Many people with lung cancer have difficulty breathing and shortness of breath (dyspnoea) before or after diagnosis.
Learn more about:
- What causes it?
- How breathlessness is managed
- Having a pleural tap
- Indwelling pleural catheter
- Improving breathlessness at home
What causes it?
Difficulty breathing and shortness of breath (dyspnoea) can occur for several reasons, such as the cancer itself and a reduction in lung function, a drop in fitness level due to less physical activity, or a build-up of fluid between the linings of the lung (pleural effusion).
How breathlessness is managed
If breathlessness is caused by pleural effusion, you may need to have surgery. Types of surgery include:
- pleural tap to drain the fluid
- pleurodesis to stop fluid building up again
- indwelling pleural catheter to drain the fluid.
If the cancer is blocking one of the main airways, a doctor may be able to use a laser, stent (a metal or plastic tube) or radiation therapy to open up the airway and improve breathing. You may also be referred to a pulmonary rehabilitation course to learn how to manage breathlessness. This will include exercise training, breathing techniques, ways to clear the airways, and tips for pacing yourself.
For some people, fluid may build up in the pleural cavity, the space between the 2 layers of thin tissue covering the lung. The build-up of fluid is called pleural effusion. This can put pressure on the lung, making it hard to breathe. Having a pleural tap can relieve this symptom. This procedure is also known as pleurocentesis or thoracentesis.
To drain the fluid, your doctor or radiologist numbs the area with a local anaesthetic and inserts a hollow needle between your ribs into the pleural cavity. It then takes about 30–60 minutes to drain the fluid. You usually don’t have to stay overnight in hospital after a pleural tap. A sample of the fluid is sent to a laboratory for testing.
If you smoke, your doctor will advise you to quit and suggest ways to do this. See more ideas about how to manage breathlessness at home.
Pleurodesis is a way to close the pleural cavity. Your doctors might recommend this procedure if the fluid builds up again after you have had a pleural tap. It may be done by a thoracic surgeon or respiratory physician in one of 2 ways, depending on how well you are and what you would prefer:
This method uses a keyhole approach called video-assisted thoracoscopic surgery (VATS). You will be given a general anaesthetic, then a tiny video camera and operating instruments will be passed through one or more small cuts in the chest. After all fluid has been drained, the surgeon then injects some sterile talcum powder into the pleural cavity. This causes inflammation that helps fuse the 2 layers of the pleura together and prevents fluid from building up again. You will stay in hospital for a few days.
Bedside talc slurry pleurodesis
If you are unable to have a general anaesthetic, a pleurodesis can be done under local anaesthetic while you are in bed. A small cut is made in the chest, then a tube is inserted into the pleural cavity. Fluid can be drained through the tube into a bottle.
Next, sterile talcum powder mixed with salt water (a “slurry”) is injected through the tube into the pleural cavity. Nurses will help you move into various positions every 10 minutes to get the talc slurry to spread throughout the pleural cavity. The process takes about an hour.
A slurry pleurodesis usually requires a hospital stay of 2–3 days. After the procedure, some people experience a burning pain in the chest for a day or two, but this can be eased with medicines.
An indwelling pleural catheter is a small tube used to drain fluid from around the lungs. It may be offered to people who repeatedly have a build-up of fluid in the pleural cavity that makes it hard to breathe and who are unable to or prefer not to have a pleurodesis.
You will be given a local anaesthetic, then the doctor inserts the catheter through the chest wall into the pleural cavity. One end of the tube is inside the chest, and the other stays outside the body for drainage. This end is coiled and tucked under a small dressing.
When fluid builds up and needs to be drained (usually once or twice a week), the end of the catheter is connected to a small bottle. You can manage the catheter at home with the help of a community nurse. A family member or friend can also be taught how to clear the catheter, which may be more convenient.
Now I have good and bad days. I do breathing exercises during rehabilitation. Sometimes I feel so good that I overdo it. I forget that I have one lung and I tire easily. I’m learning to pace myself.Lois
Podcast: Coping with a Cancer Diagnosis
A/Prof Brett Hughes, Senior Staff Specialist Medical Oncologist, Royal Brisbane and Women’s Hospital, The Prince Charles Hospital and The University of Queensland, QLD; Dr Brendan Dougherty, Respiratory and Sleep Medicine Specialist, Flinders Medical Centre, SA; Kim Greco, Nurse Consultant – Lung Cancer, Flinders Medical Centre, SA; Dr Susan Harden, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; A/Prof Rohit Joshi, Medical Oncologist, GenesisCare and Lyell McEwin Hospital, Director, Cancer Research SA; Kathlene Robson, 13 11 20 Consultant, Cancer Council ACT; Peter Spolc, Consumer; Nicole Taylor, Lung Cancer and Mesothelioma Cancer Specialist Nurse, Canberra Hospital, ACT; Rosemary Taylor, Consumer; A/Prof Gavin M Wright, Director of Surgical Oncology, St Vincent’s Hospital and Research and Education Lead – Lung Cancer, Victorian Comprehensive Cancer Centre, VIC.
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