Breathlessness

Shortness of breath, also called breathlessness or dyspnoea, is the most common symptom of pleural mesothelioma. This is often caused by a build-up of fluid in the pleural cavity known as pleural effusion. The fluid can put pressure on the lung, making it harder to breathe.

Learn more about:

• Overview
• Draining fluid around the lungs
• Ways to control fluid around the lungs
• Improving breathlessness at home

Overview

In the earlier stages of pleural mesothelioma, controlling this fluid build-up will improve breathlessness. The level of improvement will depend on the health of your lungs before diagnosis, and how well they function after surgery. You may also feel breathless because of the cancer itself not allowing the lung to work properly (trapped lung).

Other problems such as infection or a low level of red blood cells (anaemia) can also cause breathlessness. Living with breathlessness can be difficult, but there are ways to reduce its impact on your life and manage it at home.

Draining fluid around the lungs

Fluid build-up around the lungs may be drained before mesothelioma is diagnosed or at the same time as a biopsy.

Having a pleural tap

In pleural mesothelioma, a pleural tap (also known as pleurocentesis or thoracentesis) drains fluid from around the lungs.

• Your doctor will numb the area with a local anaesthetic and insert a needle between your ribs into the fluid-filled pleural cavity.
• An ultrasound scan may guide the needle to the fluid. The needle is connected to a bag for the fluid to drain into.
• The process of draining the fluid usually takes anywhere between 30 and 60 minutes.
• You usually don’t have to stay overnight in hospital after having a pleural tap.

Ways to control fluid around the lungs

Below we discuss different ways to control fluid around the lungs.

Talc pleurodesis 

To prevent fluid building up again in the lining of the lungs, you may have a talc pleurodesis. Pleurodesis means closing the pleural cavity. Sterile talcum powder (talc slurry) is injected into the pleural cavity, and the talc slurry causes an inflammation that helps fuse the 2 layers of the pleura together and closes the space.

A talc pleurodesis is best done during VATS by a thoracic surgeon, but is sometimes done by a respiratory physician. After a talc pleurodesis, some people experience a burning pain in the chest for 24–48 hours. This pain can be eased with medicine and you will be able to have physiotherapy to improve lung expansion.

VATS with pleurectomy decortication 

When fluid is drained and talc pleurodesis is done during VATS, part or all of the outer layer of the pleura (parietal pleura) is removed. This is known as pleurectomy decortication (PD).

This may be done when the parietal pleura, which lines the chest wall, has become thick and stiff.

Thoracotomy with pleurectomy decortication

Even after VATS and talc pleurodesis, the fluid may build up around the lungs again, causing breathlessness. The surgeon may suggest a more extensive surgery called thoracotomy (open surgery) with pleurectomy decortication (PD).

This surgery may also be recommended as a first option if the cancer has grown in a way that makes it difficult to perform VATS successfully. A thoracotomy helps to prevent fluid building up again in most cases. It also makes it easier for the lungs to expand and to transfer oxygen to the blood.

Pain after having a thoracotomy can last longer than pain after having VATS, but the improvement in symptoms may make open surgery a worthwhile option if VATS has not been successful or if it isn’t possible.

Indwelling pleural catheter

Some people cannot have VATS or open surgery, either because they are too unwell or because the cancer has grown in a way that makes the surgery too difficult. Instead, you may be offered an indwelling pleural catheter (also known as a drain) to remove the fluid and improve your breathing. This can also be used if the pleural fluid builds up again after pleurodesis.

Under local anaesthetic, the specialist inserts a thin tube (the catheter) through the chest wall into the pleural cavity. You can manage the drain at home with the help of a community nurse, family member or friend. When the fluid builds up and needs to be drained (usually once or twice a week), the end of the catheter is connected to a bottle.

With an indwelling pleural catheter, the fluid may stop building up, and the cavity may close. In these cases the drain can be removed.