Lung metastases and pleural effusion in breast cancer

Lung metastases are areas where breast cancer has spread to the lungs. Breast cancer can also spread to the pleura, the thin lining around the lungs, where it can cause fluid to build up between the lung and chest wall. This is called a malignant pleural effusion. Lung metastases may cause no symptoms at first, or they can lead to a persistent cough, breathlessness, chest discomfort or, rarely, coughing up blood. A pleural effusion often causes increasing breathlessness, especially on exertion or lying flat. The cancer in the lungs is still breast cancer and is treated mainly with whole-body treatments. Fluid around the lungs can be drained to relieve breathlessness quickly, and procedures can help stop it coming back. Many people get good relief from symptoms with treatment.

How it is usually found

Through a chest X-ray, CT scan or PET-CT done because of symptoms or during follow-up, sometimes confirmed by testing fluid or tissue.

Why testing matters

Testing fluid or tissue confirms breast cancer and can recheck receptors, which guide treatment. Lung spots can sometimes have other causes, such as infection.

When to seek urgent help

Seek emergency care for sudden or severe breathlessness, chest pain, coughing up more than a small amount of blood, or bluish lips.

Lung metastases and pleural effusion mean breast cancer has become metastatic, which is generally not curable. Treatment can often control the cancer and relieve breathlessness, and many people live for a meaningful time with good symptom control.

Fluid often returns

Draining a pleural effusion gives quick relief, but fluid may build up again. Pleurodesis or a home drainage catheter can reduce repeated procedures.

Breathlessness can be eased

Treating the cancer, draining fluid, breathing techniques, fans and sometimes medicines help breathlessness.

Not every lung spot is cancer

Infections, scarring from radiation and other conditions can look similar, so investigation matters.

What this page cannot tell you

It cannot predict your own course. Ask your oncologist what to expect.

For fluid that keeps returning, a small tube can be placed so fluid can be drained at home.

How it works

A soft tube sits under the skin of the chest, and fluid is drained into a bottle every few days by a nurse, carer or yourself after training.

Benefits

It avoids repeated hospital visits and gives more control over breathlessness.

Caring for it

Keep the site clean and dry, and report redness, fever or pain.

Draining a pleural effusion is often the fastest way to relieve breathlessness.

Before the procedure

An ultrasound usually marks the best place to insert the needle, and blood tests may check clotting.

During the procedure

You sit leaning forward. After local anaesthetic, a needle or thin tube is placed between the ribs and fluid is drained slowly.

Afterwards

Many people breathe more easily straight away. Some cough or feel chest tightness as the lung re-expands. The fluid may be tested to confirm the cause.

Writing questions down before an appointment makes it easier to remember what matters most to you and your family, and to leave with clear answers.

About breathlessness

What is causing my breathlessness: spots in the lung, fluid, or something else such as low blood counts or a clot? What can be done to ease it quickly, and what can I do at home?

About fluid drainage

If fluid keeps returning, would a longer-term option such as an indwelling catheter or sealing the pleural space suit me? What are the benefits and risks of each?

About treatment and daily life

What is the aim of treatment now, how will we check whether it is working, and which symptoms mean I should seek urgent care? Is it safe for me to travel or fly?