cases are NSCLC. It's also usually less aggressive than small-cell lung cancer (SCLC).

Is pleural effusion the last stage of cancer? ›

Malignant pleural effusion (MPE) is a common complication in the late stage of malignant tumors. The appearance of MPE indicates that the primary tumor has spread to the pleura or progressed to an advanced stage.

What is the prognosis for pleural effusion in lung cancer? ›

Malignant pleural effusion (MPE) is often associated with advanced lung cancer. About 15% of non-small cell lung cancer (NSCLC) patients shows a MPE; adenocarcinoma is the most frequently associated histology with negative impact on the prognosis (1). In fact, the average survival is approximately 4.3 months (2).

What is the life expectancy of a person with malignant pleural effusion? ›

The presence of MPE is considered as metastatic disease (M1b) [30]. The survival time following diagnosis ranged from 1 to 96 months (median: 5 months) in the patients in our study (Table 3).

Is pleural effusion always stage 4? ›

Malignant pleural effusion is a complication of cancer that causes the build-up of fluid in the membrane surrounding the lungs. It most often occurs with advanced stage 4 cancer, including lung and breast cancer.

How long can you live with fluid on lungs with cancer? ›

The general treatment for MPE is palliative in nature. Those patients who have developed MPE associated with a primary breast tumor as Mrs. Peters has may have a survival of 1-2 more years, whereas patients with a lung cancer primary have a much shorter time span such as 4-6 months.

Is pleural effusion terminal? ›

A pleural effusion can be serious and potentially life-threatening, but it is treatable. If cancer grows in the pleural space, it causes a "malignant pleural effusion." This condition is a sign that the cancer has spread, or metastasized, to other areas of the body.

How fast does pleural effusion progress? ›

Explosive pleuritis is defined as a pleural effusion that increases in size in less than 24 hours.

How quickly do you deteriorate with lung cancer? ›

Studies have shown that lung cancer doubling time can vary, from 229 days to 647 days in one study, depending upon the type. 7 It's possible that some types of lung cancer progress within weeks to months, while others may take years to grow.

Does malignant pleural effusion mean cancer has spread? ›

A malignant pleural effusion is caused by cancer cells spreading to the space between the pleural layers. Cancer cells cause the body to make too much pleural fluid, and they stop the fluid from draining properly. They can also block or change the flow of lymph fluid in the pleural cavity.

Does chemo help with pleural effusion? ›

After intrapleural chemotherapy. Pleural effusion in the left lung greatly decreased and left lung reexpanded fully. On day 11 of intrapleural chemotherapy with cisplatin plus cytarabine, the median amount of drained fluid decreased to 110 mL.

What is the difference between Stage 3 and Stage 4 NSCLC? ›

Stage III (“stage 3”): It has spread further into your lymph nodes and the middle of your chest. Stage IV (“stage 4”): Cancer has spread widely around your body. It may have spread to your brain, bones, or liver.

What are the stages of pleural effusion? ›

The evolution of a parapneumonic pleural effusion, as shown in the image below, can be divided into 3 stages, including exudative, fibrinopurulent, and organization stages.

What is stage 2 NSCLC? ›

Stage II non-small cell lung cancer is divided into stages IIA and IIB. In stage IIB, the tumor is 5 centimeters or smaller and cancer has spread to the lymph nodes on the same side of the chest as the primary tumor. The lymph nodes with cancer are in the lung or near the bronchus.

What is Stage 4 NSCLC staging? ›

Stage 4A can mean the following: the cancer can be any size and might have grown into nearby structures (any T) it might have spread to nearby lymph nodes (any N) it has spread to the other lung.

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