Cardiopulmonary Syndrome Overview

Cardiopulmonary syndromes are conditions of the heart and lung that may be caused by cancer or by other health problems. Four cardiopulmonary syndromes that may be caused by cancer are covered in this summary:

• Dyspnea(shortness of breath).
• Malignant pleural effusion (extrafluidaround the lungs).
• Malignant pericardial effusion(extra fluid in the sac around the heart).
• Superior vena cava syndrome (a blockedsuperior vena cava , the largevein that takesbloodback to the heart).

This summary is about cardiopulmonary syndromes in adults and children with cancer. Section titles show when the information is about children.

Dyspnea and Coughing During Advanced Cancer

Many conditions can cause dyspnea.

Dyspnea is the feeling of difficult or uncomfortable breathing or of not getting enough air. It also may be called shortness of breath, breathlessness, or air hunger. In cancer patients, causes of dyspnea include the following:

• Effects related to thetumor:
  • The tumor blocks the airways in the chest andlung or thevein that carriesbloodthrough the chest to the heart.
  • The tumor causes extrafluid to build up in the space between the thin layer oftissue covering the lung and the thin layer of tissue covering thechest wall (pleural effusion ), between the sac that covers the heart and the heart (pericardial effusion ), or in theabdominal cavity (ascites).
  • Carcinomatous lymphangitis (inflammation of thelymph vessels).
  • Chestinfections . Some cancer treatments may increase the risk of an infection, such aspneumonia.
  • Blood clots or tumorcells that break loose and block ablood vesselin the lungs.
  • Paralysis of part of thediaphragm(a muscle used for breathing).
  • Breathing muscles get weaker.
• Effects related to treatment:
  • Damage to the lung caused byradiation therapy orchemotherapy.
  • Weakened heart muscle caused by chemotherapy.
• Conditionsthat are not related to cancer:
  • Chronic obstructive pulmonary disease (COPD), such aschronic bronchitis oremphysema.
  • Bronchospasm. The muscles in the airways contract and causespasms.
  • A weak diaphragm.
  • Congestive heart failure.
  • Anemia.
• Conditions with no known physical cause, such asanxiety.

A diagnosis of the cause of dyspnea or coughing helps to plan treatment.

Diagnostic tests and procedures include the following:

• Physical exam andhistory for dyspnea: An exam of the body to check general signs of health, including checking for signs of dyspnea, such as breathing fast or using the neck or chest muscles to breathe. A history of your health habits and past illnesses and treatments will also be taken. Your doctor will also ask about when the dyspnea occurs, what it feels like, othersymptomsthat happen at the same time as the dyspnea, and anything that makes it better or worse.
• Functionalassessment : An exam to check for how the dyspnea affects your ability to performactivities of daily livingsuch as eating, bathing, or climbing stairs.
• Chest x-ray : Anx-ray of theorgansand bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may beinjectedinto a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Complete blood count: A procedure in which a sample of blood is taken and checked for the following:
  • The number ofred blood cells ,white blood cells , andplatelets.
  • The amount ofhemoglobin (theprotein that carriesoxygen) in the red blood cells.
  • The portion of the blood sample made of red blood cells.
• Oxygen saturation test : A procedure to check for the amount of oxygen being carried by the red blood cells. A lower than normal amount of oxygen may be a sign of lung disease or other health problems. One method uses adevice clipped to the finger. The device senses the amount of oxygen in the blood flowing through the small blood vessels in the finger. Another method uses a sample of blood taken from anartery, usually in the wrist, that is tested for the amount of oxygen.
• Maximum inspiratory pressure (MIP) test: The MIP is the highest pressure that can be reached in the lungs when you take a deep breath. When you breathe through a device called a manometer, the device measures the pressure. The information is sent to a computer. The pressure level shows how strong the breathing muscles are.

It may be possible to treat the cause of dyspnea.

