Malignant Pleural Effusions: Management Options

David J. McCracken, MRCP; Jose M. Porcel, MD; Najib M. Rahman, DPhil


Semin Respir Crit Care Med. 2018;39(6):704-712. 

In This Article

Epidemiology and Relevance

Overall cancer incidence worldwide continues to increase, with a projected increase of 68% between 2012 and 2030.[4] Incidence within the United Kingdom has increased by 7% over the past 10 years.[5] This may be explained at least in part by increase in life expectancy along with overall changing population demographics toward a more elderly population, especially in more developed countries.

Metastatic malignant disease of the pleura is already seen commonly in clinical respiratory medicine and may complicate the management of almost all cancer subtypes. Increases in overall cancer incidence have resulted in a concomitant increase in the incidence of malignant pleural disease and, in particular, MPE. A similar increase has been evident in the incidence of primary pleural malignancy with around 2,700 cases of malignant pleural mesothelioma diagnosed annually in the United Kingdom.[6]

The approximate incidence of MPE across the combined population of the United Kingdom and United States is thought to be in the region of 300,000 per year, with the United Kingdom's incidence accounting for more than 40,000 of those cases alone.[1,7]

As a result, malignant pleural disease represents a significant and increasing burden on health care resources. The management may be complex and varied, with multiple options available. This article will explore the options available with particular reference to a patient-centered approach as well as the exploration of recent and projected future developments in the field.