Download PDF. This Fast Fact reviews the causes and diagnosis of malignant ascites. Fast Fact will review its treatment. Contributing mechanisms include tumor-related obstruction of lymphatic drainage, increased vascular permeability, over-activation of the renin-angiotensin-aldosterone system, neoplastic fluid production, and production of metalloproteinases that degrade the extracellular matrix.
Ascites, or Fluid in the Belly, in Patients With Cancer
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Malignant ascites indicates the presence of malignant cells in the peritoneal cavity and is a grave prognostic sign. While survival in this patient population is poor, averaging about 20 wk from time of diagnosis, quality of life can be improved through palliative procedures. Selecting the appropriate treatment modality remains a careful process, which should take into account potential risks and benefits and the life expectancy of the patient. Traditional therapies, including paracentesis, peritoneovenous shunt placement and diuretics, are successful and effective in varying degrees.
Ascites refers to fluid that accumulates within the peritoneal cavity. The development of malignant ascites carries a poor prognosis, with the median survival reported anywhere between 1 and 4 months. Patients with malignant ascites clinically present similarly to those with ascites secondary to cirrhosis. These patients might have similar physical exam findings to those with cirrhotics including spider angiomas, distended umbilical veins caput medusa , sclera icterus, jaundice, anasarca, and a distended abdomen. Upon closer examination of the abdomen, patients with malignant ascites may have increased dullness to percussion or shifting dullness.
Ascites uh-SIGH-tees refers to excess fluid in the abdomen. This fluid collects in the space within the walls of the abdomen, between the abdominal organs. It is common in patients with liver disease and cirrhosis, though patients with cancer can also develop ascites. Two main reasons cause ascites in patients with cancer. First, cancer can spread to the lining of the organs—the peritoneum—and make it leaky, causing malignant ascites.