Treatment may include the following:

• Radiation therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.External radiation therapyuses a machine outside the body to send radiation toward the cancer.
• Hormone therapy : Hormone therapy is a cancer treatment that removeshormones or blocks their action and stops cancer cells from growing. Hormones are substances made byglands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors ),drugs ,surgery, or radiation therapy is used to reduce the production of hormones or block them from working.
• Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy ). When chemotherapy is placed directly into thecerebrospinal fluid , an organ, or a body cavity such as theabdomen , the drugs mainly affect cancer cells in those areas (regional chemotherapy ). The way the chemotherapy is given depends on the type andstageof the cancer being treated.
• Laser therapy for tumors inside large airways: Use of alaser beam(a narrow beam of intense light) as a knife to remove the tumor.
• Cauterizationof tumors inside large airways: Use of a hot instrument, an electric current, or a caustic substance to destroy the tumor.
• Procedures to remove fluid that has built up around the lungs (malignant pleural effusion ), around the heart (malignant pericardial effusion), or in the abdominal cavity. (See the sections on controlling the symptoms ofmalignant pleural effusion andmalignant pericardial effusionfor more information.)
• Stentplacement: Surgery to place a stent (thin tube) in an airway to keep it open. This may be done if a large airway is blocked by a tumor that is pressing on it from the outside.
• Medicine:
  • Steroid drugsfor inflamed or swollen lymph vessels in the lungs.
  • Antibiotics for chest infections. These may be used with chestphysical therapy.
  • Anticoagulantsfor blood clots that are blocking blood vessels in the lungs.
  • Bronchodilators that areinhaled to open up thebronchioles(small airways) in the lungs.
  • Diureticsand other drugs for heart failure.
• Blood transfusionsfor anemia.

Treatment of dyspnea depends on the cause of it.

The treatment of dyspnea depends on its cause, as follows:

Treatment may be to control the symptoms of dyspnea.

Treatment to control the symptoms of dyspnea may include the following:

• Oxygen therapy : Patients who cannot get enough oxygen from the air may be given extra oxygen to inhale from a tank. Devices that concentrate oxygen already in the air may also beprescribed.
• Medicines:Opioids , such as morphine, may lessen physical and mentaldistress and exhaustion and the feeling that the patient cannot take enough air in. Other drugs may be used to treat dyspnea that is related topanic disorderor severe anxiety.
• Supportive care:
  • Breathing methods, such as breathing with the lips pursed (almost closed).
  • Using a fan to blow cold air across the cheek.
  • Meditation.
  • Relaxation training.
  • Biofeedback.
  • Talk therapyto relieve anxiety.

Chronic coughing may cause dyspnea.

The causes of chronic coughing are almost the same as the causes of dyspnea. A chronic cough may cause pain, trouble sleeping, dyspnea, and fatigue.

Medicines used to control coughing include the following:

• Cough-suppressing medicine, including opioids.
• Medicine that breaks downmucus.
• An inhaled drug for chronic coughing related tolung cancer.

The cause of the coughing is also treated.

Malignant Pleural Effusion

Pleural effusion is extra fluid around the lungs.

The pleural cavity is the space between the pleura (thin layer of tissue ) that covers the outer surface of each lung and lines the inner wall of the chest cavity . Pleural tissue usually makes a small amount of fluid that helps the lungs move smoothly in the chest while a person is breathing. A pleural effusion is extra fluid in the pleural cavity. The fluid presses on the lungs and makes it hard to breathe.

Pleural effusion may be caused by cancer, cancer treatment, or other conditions.

A pleural effusion may be malignant (caused by cancer ) or nonmalignant (caused by a condition that is not cancer). Malignant pleural effusion is a common problem for patients who have certain cancers. Lung cancer , breast cancer , lymphoma , and leukemia cause most malignant effusions. An effusion also may be caused by cancer treatment, such as radiation therapy or chemotherapy . Some cancer patients have conditions such as congestive heart failure , pneumonia , blood clot in the lung, and poor nutrition that may lead to a pleural effusion.

