Malignant pleural effusions are common in cancer patients with advanced disease. These patients usually present with chest pain, cough, and progressive shortness of breath, all of which may cause significant impairment in quality of life. Therapeutic options include systemic treatment; thoracentesis; or, most commonly, tube drainage and sclerotherapy. These procedures are usually palliative and are performed depending on patients' symptoms, underlying medical conditions, extent of disease, performance status, and prognosis. This review focuses on the diagnosis and treatment of patients with malignant pleural effusions.