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.
Many conditions can cause dyspnea.
Dyspnea is the feeling that you can't catch your breath or you can't breathe in enough air. It also may be called shortness of breath, breathlessness, or air hunger. In cancer patients, dyspnea can be caused by the following:
A physical exam and health history are important in finding out the cause of dyspnea.
Diagnostic tests and procedures include the following:
There are different ways to treat the causes of dyspnea in cancer patients.
Treatment may include the following:
Treatment of dyspnea will depend on what is causing it.
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 usuallyrespondquickly to this treatment.|
|•Laser surgeryto remove the tumor.|
|• Cauterization of tumors.|
|• Stent placement to keep airway open.|
|Pleural effusion||• Removal of the extra fluid around the lung using a needle or chestdrain.|
|Pericardial effusion||• Removal of the extra fluid around the heart using a needle.|
|• Intrapericardial chemotherapy.|
|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.|
|• Radiation therapy.|
|• Surgery to place a stent in thesuperior vena cavato keep it open.|
|•Opioidsand/or steroid therapy.|
|Chest infections||• Antibiotics.|
|• Breathing treatments.|
|Pulmonary embolism||• Anticoagulants.|
|Bronchospasms or chronic obstructive pulmonary disease||• Bronchodilators.|
|• Inhaled steroids.|
|Postradiation bronchiolitis obliterans||• Steroid therapy.|
|Heart failure||• Diuretics and other heart medicines.|
|Anemia||• Blood transfusion|
|Checkpoint inhibitor immunotherapy–related pneumonitis||• Withholding drug therapy.|
Treatment may be to control the signs and symptoms of dyspnea.
Treatment to control the signs and symptoms of dyspnea may include the following:
Chronic coughing may cause much physical distress.
Chronic cough may cause pain, trouble sleeping, dyspnea, or fatigue. The causes of chronic coughing are almost the same as the causes of dyspnea. See Dyspnea section for list of causes.
It may be possible to treat the cause of chronic coughing.
Treatments may include:
Medicines may be used to control chronic coughing.
Medicines may include:
Pleural effusion is extra fluid around the lungs.
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.
Pleural effusion also may be caused by radiation therapy, chemotherapy, a collapsed lung, or cancer that has spread to lymph nodes. 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.
Signs and symptoms of pleural effusion include dyspnea (shortness of breath) and cough.
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:
Finding out the cause of pleural effusion will help plan the treatment.
Treatment for a malignant pleural effusion is different from treatment for a nonmalignant effusion, so the right diagnosis is important. Diagnostic tests used to find the cause of the pleural effusion include the following:
The type of cancer, previous treatment for cancer, and your choices 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:
Pericardial effusion is extra fluid around the heart.
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. If fluid builds up, 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). Malignant pericardial effusion is common in lung cancer, breast cancer, melanoma, lymphoma, and leukemia patients. Pericarditis (swelling of tissues around the heart), a heart attack, hypothyroidism, or systemic lupus erythematosus are examples of nonmalignant causes of pericardial effusion. Radiation therapy or chemotherapy may cause pericarditis, leading to pericardial effusion.
Signs and symptoms of pericardial effusion include dyspnea (shortness of breath) and cough.
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 cardiac tamponade. Check with your doctor if you have any of the following:
Pericardial effusion usually occurs in advanced cancer.
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:
Treatment may be to control the symptoms of pericardial effusion and improve quality of life.
The goal of treatment is usually palliative, to relieve symptoms and improve quality of life. If a malignant pericardial effusion is severe, it is usually controlled by draining the fluid.
Treatment options include the following:
Superior vena cava syndrome (SVCS) is a group of signs and symptoms that occur when the superior vena cava is partly blocked.
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.
SVCS is usually caused by cancer. In adults, SVCS is most common in the following types of cancer:
Less common causes of SVCS include:
Common signs and symptoms of SVCS include breathing problems and coughing.
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:
Tests are done to find and diagnose the blockage.
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:
Treatments for SVCS include watchful waiting, chemotherapy, radiation therapy, thrombolysis, stent placement, and surgery.
The following may be used to relieve signs or symptoms and keep the patient comfortable:
Palliative care may be given to relieve signs and symptoms of SVCS.
The signs and symptoms of superior vena cava syndrome can be upsetting. It is important that you and your family 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.
If you have advanced cancer you may decide not to have any more treatment. Palliative care can help keep you comfortable by relieving signs and symptoms to improve your quality of life.
Superior vena cava syndrome (SVCS) in a child is a serious medical emergency because the child's windpipe can become blocked.
Superior vena cava syndrome (SVCS) is rare in children, but when it occurs, it can be life-threatening. In adults, the windpipe is stiff, but in children, it is softer and can more easily be squeezed shut or blocked. A child's windpipe is narrow, 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 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 for SVCS will begin before a diagnosis of cancer is made.
Treatment for SVCS in children may include radiation therapy, drugs, or surgery.
There are several ways to treat SVCS in children.
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Purpose of This Summary
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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Last Revised: 2019-10-31
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