A diagnosis of the cause of pleural effusion is important in planning treatment.

These and other symptoms may be caused by a pleural effusion. Talk to your doctor if you have any of the following problems:

• Dyspnea(shortness of breath).
• Cough.
• An uncomfortable feeling or pain in the chest.

Treatment for a malignant pleural effusion is different from treatment for a nonmalignant effusion, so the right diagnosis is important. Diagnostic tests include the following:

• Chest x-ray : Anx-ray of theorgansand bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  
  X-ray of the chest. X-rays are used to take pictures of organs and bones of the chest. X-rays pass through the patient onto film.
• CT scan : A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may beinjected into aveinor swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  
  Computed tomography (CT) scan of the abdomen. The patient lies on a table that slides through the CT machine, which takes x-ray pictures of the inside of the body.
• Thoracentesis : The removal of fluid from the space between the lining of the chest and the lung, using a needle. Apathologist views the fluid under amicroscope to look for cancercells. This procedure may be used to reduce pressure on the lungs.
• Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If thoracentesis is not possible, a biopsy may be done during athoracoscopy . A thoracoscopy is a procedure to look at the organs inside the chest to check forabnormal areas. Anincision (cut) is made between two ribs and athoracoscope (a thin, lighted tube with alensfor viewing) is inserted into the chest. A cutting tool at the end of the thoracoscope is used to remove a sample of tissue.

The type of cancer, previous treatment for cancer, and the patient's wishes also are important in planning treatment.

Treatment may be to control symptoms of pleural effusion and improve quality of life.

A malignant pleural effusion often occurs in cancer that is advanced , cannot be removed by surgery , or continues to grow or spread during treatment. It is also common during the last few weeks of life. The goal of treatment is usually palliative , to relieve symptoms and improve quality of life.

Treatment of the symptoms of malignant pleural effusion includes the following:

• Thoracentesis

  Thoracentesis is a procedure to remove extra fluid from the pleural cavity using a needle and/or a thin, hollow plastic tube. Removal of the fluid may help to relieve severe symptoms for a short time. A few days after the extra fluid is removed it is likely it will begin to come back. The risk of a thoracentesis includes bleeding, infection , collapsed lung, fluid in the lungs, and low blood pressure.

• Pleurodesis

  This is a procedure to close the pleural space so that fluid cannot collect there. Fluid is first removed by thoracentesis, using a chest tube. A drug that causes the pleural space to close is then inserted into the space through a chest tube. Drugs such as bleomycin or talc may be used.

• Surgery

  Surgery may be done to put in a shunt (tube) to carry the fluid from the pleural cavity to the abdominal cavity, where the fluid is easier to remove. Pleurectomy is another type of surgery that may be used. In this procedure, the part of the pleura that lines the chest cavity is removed.

Malignant Pericardial Effusion

Pericardial effusion is extra fluid around the heart.

Pericardial effusion is extra fluid inside the sac that surrounds the heart. The extra fluid causes pressure on the heart, which stops it from pumping blood normally. Lymph vessels may also be blocked, which often causes bacterial or viral infections . If fluid builds up quickly, a condition called cardiac tamponade may occur. In cardiac tamponade, the heart cannot pump enough blood to the rest of the body. This is life-threatening and must be treated right away.

Pericardial effusion may be caused by cancer or other conditions.

A pericardial effusion may be malignant (caused by cancer ) or nonmalignant (caused by a condition that is not cancer). A malignant effusion is common in certain types of cancer. Lung cancer , breast cancer , melanoma , lymphoma , and leukemia cause most malignant effusions. An effusion also may be caused by cancer treatment, such as radiation therapy or chemotherapy.

Possible signs of pericardial effusion include anxiety and dyspnea (shortness of breath).

