What is pericardial effusion?

Risk factors: For cancer patients, the advanced stages of cancer pose
the greatest risk. A less serious but still common risk is earlier radiation
treatments to the chest, especially for lung cancer.

Etiology and the disease process: The causes of effusions in patients
who do not have cancer are many, including infection, autoimmune disorders such as
lupus, certain medications, uremia, and trauma near the heart. The
cause of malignant pericardial effusion in cancer patients is cancer that develops
in the pericardium or the heart muscle, or cancer that has metastasized from
almost anywhere else in the body, particularly the lungs, breasts, esophagus,
colon, prostate, and even bone marrow (leukemia) and skin (melanoma). Radiation
therapy for cancer that occurred near the heart can also cause pericardial
effusion, as well as certain chemotherapeutic drugs, such as doxorubicin and
cyclophosphamide.

Cancerous cells rub against the pericardium. This irritant causes fluid to build up, much the way a blister forms under the skin. Some cancers produce little fluid but cause the pericardium to thicken and become rigid. Both conditions are serious.

An effusion can be chronic (present over time) or acute (occurring suddenly). If the fluid collects slowly over time, the pericardium may stretch enough to hold it. The patient usually feels no symptoms until a large amount of fluid accumulates. When the volume of fluid reaches a critical amount or when fluid accumulates rapidly even a relatively small amount of fluid a condition known as cardiac tamponade occurs. At this stage, the effusion surrounds and squeezes at the heart. This interferes with the heart’s ability to effectively pump blood. Cardiac tamponade is a medical emergency that can be fatal if not promptly treated.

Incidence: Because effusions develop from a number of different diseases or conditions, any patient with any of the many conditions that can produce an effusion may be stricken with one. Effusions affect both sexes, all age groups, and all racial and ethnic groups.

According to the US National Cancer Institute, approximately one-third of
patients with lung cancer have a pericardial effusion caused by the spread of
their cancer at the time of their death. Lung cancer
is the most common cause of malignant pericardial effusions, accounting for
one-third of cases, followed by breast cancer (25 percent) and
hematological malignancies such as leukemia, Hodgkin disease, and
non-Hodgkin
lymphoma (15 percent).

Symptoms: Symptoms of an effusion are similar to symptoms associated with heart problems and include chest pain, rapid heartbeat, shortness of breath, dizziness or fainting, difficulty in swallowing, cough, and low blood pressure.

Screening and diagnosis: Spotting an effusion is relatively easy for
doctors. X-rays and other imaging techniques reveal the characteristic
“water-bottle” shape of the swollen pericardial sac. Doctors may perform
pericardiocentesis, a procedure that uses a needle to
withdraw some of the excess fluid. Doctors may then analyze the fluid to determine
the cause of the effusion.

Treatment and therapy: For cancer patients, treatment generally
involves relief of symptoms, because pericardial effusions usually arise in the
later stages of cancer, often in the last few week of life. Doctors use various
noninvasive and surgical procedures to drain the fluid, thus offering the patient
some relief. In addition, doctors may prescribe anti-inflammatory drugs.

Prognosis, prevention, and outcomes: There is no way to prevent an
effusion in cancer patients. The prognosis for cancer patients with malignant
pericardial effusion is poor. One study showed that of patients diagnosed with
malignant pericardial effusions, 86 percent died within a year of diagnosis. About
one-third died within the first month.

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Kiselevsky, Mikhail V., ed.
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Dordrecht: Springer, 2012. Print.

Laham, R., et al.
“Pericardial Effusion in Patients with Cancer: Outcome with Contemporary
Management Strategies.” Heart 75.1 (1996): 67–71.
Print.

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National Cancer Institute. US Dept. of Health and Human
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Need to Know About Managing the Side Effects of Your Treatment.
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