Managing pleural malignancy

Pleural malignancy is a growing problem, with malignant pleural effusions (MPEs) affecting 70 per 100,000 people every year. Around 15% of all cancer patients are diagnosed with pleural malignancy during their cancer journey, and they are treated by general and respiratory physicians alike. MPEs usually indicate advanced or aggressive disease, with median survival typically 6–12 months. Symptoms can be debilitating, so effusion management and symptom control form key aspects of care. Management options for MPE have grown in recent years, and important differences in the benefits and disadvantages of the various methods mean that patient choice is paramount. This review covers the investigation, diagnosis and management of individuals with suspected MPE. It details the strategies available for definitive MPE management, explores which approaches to consider in different situations, and describes how to manage potential complications.