At first, a pericardial effusion may not cause any symptoms. These and other symptoms may be caused by a pericardial effusion or by other conditions. Check with your doctor if you have any of the following problems:

• Dyspnea(shortness of breath).
• Cough.
• Trouble breathing while lying flat.
• Chest pain.
• Fast heart beat or breathing.
• Feeling faint.
• Swelling in the upperabdomen.
• Extreme tiredness or weakness.
• Beinganxious.

Pericardial effusion usually occurs in advanced cancer or in the last few weeks of life. During these times, it may be more important to relieve the symptoms than to diagnose the condition. However, in some cases, the following tests and procedures may be used to diagnose pericardial effusion:

• Chest x-ray : Anx-ray of theorgansand bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• Echocardiography : A procedure in which high-energy sound waves (ultrasound ) are bounced off internaltissuesor organs of the chest. The echoes form a picture of the heart's position, motion of the walls, and internal parts such as the valves.
• Electrocardiogram(EKG or ECG): A line graph recording of the heart's electrical activity to check its rate and rhythm. A number of electrodes (small pads) are placed on the patient's chest, arms, and legs. The electrodes are connected by wires to the EKG machine. Heart activity is then recorded on paper. Electrical activity that is faster or slower than normal may be a sign of heart problems.
• Pericardiocentesis: A procedure to remove fluid from the pericardium using a needle inserted through thechest wall . The doctor may use echocardiography to watch the movement of the heart and needle inside the chest. The fluid is viewed under amicroscope by apathologist to check for cancercellsor signs of infection. This procedure can also be used to treat pericardial effusion. Removing the fluid reduces pressure on the heart.

Treatment may be to control the symptoms of pericardial effusion and improve quality of life.

The goal of treatment is usually palliative , to relieve symptoms and improve quality of life. A large malignant pericardial effusion is controlled by draining the fluid.

Treatment options include the following:

• Pericardiocentesis

  A procedure to remove the extra fluid from the sac around the heart using a needle inserted through the chest wall. The doctor may use echocardiography to watch the movement of the heart and needle inside the chest. Removing the fluid can reduce pressure on the heart. In some patients, fluid may again collect in the sac around the heart after pericardiocentesis. A catheter (flexible tube used to put fluids into or take blood out of a vein ) may be inserted and left in place so the fluid will keep draining . This procedure may be used instead of more serious surgery for patients with advanced cancer.

• Pericardial sclerosis

  A procedure to close the pericardial space so fluid cannot collect in the sac around the heart. Fluid is first removed by pericardiocentesis. A drug or chemical is then injected through a catheter (flexible tube used to put fluids into or take blood out of a vein) into the pericardial space to cause it to close. Three or more treatments may be needed to completely close the pericardial space.

• Pericardotomy

  A procedure to insert a drainage tube. An incision (cut) is made in the chest and then in the pericardium and a drainage tube is put in place. This increases the amount of fluid that can be drained from the pericardium.

• Pericardiectomy

  Surgery to remove part of the pericardium. This may be done to drain fluid quickly when cardiac tamponade occurs. This surgery is also called pericardial window.

• Balloon pericardiostomy

  A catheter (flexible tube used to put fluids into or take blood out of a vein) with a balloon tip is inserted through the chest and into the pericardium. The balloon is then inflated to make the pericardial opening bigger. The balloon is then deflated and removed. The bigger opening allows the fluid to drain into the pleural cavity . This may be used when an effusion has recurred (come back) after pericardiocentesis or instead of more serious surgery.

Superior Vena Cava Syndrome

Superior vena cava syndrome (SVCS) is a group of symptoms that occur when the superior vena cava is partly blocked.

The superior vena cava is a major vein that leads to the heart. The heart is divided into four parts. The right and left atrium make up the top parts of the heart and the right and left ventricle make up the bottom parts of the heart. The right atrium of the heart receives blood from two major veins:

• The superior vena cava returns blood from the upper body to the heart.
• Theinferior vena cavareturns blood from the lower body to the heart.

