Also called:
- malignant ascites
- malignant peritoneal effusion
Ascites is a buildup of fluid in the abdomen (peritoneal cavity). It occurs when the body's production of fluids is greater than the body's ability to remove it. Ascites can occur in people with certain types of cancer. When ascites is due to cancer or if the fluid in the abdomen contains cancer cells, it is often called malignant ascites.
Causes
Ascites is most commonly associated with ovarian, uterine (endometrial), cervical, colorectal, stomach (gastric), pancreatic and primary liver cancer. Cancer that spreads to the liver can also cause ascites. There are also many non-cancer related causes of ascites.
Cancer can cause ascites in a number of ways:
- cancer cells spread to the thin membrane that lines the inner wall of the abdomen (peritoneum), causing irritation and fluid buildup
- tumours block the lymphatic system and lymph gathers in the abdomen
- cancer interferes with nutrition, lowering protein (albumin) production by the liver
- this causes fluid to leak out of the blood stream and into tissues and body cavities
- cancer cells in the liver can block blood flow through the liver causing fluid buildup
Symptoms
Symptoms that may occur because of ascites include:
- swelling of the abdomen
- discomfort or pain
- fatigue
- shortness of breath
- weight gain
- nausea
- vomiting
- indigestion
- loss of appetite (anorexia)
- constipation
Diagnosis
Diagnostic tests include:
Treatment
Malignant ascites may be managed by relieving symptoms (draining the fluid) or by treating the cancer that is causing the ascites with chemotherapy. Occasionally, medications (diuretics) are given to help get rid of extra fluids, but these are usually not very effective in treating ascites caused by cancer.
Draining fluid
Paracentesis is a procedure used to relieve abdominal swelling by draining fluid from the abdomen. A local anaesthetic is used to numb the area and an ultrasound may be used to guide the doctor to the area where there is the most fluid. The fluid is drained by putting a needle or small tube (catheter) through the skin and abdominal wall into the peritoneal cavity. If fluid drains too quickly, blood pressure may drop, so intravenous fluids may be given at the same time as the paracentesis.
This procedure can be repeated when then ascites builds up again.
Chemotherapy
Systemic chemotherapy may be given either intravenously or sometimes with pills. The specific drugs used will depend on the type of cancer causing the fluid buildup.
Intraperitoneal chemotherapy is another option. It is not commonly used. In this form of chemotherapy, drugs are given directly into the abdominal cavity through a plastic tube (catheter) such as a Groshong or Tenckhoff catheter, so that the drug comes in direct contact with the cancer cells. This chemotherapy works best if there is a small amount of cancer in the abdomen.