Polymembrane effusion due to cancer

Polymembrane effusion is a common condition in patients with advanced cancer, which can lead to complications of organ dysfunction, rapid disability and death. Because of the danger of this condition, when treating cancer patients, it is always important to pay attention to early detection and treatment.

Polymembrane effusion is a common condition in patients with advanced cancer. Several types of effusion can be encountered such as pleural, pericardial, peritoneal effusion or malignant infiltration of the subarachnoid space.
1.1 Pleural effusion Malignant pleural effusion appears related to the condition that cancer cells invade the pleura, causing fluid to enter the pleural space or blocked veins and lymphatics.
Clinical signs of pleural effusion:
Patient appears dyspnea, shortness of breath with exertion or rest, dyspnea when lying down, difficulty breathing much at night; Cough, chest pain ; If the effusion is unilateral, it may be more comfortable to lie on your side; Sometimes the signs are not obvious if the effusion is small. Subclinical signs:
X-ray of the chest and lungs straight and inclined: The image is oblique to the costophrenic angle if the effusion is small or the opacities diffuse to one lung or the whole lung segment in the case of large effusion. . Pulmonary CT scan: Diagnosis of effusion and volume of fluid. Can detect primary tumor such as lung cancer, mediastinal tumor, thymoma... Pleural aspiration: Do cytological tests to help find and orient cancer. Pleural biopsy: Diagnosis in 20% of patients has negative pleural fluid cytology. Thoracotomy or pleuroscopy: If cancer is suspected but cytology or biopsy results are negative.

1.2 Pericardial effusion The maximum amount of fluid that the pericardium can hold ranges from 80-200ml. If the pericardial effusion is more than this amount, it will cause a dangerous situation of acute cardiac tamponade.
This is a medical emergency that needs to be detected and treated promptly because it can cause acute cardiac tamponade and death.
Common cancers that can cause pericardial effusion are lung carcinoma, breast cancer and malignant melanoma...
Clinical signs:
Small pericardial effusion: Usually not present or sometimes feel a dull pain or a feeling of heaviness in the chest. In case of large effusion: Restlessness, frequent dyspnea and increased dyspnea when lying down, left chest pain or epigastric pain, may be accompanied by cough or hoarseness. Subclinical signs:
Electrocardiogram: Typically will see diffuse low voltage, electrocardiographic signs are common in the case of large pericardial effusion. Chest radiograph: Typically, a wide trabecular heart with signs of arch dilatation of the superior vena cava, Azygos vein, pulmonary hypoperfusion, often accompanied by signs of pleural effusion. Echocardiography: Diagnosis and information about the location of the effusion, the extent of the effusion, and the pressure on the chambers of the heart. Pericardial effusion: Test to find malignant cells to confirm diagnosis (appears in about 5% of cases), Cellblock test of pericardial fluid helps to diagnose histopathology and immunohistochemical staining helps to identify in the case of primary cancer.

1.3 Peritoneal effusion Malignant peritoneal effusion occurs when there are malignant lesions in the peritoneum. Common cancers that cause peritoneal effusion are ovarian carcinoma, gastrointestinal cancer...
Clinical signs:
The patient may have no symptoms; If there is a lot of fluid, the patient feels fullness, abdominal pain and difficulty breathing; Patients may also experience anorexia, nausea, and vomiting due to decreased bowel movements. Subclinical signs:
Ultrasound and computed tomography of the abdomen: Definitive diagnosis of abdominal effusion as well as detecting metastatic lymph node lesions, intra-abdominal, pelvic tumors or metastatic status liver. Lumbar puncture to find malignant cells: Found in 50% of cases due to cancer; Cellblock test of peritoneal fluid for histopathology and immunohistochemical staining helps to identify primary cancer. 1.4 Malignant invasion of the subarachnoid space Meningeal infiltration without CNS involvement is a relatively uncommon condition for most cancers. In cases of acute leukemia in children up to 50%, there may be breast carcinoma, lymphoma, lung carcinoma and malignant melanoma..
Clinical signs:
Disease Patients often present with headache and nausea. Changes in personality, reduction or loss of cranial nerve function... Subclinical signs:
Lumbar puncture: Assess signs such as CSF pressure, CSF centrifugation to look for malignant cells. Compute... Cranial CT scan: Exclude mass in the skull or combine magnetic resonance imaging of the spine if there are signs of spinal cord compression.

2.1 Pleural effusion When there is a large amount of effusion, emergency treatment is required by the following methods:
Breathing oxygen through the nose from 3-4l / min, if the respiratory failure is severe, it is necessary to conduct endotracheal intubation and ventilation. artificial gas. Pleural aspiration or drainage: May improve effusion in weeks or months. Using cytotoxic and fibrous substances injected into the pleura such as: Bleomycin 1mg/kg or 40mg/m2 or 5g talc powder causes pleural adhesions through pleural endoscopy... Use radioactive colloid for treatment pleural effusion due to cancer; Open the pleura and place a pleural drainage tube: Used in cases of large effusion and used treatment measures but rapid recurrence. Thoracic surgery and pleural dissection: When the above methods have failed, however, this method carries a risk of infection if not well cared for. 2.2 Pericardial effusion In case the pericardial effusion is small and does not cause cardiac tamponade, it is necessary to monitor, without the need for percutaneous pericardial drainage. In combination with other symptomatic treatment. In case of large pericardial effusion and cardiac tamponade: Percutaneous pericardial drainage is required, percutaneous pericardial dilation with balloon or pericardiotomy, depending on the case. Combination of symptomatic treatment includes fluid resuscitation, vasopressor therapy if hypotension occurs. 2.3 Peritoneal effusion Apply systemic chemotherapy if effective. If the case is not effective, it is necessary to combine additional methods such as:
Bed rest and limit salt intake. Aspiration of peritoneal fluid: However, some common complications should be noted; rapid and large volume puncture may cause hypotension and shock; repeated aspiration may cause severe hypoalbuminemia, fluid and electrical disturbances. solution... This method is only temporary. Diuretics: May help reduce peritoneal fluid, but be aware that dehydration, hypokalemia, and hypotension can occur if strong diuretics are used. Treatment of the peritoneal cavity with chemicals or radioisotopes. 2.4 Malignant invasion of the subarachnoid space Radiotherapy: However, it is often limited by the risk of severe bone marrow suppression. Chemotherapy: Chemotherapy may be given by the spinal cord or through a ventricular drain into the lateral ventricle.

In summary, cancerous pleural effusion can be life-threatening, so it should be detected and treated early. Especially in cases of large effusion.
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