Bronchial
cancer associated with a homolateral malignant
pleurisy is classed as T4 whether the
pleural disease is a direct extension or metastatic. Effusions without neoplastic cells do not enter into the TNM classification. Investigations of
pleural disease consist initially of needle biopsies, completed sometimes by a thoracoscopy, which enable a precise staging and also the achievement of a
pleurodesis. A review of the literature does not currently establish the value of a pleurectomy in cases of a homolateral effusion in
bronchial carcinoma. Surgical excision may be carried out in a case of neoplastic
pleurisy where no pleural invasion is found without knowing the benefits in terms of survival. The inverse exists, with local or diffuse pleural invasion without
pleurisy, which are difficult to evaluate by imagery techniques. Thus certain authors recommend pleural lavage during surgical operations for bronchial
cancer even without
pleural disease: positive cytology seems to be a poor prognostic feature and would justify adjuvant treatment. Thoracoscopy should be carried out when the neoplastic nature of a
pleurisy has not been established by needle biopsy in order to evaluate the resectability of the tumour in the absence of surgical contra-indication. In the case of a disabling neoplastic
pleurisy a
pleurodesis carried out at the time of pleuroscopy may avoid the recurrence of the effusion.
Talc is most often employed for
pleurodesis but
Bleomycin or
Tetracycline are also used. In the case of failure to re-expand a shrunken lung the failure of the
pleurodesis may lead to a pleuroperitoneal shunt. The type of homolateral
pleural disease in bronchial
cancer with local invasion by contiguity as against pleural
metastases should appear in the TNM classification because there are different treatments and also a different prognosis.