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Lung cancer and its treatment often affect other areas of the chest. For 1 out of 5 patients with lung cancer, the disease affects the pleura (layers of thin tissue that cover the lungs and line the chest cavity) and the pleural cavity (the space between those layers of tissue). Pleural conditions can cause discomfort and may be a sign of more advanced cancer.
At UCLA Health, our interventional pulmonologists (lung specialists) and thoracic surgeons perform advanced pleural procedures for lung cancer. Our expert team uses interventional pulmonology and other minimally invasive techniques to treat pleural conditions. We quickly identify the problem, find the cause and treat your symptoms.
How does lung cancer affect the pleural cavity?
Our lung cancer team keeps a close eye on the pleural space when diagnosing and treating lung cancer. They look for conditions including:
Pleural effusion (fluid around the lungs): Pleural effusion occurs when too much fluid collects between the layers of tissue in the pleural cavity. Causes of pleural effusion include infection, metastasis (cancer spread) or a reaction to lung cancer treatment. Symptoms may include shortness of breath, chest pain and a dry cough.
Malignant pleural effusion (MPE): A pleural effusion that contains cancer cells signals that cancer has spread beyond your lungs. An MPE can be a life-threatening condition. We monitor you closely to catch and treat this condition early and aggressively.
Pleural nodules: Nodules (lumps) can develop in the pleural cavity either with or without a pleural effusion. A pleural nodule may be a benign (noncancerous) tumor, the first sign of lung cancer or an indication of lung cancer metastasis (spread).
Why choose UCLA Health for pleural cavity procedures
As a National Cancer Institute (NCI)-designated cancer center, we offer comprehensive care for lung cancer and all related conditions. At UCLA Health, you’ll find:
Expert physicians: Our interventional pulmonologists (lung physicians) and thoracic surgeons perform a full range of pleural procedures. They often diagnose and treat the issue in one procedure and can perform airway procedures at the same time. That means less time in the hospital and quicker relief from your symptoms.
Collaborative approach: Our thoracic (lung and chest) surgeons and interventional pulmonologists work closely together to treat pleural conditions related to lung cancer. Meet our lung cancer team.
Advanced procedures: We use innovative techniques to perform minimally invasive procedures (done with small incisions) that aren’t widely available. You can often stay in the hospital for a shorter time and recover more quickly.
Compassionate support: You’ll find oncology (cancer) nurse navigators and specialized nurse practitioners by your side every step of the way. Our wide range of support services keeps you comfortable during your lung cancer care.
Procedures we perform for pleural effusion and nodules
For patients with lung cancer, we use pleural procedures that are:
Diagnostic, to understand whether a pleural abnormality is the result of cancer spread, complications of treatment, infection or other reasons unrelated to cancer
Therapeutic, to relieve symptoms associated with pleural effusion or a pleural nodule, usually by draining fluid from the pleural cavity or preventing fluid from collecting
At UCLA Health, our interventional pulmonologists and thoracic surgeons perform:
We use a sample of fluid or tissue removed from the pleural cavity to understand the cause of pleural issues. We perform pleural biopsy with methods including:
Needle biopsy: This is the most common way we perform pleural biopsy. We use local anesthetic (numbing medicine) on your chest and then insert a hollow needle to collect the sample.
Thorascopic biopsy: We insert a flexible, lighted tube (endoscope) into the pleural space to retrieve a tissue sample. General anesthetic (which puts you to sleep) or local anesthetic keeps you comfortable during the procedure.
Open biopsy: We use a small incision to access the lung and collect a sample. You sleep under general anesthesia during the procedure.
Thoracentesis (pleural tap)
During thoracentesis, we drain fluid from the pleural space. Our interventional pulmonologists:
- Numb the area with local anesthetic
- Insert a long, hollow needle to collect the fluid
- Attach a soft, thin tube (catheter) to drain the fluid into a bag or bottle, if there’s a lot of fluid to drain
- Perform repeated drainage for fluid that gathers again
Indwelling pleural catheter placement
If pleural effusion continues to happen, we can use an indwelling pleural catheter (IPC) for drainage. We insert one end of this soft silicone tube in the pleural cavity while the other end remains outside the body. With an IPC in place, patients can manage their fluid buildup safely at home.
To keep fluid from forming again, we inject medication into the pleural cavity through a chest tube. The medication works like glue by causing inflammation that makes the layers of pleura membrane stick together. As a result, fluid can’t continue to collect in that space.
When performed with traditional techniques, pleurodesis can take anywhere from three days to two weeks to take full effect. UCLA Health uses advanced techniques for this procedure that include:
Catheter-based pleurodesis, which allows us to deliver the medication to the pleural space through an existing IPC and requires no hospital stay.
Rapid pleurodesis protocol, which achieves results more quickly, so you spend less time in the hospital and recovering.
We perform pleural manometry during a thoracentesis to measure the pressure in the pleural cavity. Based on this measurement, we know whether pleurodesis will be successful in controlling fluid accumulation.