Abstract
Ascites is the pathological accumulation of fluid in the abdominal cavity caused by an imbalance of fluid in and out of the blood and lymphatic vessels. Portal hypertension is the major cause of ascites, but infectious and malignant causes are also very important. Cancer-induced ascites is present in about 10% of all patients. Palliation of ascites is important for holistic patient management. Median survival after diagnosis of malignant ascites was only 20 weeks from the time of diagnosis of ascites, except for tumors of ovarian and lymphatic origin, which have better mean survivals (32 and 58 weeks, respectively). The most common cancers associated with ascites are adenocarcinomas of the ovary, breast, colon, stomach, and pancreas. The cancer type largely influences the sites of abdominal metastases and the cause of the ascites. The manifestation of symptoms depends on the amount of fluid, rapidity of fluid accumulation, and the cause of ascites. Patients often first seek medical attention because of abdominal discomfort, pain, breathing difficulty, or early satiety. They may also complain of reduced appetite, nausea, vomiting, lower extremity edema, weight gain, and reduced mobility. The diagnosis is based upon the clinical setting, imaging tests, and ascitic fluid analysis. Radiologic studies are useful in detecting small amounts of ascitic fluid as well as helpful in assessing the etiology of ascites. Ultrasonography is the commonest and most convenient investigation for diagnosing ascites. Depending on the clinical setting, computed tomography or magnetic resonance imaging scans are excellent investigations. The detection of tumor cells by cytology remains the gold standard for the detection of malignancy. In most instances, the treatment of metastatic cancer with ascites is palliative. Treatment options include large-volume paracentesis, peritoneovenous shunting, drainage catheters, surgery, intraperitoneal therapy, and tumor-targeted treatment.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Runyon BA. Management of adult patients with ascites due to cirrhosis. Hepatology. 2004;39(3):841–56.
Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer. 2006;42(5):589–97.
Adam RA, Adam YG. Malignant ascites: past, present, and future. J Am Coll Surg. 2004;198(6):999–1011.
Runyon BA. Care of patients with ascites. N Engl J Med. 1994;330(5):337–42.
Mackey JR, Venner PM. Malignant ascites: demographics, therapeutic efficacy and predictors of survival. Can J Oncol. 1996;6(2):474–80.
Garrison RN, Kaelin LD, Galloway RH, Heuser LS. Malignant ascites. Clinical and experimental. Ann Surg. 1986;203(6):644–51.
McIntyre N, Burroughs AK. Cirrhosis, portal hypertension, and ascites. In: Weatherall DJ, Ledingham J, Warrell DA, editors. Oxford textbook of medicine. 3rd ed. Oxford: Oxford University Press; 1996. p. 2085–100.
Lifshitz S. Ascites, pathophysiology and control measures. Int J Radiat Oncol Biol Phys. 1982;8(8):1423–6.
Saif MW, Siddiqui IA, Sohail MA. Management of ascites due to gastrointestinal malignancy. Ann Saudi Med. 2009;29(5):369–77.
El-Shami K, Elsaid A, El-Kerm Y. Open-label safety and efficacy pilot trial of intraperitoneal bevacizumab as palliative treatment in refractory malignant ascites. J Clin Oncol. 2007;25(18S):9043.
Runyon BA. Management of adult patients with ascites due to cirrhosis: an update. Hepatology. 2009;49(6):2087–107.
Cattau EL Jr, Benjamin SB, Knuff TE, Castell DO. The accuracy of the physical examination in the diagnosis of suspected ascites. JAMA. 1982;247(8):1164–6.
Chongtham DS, Singh MM, Kalantri SP, Pathak S. A simple bedside manoeuvre to detect ascites. Natl Med J India. 1997;10(1):13–4.
Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med. 1992;117(3):215–20.
Akriviadis EA. Hemoperitoneum in patients with ascites. Am J Gastroenterol. 1997;92(4):567–75.
Kielhorn E, Schofield K, Rimm DL. Use of magnetic enrichment for detection of carcinoma cells in fluid specimens. Cancer. 2002;94(1):205–11.
Ayantunde AA, Parsons SL. Pattern and prognostic factors in patients with malignant ascites: a retrospective study. Ann Oncol. 2007;18(5):945–9.
Runyon BA. Management of adult patients with ascites caused by cirrhosis. Hepatology. 1998;27(1):264–72.
Sharma S, Walsh D. Management of symptomatic malignant ascites with diuretics: two case reports and a review of the literature. J Pain Symptom Manage. 1995;10(3):237–42.
Greenway B, Johnson PJ, Williams R. Control of malignant ascites with spironolactone. Br J Surg. 1982;69(8):441–2.
Lee CW, Bociek G, Faught W. A survey of practice in management of malignant ascites. J Pain Symptom Manage. 1998;16(2):96–101.
Rosenberg SM. Palliation of malignant ascites. Gastroenterol Clin North Am. 2006;35(1):189–99. xi
Smith EM, Jayson GC. The current and future management of malignant ascites. Clin Oncol (R Coll Radiol). 2003;15(2):59–72.
Straus AK, Roseman DL, Shapiro TM. Peritoneovenous shunting in the management of malignant ascites. Arch Surg. 1979;114(4):489–91.
