Pulmonary medicine and palliative care

Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: manage ment options include repeated thoracentesis, chemical pleurodesis, symptoma tic relief of dyspnoea with oxygen and morphine, and external drainage. Par enchymal metastases are typically multifocal and respond to chemotherapy, w ith a limited role for pulmonary metastatectomy. Pulmonary tumour embolism is frequently associated with lymphangitic carcinomatosis, and is most comm on in choriocarcinoma. Thromboembolic disease, associated with the hypercoa gulable state of cancer, is treated with anticoagulation. Inferior vena cav a filter placement is indicated when anticoagulation cannot be given, or wh en emboli recur despite adequate anticoagulation. Palliative care has a maj or role for respiratory symptoms of gynaecological malignancies. Treatable causes of dyspnoea include bronchospasm, fluid overload and retained secret ions. Opiates are effective at relieving dyspnoea associated with effusions , metatases, and lymphangitic tumour spread. Non-pharmacological therapies include energy conservation, home redesign, and dyspnoea relief strategies, including pursed lip breathing, relaxation, oxygen, circulation of air wit h a fan, and attention to spiritual suffering. Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patient s' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of lif e issues.