Different conditions can slow the flow of blood through the superior vena cava. These include a tumor in the chest, nearby lymph nodes that are swollen (from cancer ), or a blood clot in the superior vena cava. The vein may become completely blocked. Sometimes, smaller veins in the area become larger and take over for the superior vena cava if it is blocked, but this takes time. Superior vena cava syndrome (SVCS) is the group of symptoms that occur when this vein is partly blocked.

SVCS is usually caused by cancer.

Superior vena cava syndrome (SVCS) is usually caused by cancer. In adults, SVCS is most common in the following types of cancer:

• Lung cancer.
• Non-Hodgkin lymphoma(NHL).

Less common causes of SVCS include:

• A blood clot that forms during the use of anintravenous catheter (flexible tube used to putfluids into or take blood out of a vein) in the superior vena cava. A clot may also be caused bypacemakerwires.
• Infection or cancer in the chest that causes affectedtissuesto become thick and hard.
• Other cancers, includingmetastatic breast cancer , metastaticgerm cell tumors ,colon cancer ,esophageal cancer ,Kaposi sarcoma ,Hodgkin lymphoma ,thymus cancer, andthyroid cancer.
• Behcet syndrome (a disease of theimmune system).
• Sarcoidosis (a disease of the lymph nodes that acts liketuberculosis).

Common symptoms of SVCS include breathing problems and coughing.

The symptoms of SVCS are more severe if the vein becomes blocked quickly. This is because the other veins in the area do not have time to widen and take over the blood flow that cannot pass through the superior vena cava.

The most common symptoms are:

• Trouble breathing.
• Coughing.
• Swelling in the face, neck, upper body, or arms.

Less common symptoms include the following:

• Hoarse voice.
• Trouble swallowing or talking.
• Coughing up blood.
• Swollen veins in the chest or neck.
• Chest pain.
• Reddish skin color.

Tests are done to find and diagnose the blockage.

The following tests may be done to diagnose SVCS and find the blockage:

• Chest x-ray : Anx-ray of theorgansand bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may beinjectedinto a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A CT scan of the chest will be done to diagnose SVCS.
• Venography : A procedure to x-ray veins. Acontrast dyeis injected into the veins to outline them on the x-rays.
• MRI(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Ultrasound : A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called asonogram. The picture can be printed to be looked at later.

It is important to find out the cause of SVCS before starting treatment. The type of cancer can affect the type of treatment needed. Unless the airway is blocked or the brain is swelling, waiting to start treatment while a diagnosis is made usually causes no problem in adults. If doctors think lung cancer is causing the problem, a sputum sample may be taken and a biopsy may be done.

Treatment for SVCS caused by cancer depends on the cause, symptoms, and prognosis.

Treatment for SCVS caused by cancer depends on the following:

• The type of cancer.
• The cause of the blockage.
• How severe the symptoms are.
• Theprognosis (chance ofrecovery).
• Whether treatment is tocure, control, or relieve the symptoms of cancer.
• The patient's wishes.

Treatment may include the following:

• Watchful waiting

  Watchful waiting is closely monitoring a patient's condition without giving any treatment unless symptoms appear or change. A patient who has good blood flow through smaller veins in the area and mild symptoms may not need treatment.

  The following may be used to relieve symptoms and keep the patient comfortable:

  • Keeping the upper body raised higher than the lower body.
  • Corticosteroids (drugsthat reduce swelling).
  • Diuretics (drugs that make excess fluid pass from the body inurine ). Patients taking diuretics are closely watched because these drugs can causedehydration(loss of too much fluid from the body).
• Chemotherapy

  Chemotherapy is the usual treatment for tumors that respond to anticancer drugs, including small cell lung cancer and lymphoma . Chemotherapy uses drugs to stop the growth of cancer cells , either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy ). When chemotherapy is placed directly into the cerebrospinal fluid , an organ, or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas (regional chemotherapy ). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

