www.ncbi.nlm.nih.gov › Journal List › Thorax › v.38(1); Jan 1983
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC459478/
A malignant pleural effusion can occur as a complication of lung cancer.
A pilot study of topical (intrapleural) treatment with Corynebacterium parvum was carried out in 10 patients with malignant pleural effusions complicating primary or secondary neoplasms and necessitating frequent thoracocentesis for symptomatic relief. The method was aspiration of all intrapleural fluid except a small portion left for dilution, and then injection of 7 mg of a preparation of Corynebacterium parvum suspended in 20 ml of normal saline solution. The treatment was repeated in each case as clinical conditions called for further thoracocentesis. In eight of these 10 patients the treatment resulted in prompt reduction of the rate of accumulation of pleural fluid and a striking change of cell sediment composition, with appreciable reduction in or complete disappearance of malignant cells and a rise in lymphocyte and neutrophil polymorph counts. The best responders were patients with primary pleural mesothelioma. Clinical improvement was evident in all responders.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC459478/pdf/thorax00205-0031.pdf
A pleural effusion is defined as an abnormal amount of fluid in the space between the layers of tissue (the pleura) that line the lungs. If cancer cells are present in this fluid, it is called a malignant (cancerous) pleural effusion.
Causes of a Malignant Pleural Effusion
Almost any type of cancer can cause a pleural effusion if it is present in or spreads (metastasizes) to the chest area. The most common are those mentioned above.
Symptoms of a Malignant Pleural Effusion
The symptoms of a malignant pleural effusion can be very uncomfortable and may include shortness of breath, coughing, and chest pain.
Diagnosis of a Malignant Pleural Effusion
It is important to make an accurate diagnosis of a malignant pleural effusion, since the prognosis and treatment are much different than for non-malignant (benign) pleural effusions. Even with cancer, up to 50% of pleural effusions are benign.
A malignant pleural effusion is often first suspected because of symptoms or findings seen on a chest x-ray or CT scan. If your doctor suspects a malignant pleural effusion, the next step is usually a thoracentesis, a procedure in which a needle is inserted into the pleural space to get a sample of the fluid. This fluid is then examined under a microscope (cytology exam of pleural fluid) to see if cancer cells are present.
If a thoracentesis cannot be done, or if the results are inconclusive, further procedures may need to be done to get an accurate diagnosis. In some cases, a thoracoscopy (a procedure in which a thorascope is inserted into the chest) may need to be done to obtain a biopsy to diagnose a malignant pleural effusion.
Treatment of a Malignant Pleural Effusion
The goal in treating a malignant pleural effusion is palliative, that is, to improve quality of life and reduce symptoms but not to cure the cancer.
If a malignant pleural effusion is very small, it can sometimes be left alone. Thoracentesis can be performed to remove the fluid, but it frequently returns. To prevent fluid from returning, a procedure called a pleurodesis may be done. In this procedure, a chemical such as talc is inserted between the 2 layers of the pleura so that they stick together, preventing fluid from accumulating. This is successful for 60 to 90% of people.
If a malignant pleural effusion persists, surgery may be done to drain the fluid into the abdomen, or a pleurectomy (a procedure that removes part of the pleura) may be performed. New treatments (such as medical pleuroscopy) are emerging to treat malignant pleural effusions as well. Chemotherapy may help with malignant pleural effusions due to small cell lung cancer, but it does not seem to help with those due to non-small cell lung cancer.
Prognosis of Lung Cancer With a Malignant Pleural Effusion
Sadly, the average life expectancy for lung cancer with a malignant pleural effusion is less than 6 months. The median survival time (the time at which 50% of people have died and 50% are still living) is 4 months.
http://www.nature.com/nature/journal/v257/n5525/abs/257396a0.html
Nature 257, 396 - 398 (02 October 1975); doi:10.1038/257396a0
Suppression of cell-mediated tumour immunity by Corynebacterium parvum
HOLGER KIRCHNER, MOSHE GLASER & RONALD B. HERBERMAN
Laboratory of Immunodiagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20014
THE use of immunoadjuvants in tumour therapy is based largely on the concept that an increased level of specific immunity against tumour-associated antigens may be achieved by nonspecific stimulation of the immune system (for review see ref. 1). Among these adjuvants, Corynebacterium parvum has received much attention since it represents one of the most powerful stimulants of the reticuloendothelial system in mice2, and is effective in inhibiting tumour growth in several animal tumour systems (for example, see refs 3-6). The mechanisms by which C. parvum interferes with tumour growth have not been established and the tumour protective effect of C. parvum has not been entirely consistent in all systems studied. An immunosuppressive effect of C. parvum has been demonstrated too. In mice, the in vitro lymphoproliferative responses to mitogens and to alloantigens were depressed after injection of C. parvum. It remains to be determined, however, whether a defect measured by these general tests of T lymphocytes may also represent an indication of depressed cell-mediated immunity against tumour cells.
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keywords: immune system immunoresponse coley's toxins, bcg, fever treatement
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