Pleural effusion in lung cancer.

Pleural effusions are common in the setting of lung cancer. The clinician must establish whether the effusion is malignant, ruling out the possibility of curative surgery; paramalignant, which may or may not rule out surgery; or unassociated with the cancer. A pleural effusion associated with lung cancer is an ominous finding, but a small percentage of patients in this setting will be candidates for curative surgery. When a malignant pleural effusion is diagnosed by cytology or histology, the clinician must decide on the most appropriate form of palliative therapy for the symptomatic patient. In the symptomatic patient with a reasonable life expectancy, chest tube drainage with the instillation of tetracycline hydrochloride appears to be the most effective and least morbid form of palliative therapy.