Cardiopulmonary syndromes are conditions of the heart and lung that may be caused by cancer or by other health problems. Five cardiopulmonary syndromes that may be caused by cancer are covered in this summary:
This summary is about cardiopulmonary syndromes in adults and children with cancer. Section titles show when the information is about children.
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:
Diagnostic tests and procedures include the following:
Treatment may include the following:
The treatment of dyspnea depends on its cause, as follows:
|If the dyspnea is caused by:||Then the treatment may be:|
|Tumor blocking the large or small airways in the chest or lung||Radiation therapy.|
|Chemotherapy, for tumors that usually respond quickly to this treatment.|
|Laser surgery to remove the tumor.|
|Cauterization of tumors.|
|Pleural effusion||Removal of the extra fluid around the lung using a needle or chest drain.|
|Pericardial effusion||Removal of the extra fluid around the heart using a needle.|
|Ascites||Removal of the extra fluid in the abdominal cavity using a needle.|
|Carcinomatous lymphangitis||Steroid therapy.|
|Chemotherapy, for tumors that usually respond quickly to this treatment.|
|Superior vena cava syndrome||Chemotherapy, for tumors that usually respond quickly to this treatment.|
|Surgery to place a stent in the superior vena cava to keep it open.|
|Bronchospasms or chronic obstructive pulmonary disease||Bronchodilators.|
|Postradiation bronchiolitis obliterans||Steroid therapy.|
|Heart failure||Diuretics and other heart medicines.|
Treatment to control the signs and symptoms of dyspnea may include the following:
Chronic cough may cause severe pain, trouble sleeping, dyspnea, or fatigue. The causes of chronic coughing are almost the same as the causes of dyspnea.It may be possible to treat the cause of chronic coughing.
Treatments may include:
Medicines may include:
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, or 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 signs and symptoms may be caused by a pleural effusion. Talk to your doctor if you have any of the following problems:
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:
The type of cancer, previous treatment for cancer, and the patient's wishes also are important in planning treatment.Treatment may be to control signs and 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 signs and symptoms and improve quality of life.
Treatment of the signs and symptoms of malignant pleural effusion includes the following:
Thoracentesis is a procedure to remove extra fluid from the pleural cavity using a needle and/or a thin, 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.
An indwelling pleural catheter (IPC) is a small tube that is inserted and left in place to keep fluid from building up around the lungs. One end of the tube stays inside the chest and the other passes outside the body to allow fluid to drain. This type of catheter may be used for long-term care so that a separate procedure won't need to be done each time draining is needed. Risks of IPCs include infection and blockage of the catheter.
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 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.
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.Signs and symptoms of pericardial effusion include dyspnea (shortness of breath) and anxiety.
At first, a pericardial effusion may not cause any signs or symptoms. These and other signs and symptoms may be caused by a pericardial effusion or by other conditions. Check with your doctor if you have any of the following:
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:
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:
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. For patients with advanced cancer, this procedure may be used instead of more serious surgery.
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.
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.
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.
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.
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:
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 signs and 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:
Less common causes of SVCS include:
The signs and 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 signs are:
Less common signs and symptoms include the following:
The following tests may be done to diagnose SVCS and find the blockage:
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, signs and symptoms, and prognosis.
Treatment for SCVS caused by cancer depends on the following:
Watchful waiting is closely monitoring a patient’s condition without giving any treatment unless signs or 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 signs or symptoms and keep the patient comfortable:
Chemotherapy is the usual treatment for tumors that respond to anticancer drugs, including small cell lung cancer and lymphoma. Chemotherapy stops 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.
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 or keep them from growing. 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.
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.
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 to bypass (go around) the blocked part of the vein is sometimes used for cancer patients, but is used more often for patients who do not have cancer.
Superior vena cava syndrome is serious and the signs and 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 signs and 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 signs and symptoms to improve their quality of life.
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 signs and symptoms include the following:
There are other less common but more serious signs and symptoms:
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 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.
Anticancer drugs, steroids, or other drugs may be used.
Check the list of NCI-supported cancer clinical trials for supportive and palliative care trials about dyspnea, malignant pleural effusion and malignant pericardial effusion that are now accepting participants. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug.
General information about clinical trials is also available from the NCI website.
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This PDQ cancer information summary has current information about the pathophysiology and treatment of cardiopulmonary syndromes, including dyspnea, malignant pleural effusion, malignant pericardial effusion, and superior vena cava syndrome. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
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PDQ® Supportive and Palliative Care Editorial Board. PDQ Cardiopulmonary Syndromes. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/cardiopulmonary-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389457]
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