Malignant Pleural Effusions and Breast Cancer
Malignant Pleural Effusions and Breast Cancer
Malignant Pleural Effusions and Breast Cancer
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<strong>Malignant</strong> <strong>Pleural</strong> <strong>Effusions</strong><strong>and</strong> <strong>Breast</strong> <strong>Cancer</strong>Joseph S. Friedberg, MD, FACS
<strong>Malignant</strong> <strong>Pleural</strong> <strong>Effusions</strong><strong>and</strong> <strong>Breast</strong> <strong>Cancer</strong>• What is the pleura?• What is the pleural space?• What is a pleural effusion?• What does a pleural effusion do to a patient?• What are the treatments for a pleuraleffusion?
The Pleura
The <strong>Pleural</strong> Space
Inflow/Outflow of the <strong>Pleural</strong> Spaceoverflowblockage
What Happens When the <strong>Pleural</strong>Inflow/Outflow is Disturbed
<strong>Malignant</strong> <strong>Pleural</strong> Effusion
Thoracentesis
Talc Pleurodesis
External <strong>and</strong> Internal Indwelling <strong>Pleural</strong> Catheters• Pleurx Catheter• Pleuroperitoneal Shunt
Recurrent Effusionwith Negative Cytology• Entire operation performedthrough a half inch incisionusing a video camera forvisualization• Fluid drained• Pleura biopsied• Lung inflated <strong>and</strong> either talcinstilled or Pleurx catheterplaced under direct vision• Tube brought out from aseparate site <strong>and</strong> incision closedwith dissolving sutures
Photodynamic Therapy (PDT)• photosensitizers• oxygen• visible light
Mechanisms of PDT effect• Direct cell kill– Mitochondria– Cell membrane– Apoptosis• Damage to neovasculature• Immune response– Local– systemic
<strong>Pleural</strong> PDT
<strong>Breast</strong> <strong>Cancer</strong> Patient with Entrapped Lung, Bulky<strong>Pleural</strong> <strong>Cancer</strong> <strong>and</strong> Intractable <strong>Malignant</strong> EffusionBefore Surgery/PDTAfter Surgery/PDT
Where are We Going with <strong>Pleural</strong>PDT for <strong>Breast</strong> <strong>Cancer</strong>• Photosensitizer with shorter durationlight sensitivity (NIH sponsored trial)• Use of a minimally invasive approach• Active area of research is to develop anon-invasive approach
Why We Do What We Do
<strong>Malignant</strong> <strong>Pleural</strong> Effusion
The Pleura
![Agenda [PDF] - Abramson Cancer Center](https://img.yumpu.com/35341208/1/190x245/agenda-pdf-abramson-cancer-center.jpg?quality=85)
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