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Cancer Health Center

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Cardiopulmonary Syndromes (PDQ®): Supportive care - Health Professional Information [NCI] - Malignant Pericardial Effusion

Malignant pericardial effusions occur in up to 21% of cancer patients [1,2,3] and are frequently not suspected until clinical signs or symptoms of pericardial tamponade develop.[4] Two-thirds of patients have subclinical pericardial effusions with no overt cardiovascular signs or symptoms.[5,6] One-half of cases of pericardial effusion initially present with symptoms of cardiac tamponade.[7] In 50% of cases, pericardial effusion is the first sign of malignant disease.[8] Symptoms of pericardial effusion are often attributed to the underlying cancer. Dyspnea, fatigue, or asthenia may be the initial symptoms.[9] Symptomatic pericardial effusions are often a preterminal event; however, significant symptom palliation can be achieved by prompt diagnosis and management.

Of patients with malignant pericardial effusions, 50% will have concomitant pleural effusions, and one-third will have pulmonary parenchymal disease.[4]

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Metastatic squamous neck cancer with occult primary is a disease in which squamous cell cancer spreads to lymph nodes in the neck and it is not known where the cancer first formed in the body. Squamous cells are thin, flat cells found in tissues that form the surface of the skin and the lining of body cavities such as the mouth, hollow organs such as the uterus and blood vessels, and the lining of the respiratory (breathing) and digestive tracts. Some organs with squamous cells are the esophagus,...

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One-third of patients with pericardial metastases will eventually die from pericardial tamponade.[4] Pericardial involvement contributed to the cause of death in 85% of patients in a series reported in 1962 but in only 46% of patients in a recent study.[10] Improvements in diagnostic and therapeutic options account for the decrease in mortality over the past 40 years.

Incidence and Prevalence

Malignant pericardial effusion occurs in up to 21% of autopsy cases in patients with common malignancies.[4,7] Of patients with lung cancer, 33% have pericardial metastases at autopsy, and one-third of cases of pericardial metastases are caused by lung cancer. Breast cancer causes 25% of pericardial effusions, and about 25% of patients with breast cancer have pericardial effusion. Hematological malignancies (leukemia, Hodgkin disease, non-Hodgkin lymphoma) cause 15% of cases of malignant pericardial effusions.[11]

A retrospective review of 23,592 effusions over a 24-year period revealed 65 malignant effusions (17%) out of 375 pericardial effusions. Lung cancer was the most common cancer found among the malignant pericardial effusions in males, and breast cancer was the most common in females. In 43% of cases, pericardial effusion was the first detected sign of cancer. Of patients diagnosed with malignant pericardial effusions, 86% died within 1 year of diagnosis, with nearly one-third dying within the first month.[8]

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