• Radiation therapy

  If the blockage of the superior vena cava is caused by a tumor that does not usually respond to chemotherapy, radiation therapy may be given. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. External radiation therapy uses a machine outside the body to send radiation toward the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

• Thrombolysis

  SVCS may occur when a thrombus (blood clot) forms in a partly blocked vein. Thrombolysis is a way to break up and remove blood clots. This may done by a thrombectomy . Thrombectomy is surgery to remove the blood clot or the use of a device inserted into the vein to remove the blood clot. This may be done with or without the use of drugs to break up the clot.

• Stent placement

  If the superior vena cava is partly blocked by the tumor, an expandable stent (tube) may be placed inside the superior vena cava to help keep it open and allow blood to pass through. This helps most patients. Drugs to keep more blood clots from forming may also be used.

• Surgery

  Surgery to bypass (go around) the blocked part of the vein is sometimes used for cancer patients, but is used more often for patients without cancer.

Palliative care may be given to relieve symptoms in patients with SVCS.

Superior vena cava syndrome is serious and the symptoms can be upsetting for the patient and family. It is important that patients and family members ask questions about superior vena cava syndrome and how to treat it. This can help relieve anxiety about symptoms such as swelling, trouble swallowing, coughing, and hoarseness.

Patients with advanced cancer sometimes decide not to have any serious treatment. Palliative treatment can help keep patients comfortable by relieving symptoms to improve their quality of life.

Superior Vena Cava Syndrome in Children

Superior vena cava syndrome in a child is a serious medical emergency because the child's windpipe can become blocked.

Superior vena cava syndrome (SVCS) in children can be life-threatening. This is because the trachea (windpipe ) can quickly become blocked. In adults, the windpipe is fairly stiff, but in children, it is softer and can more easily be squeezed shut. Also, a child's windpipe is narrower, so any amount of swelling can cause breathing problems. Squeezing of the trachea is called superior mediastinal syndrome (SMS). Because SVCS and SMS usually happen together in children, the two syndromes are considered to be the same.

The most common symptoms of SVCS in children are a lot like those in adults.

Common symptoms include the following:

• Coughing.
• Hoarseness.
• Trouble breathing.
• Chest pain.

There are other less common but more serious symptoms:

• Fainting.
• Anxiety.
• Confusion.
• Headache.
• Vision problems.
• A feeling of fullness in the ears.

The causes, diagnosis, and treatment of SVCS in children are not the same as in adults.

The most common cause of SVCS in children is non-Hodgkin lymphoma.

SVCS in children is rare. The most common cause is non-Hodgkin lymphoma . As in adults, SVCS may also be caused by a blood clot that forms during use of an intravenous catheter (flexible tube used to put fluids into or take blood out of a vein ) in the superior vena cava.

SVCS in children may be diagnosed and treated before a diagnosis of cancer is made.

A physical exam , chest x-ray , and medical history are usually all that are needed to diagnose superior vena cava syndrome in children. Even if doctors think cancer is causing SVCS, a biopsy may not be done. This is because the lungs and heart of a child with SVCS may not be able to handle the anesthesia needed. Other imaging tests may be done to help find out if anesthesia can be safely used. In most cases, treatment will begin before a diagnosis of cancer is made.

The following treatments may be used for SVCS in children:

• Radiation therapy

  Radiation therapy is usually used to treat a tumor that is blocking the vein. After radiation therapy, there may be more trouble breathing because swelling narrows the windpipe. A drug to reduce swelling may be given.

• Drugs

  Anticancer drugs, steroids , or other drugs may be used. If the tumor does not respond , it may be benign (not cancer).

• Surgery

  This may include surgery to bypass (go around) the blocked part of the vein or to place a stent (thin tube) to open the vein.

Current Clinical Trials

Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about dyspnea, malignant pleural effusion and malignant pericardial effusion that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

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