Schumacher DL, Saclarides TJ, Staren ED. Peritoneovenous shunts for palliation of the patient with malignant ascites. Ann Surg Oncol. 1994;1(5):378–81.
Parsons SL, Lang MW, Steele RJ. Malignant ascites: a 2-year review from a teaching hospital. Eur J Surg Oncol. 1996;22(3):237–9.
Belfort MA, Stevens PJ, DeHaek K, Soeters R, Krige JE. A new approach to the management of malignant ascites; a permanently implanted abdominal drain. Eur J Surg Oncol. 1990;16(1):47–53.
Sugarbaker PH. Peritonectomy procedures. Ann Surg. 1995;221(1):29–42.
Sugarbaker PH, Jablonski KA. Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg. 1995;221(2):124–32.
Dedrick RL, Myers CE, Bungay PM, DeVita VT Jr. Pharmacokinetic rationale for peritoneal drug administration in the treatment of ovarian cancer. Cancer Treat Rep. 1978;62(1):1–11.
Tewari D, Java JJ, Salani R, Armstrong DK, Mrkman M, Herzog T, Monk BJ, Chan JK. Long term survival advantage and prognostic factors associated with intraperitoneal chemotherapy in advanced ovarian cancer: a gynaecologic oncology group study. J Clin Oncol. 2015;33(13):1460–6.
Bellati F, Napoletano C, Ruscito I, et al. Complete remission of ovarian cancer induced intractable malignant ascites with intraperitoneal bevacizumab. Immunological observations and a literature review. Invest New Drugs. 2010;28(6):887–94. https://doi.org/10.1007/s10637-009-9351-4.
Gotlieb W, Amant F, Advani S, Goswami C, Hirte H, Provencher D, Somani N, Yamada SD, Tamby JF, Vergote I. Intravenous aflibercept for treatment of recurrent symptomatic malignant ascities in patients with advanced ovarian cancer: a phase 2, randomized, double-blind, placebo-controlled study. Lancet Oncol. 2012;13(2):154.
Aleem A, Siddiqui N. Chronic myeloid leukemia presenting with extramedullary disease as massive ascites responding to imatinib mesylate. Leuk Lymphoma. 2005;46(7):1097–9.
Ng T, Pagliuca A, Mufti GJ. Intraperitoneal rituximab: an effective measure to control recurrent abdominal ascites due to non-Hodgkin’s lymphoma. Ann Hematol. 2002;81(7):405–6.
Sugarbaker PH. Managing the peritoneal surface component of gastrointestinal cancer. Part 1. Patterns of dissemination and treatment options. Oncology (Williston Park). 2004;18(1):51–9.
Chua TC, Al-Alem I, Saxena A, Liauw W, Morris DL. Surgical cytoreduction and survival in appendiceal cancer peritoneal carcinomatosis: an evaluatin of 46 consecutive patients. Ann Surg Oncol. 2011;18(6):1540.
Youssef H, Newman C, Chandrakumaran K, Mohamed F, Cecil TD, Moran BJ. Operative findings, early complications and long term survival in 456 patients wih pseudomyxoma peritonei syndrome of appendiceal origin. Dis Colon Rectum. 2011;54(3):293.
Parsons S, Hennig M, Linke R, Klein A, Lahr A, Lindhofer H, Heiss M. The trifunctional antibody catumaxomab for the treatment of malignant ascities due to epithelial cancer: results of a prospective randomized phase II/III trial. Int J Cancer. 2010;127(9):2209–21.
Strohlein MA, Heiss MM. The trifunctional antibody catumaxomab in treatment of malignant ascities and peritoneal carcinomatosis. Future Oncol. 2010;6(9):1387–94.
Woopen H, Sehouli J. Current and future options in the treatment of malignant ascites in ovarian cancer. Anticancer Res. 2009;29(8):3353–9.
Berek JS, Edwards RP, Parker LP, DeMars LR, Herzog TJ, Lentz SS. Catumaxomab for the treatment of malignant ascities in patients with chemotherapy-refractory ovarian cancer: a phase II study. Int J Gynaecol Cancer. 2014;24(9):1583.
Chester C, Dorigo O, Berek J, Kohrt H. Immunotherapeutic approaches to ovarian cancer treatment. J Immunother Cancer. 2015;3:7.
Sangisetty SL, Miner TJ. Malignant ascities: a review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrintest Surg. 2012;4(4):87–95.
Acknowledgments
Dr. Joseph Thomas, MD: Professor and Head of Medical Oncology, Shirdi Sai Baba Cancer Hospital and Research Centre, Kasturba Medical College, Manipal. Karnataka 576104; Mr. Ashok VK, Product Manager, Dr. Reddy’s Laboratories, Hyderabad, Andhra Pradesh.; Dr H Hong, Medical Oncology, Lyell McEwin Hospital, Elizabeth Vale SA 5112
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Joshi, R., Hong, H.W. (2018). Ascites. In: Olver, I. (eds) The MASCC Textbook of Cancer Supportive Care and Survivorship. Springer, Cham. https://doi.org/10.1007/978-3-319-90990-5_29
Download citation
DOI: https://doi.org/10.1007/978-3-319-90990-5_29
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-90989-9
Online ISBN: 978-3-319-90990-5
eBook Packages: MedicineMedicine (R0)