IntroductionMalignant pleural effusion (MPE) is a complication of advanced cancer commonly encountered in palliative care settings and is often the cause of a significant reduction in quality of life of the patient. This study will describe three cases and review the evidence regarding the management of MPE. Case presentation Case 1 Mrs. A is an 83-year-old woman. She initially presented with significant ascites and tests revealed an elevated tumor marker (CA-125). Computed tomography (CT) imaging demonstrated a mass in the right ovary. She underwent therapeutic and diagnostic paracentesis which established a diagnosis of metastatic ovarian adenocarcinoma. Palliative chemotherapy was not considered indicated. Three months later, she presented with worsening dyspnea due to significant right pleural effusion. 1500 ml of pleural fluid was drained by thoracocentesis. She presented again two weeks later with new dyspnea due to a recurrence of her right pleural effusion. An intercostal catheter was placed by the cardiothoracic surgeons. Six weeks later, she was referred to the palliative care service and admitted for dyspnea. A chest x-ray showed a new large pleural effusion on the left side, which was also drained by thoracocentesis. Her right intercostal catheter was removed during this same admission because it had become infected and was releasing frank pus. No pleural fluid was sent for laboratory analysis as it was presumed to be a malignant effusion given that she had previously had malignant ascites. Furthermore, the unilateral and sequential nature of the pleural effusions made it unlikely that they were caused by congestive heart failure. After five more months at home, Ms. YG was readmitted to the hospital...... middle of paper ......, and quality of life measurements were taken to assess the extent of the disease. Chest 2000; 117:73-8.15. Hirata T, Yonemori K, Hirakawa A et al. Effectiveness of pleurodesis for malignant pleural effusions in breast cancer patients. The European Respiratory Journal 2011; 38:1425-30.16. Ben-Aharon I, Gafter-Gvili A, Leibovici L, Stemmer SM. Interventions to relieve cancer-related dyspnea: a systematic review and meta-analysis. Acta oncologica 2012;51:996-1008.17. Brown LF, Kroenke K, Theobald DE, Wu J, Tu W. The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psycho-oncology 2010; 19:734-41.18. Emanuel LL, Librach SL. Palliative care: basic skills and clinical skills. 2nd ed. Philadelphia: Saunders; 2011.19. WHO definition of palliative care. (Accessed 12/12/2013, at www.who.int/cancer/palliative/definition/en/)