Why does peritoneal cancer cause ascites

Doctors call this a peritoneo-venous shunt. You will be given either a sedative which makes you drowsy or a general anaesthetic when the doctor puts the shunt in. One end of the shunt goes into the fluid in the tummy. The other end goes into a vein in the neck. A valve in the shunt means the fluid can only flow in one direction — from the tummy into the vein in the neck. You will need to stay in hospital for a short time while the hospital staff check the shunt is working properly.

The shunt stays in permanently. Your doctor and nurse can give you more information about this. Cancer treatments such as chemotherapy can help to reduce the number of cancer cells. This can sometimes improve ascites.

Your doctor may give you a water tablet diuretic , such as spironolactone. This may help the body get rid of excess fluid as urine pee. Your doctor or nurse may also advise you to reduce the amount of salt you have in your diet. Taking a water tablet can help slow down the build-up of the ascitic fluid. It usually makes you want to pass urine more often. You may have blood tests to check how well your kidneys are working during this treatment.

If you have ascites, the way you think and feel about your body body image may change. You may find it helpful to:. Below is a sample of the sources used in our ascites information. If you would like more information about the sources we use, please contact us at cancerinformationteam macmillan.

Paracentesis for Malignant Ascites Procedure; Management of drainage for malignant ascites in gynaecological cancer Review. Cochrane Database of Systematic Reviews; Management of ascites in ovarian cancer patients; It has been reviewed by expert medical and health professionals and people living with cancer.

On this page. What is ascites? What causes ascites? Ascites may develop when: cancer cells irritate the lining of the tummy, causing it to make too much fluid lymph nodes in the tummy become blocked and the fluid cannot drain properly cancer that has spread to the liver raises the pressure in nearby blood vessels, which forces fluid out the liver is damaged and cannot make enough blood proteins, so fluid leaks out of the veins into the tummy.

Symptoms of ascites The main symptom of ascites is bloating and a swollen tummy. Other symptoms include: discomfort or pain in the tummy feeling sick nausea loss of appetite indigestion tiredness and weakness fatigue constipation needing to pee pass urine more often breathlessness difficulty sitting comfortably and moving around. Managing ascites Ascites is often managed by draining the fluid. Draining fluid from the tummy ascitic drainage Removing the excess fluid from the tummy is a common and effective treatment for ascites.

The fluid is usually drained over a few hours, but this depends on: the amount of fluid that needs to be drained what is right for you — for example, if you have low blood pressure, fluid may be drained more slowly. Possible problems with ascitic drainage Most people do not have any serious problems from having an ascitic drain. Other problems You might need to have a catheter in more than one place if there is ascitic fluid in different places in the tummy.

There is a small risk of bleeding when the catheter is put in. Any bleeding usually stops on its own without treatment. There is a small risk of hitting the bowel when putting in the catheter.

Relieving side effects is an important part of cancer care and treatment. This type of care is called palliative care or supportive care. It helps someone, with any type or stage of cancer, feel better. Your doctor may use one or more of the following tests to locate, diagnose, or plan treatment for ascites:. Computerized tomography CT or CAT scan , which creates a 3-dimensional picture of the inside of the body using x-rays.

Paracentesis, which is when a needle removes fluid from the abdomen for testing or to relieve symptoms. The goal of treatment is to provide relief from uncomfortable symptoms. You may not need treatment if your ascites is not causing discomfort. Ascites treatment may have unpleasant side effects. Talk with your doctor about the benefits and risks of each option before deciding on a treatment plan. The treatment options for ascites include:. Changes to how you eat. For mild discomfort, eating less salt and drinking less water or other liquids may help.

Salt helps your body hold onto water. Making diet changes can be a challenge for many people. Talk to your health care team about how to make these changes. A diuretic is any substance that makes you urinate more often. This can help reduce the amount of fluid built up in your abdomen. Diuretics can be prescribed as medication. Most people do not experience side effects when taking a diuretic, but they can cause a loss of sleep, skin problems, fatigue, and low blood pressure.

Paracentesis is a procedure to remove the fluid in the abdomen. PVS placement thus provides an effective treatment option for patients with refractory malignant ascites in advanced cancer, and yields a higher likelihood of discharge compared with conventional paracentesis.

When used in the context of multidisciplinary team discussion, image-guided biopsy using ultrasound US or computed tomography CT guidance is of value in planning the management of women with suspected ovarian cancer and peritoneal carcinomatosis PC of uncertain etiology. Although abdominal paracentesis, diuretics and peritoneovenous shunting are commonly used procedures in management of malignant ascites, the evidence for these treatment options is weak.

There are no randomized controlled trials evaluating the efficacy and safety of these procedures in malignant ascites. Available data show a good but temporary effect of abdominal paracentesis on symptom relief in patients with malignant ascites.

There is no consensus on fluid withdrawal speed and concurrent intravenous hydration is not sufficiently studied.

Data show that peritoneovenous shunts can control malignant ascites, but have to be balanced by the potential risks of this procedure. The use of diuretics should be considered in all patients, but has to be evaluated individually. A recommendation for further research is a randomized controlled trial comparing the use of diuretics with paracentesis in the management of malignant ascites.

Paracentesis is indicated for those patients who have symptoms of increasing intra-abdominal pressure. Available data show good, although temporary relief of symptoms in most patients. Symptoms like discomfort, dyspnea, nausea and vomiting seem to be significantly relieved by drainage of up to 5 L of fluid. When removing up to 5 L of fluid, intravenous fluids seem to be not routinely required grade of recommendation: D Grading of the evidence and the recommendations in the guideline are based on the revised grading system by the Scottish Intercollegiate Guidelines Network SIGN.

Grades of recommendations are from grade A to D. Infusion therapy is not sufficiently studied. There is no evidence of concurrent albumin infusions in patients with malignant ascites grade of recommendation: D.

To avoid repeated paracenteses, peritoneovenous shunting may be considered. The available data are controversial and there are no clear predictors to identify which patients would benefit from diuretics. The use of diuretics therefore should be considered in all patients, but has to be evaluated individually.

Patients with malignant ascites due to massive hepatic metastasis seem to respond more likely to diuretics than patients with malignant ascites caused by peritoneal carcinomatosis or chylous ascites grade of recommendation: D. One study reported that there was resolution of malignant ascites in 3 of 10 patients treated with intraperitoneal interferon alpha-2b.

No significant myelosupression was observed. Tumor necrosis factor TNF -alpha has been shown to be effective in the palliative treatment of malignant ascites.

Of 22 patients, 16 had complete and 6 had partial resolution of their ascites. The response rate was highest in patients with ovarian cancer in which the tumor load was distributed in fine nodules all over the peritoneal cavity rather than as palpable bulky masses characteristic of non-ovarian tumors. Some reversible adverse affects such as fever, chills, nausea, vomiting, and fatigue were reported, but these were generally well tolerated. A large Japanese study showed favorable results in the use of intraperitoneal injections of streptococcal antigen OK in patients with malignant ascites.

Furthermore, the OK group had a better survival time Although each of the above studies had limitations, they suggest that intraperitoneal immunotherapy may have a role in the future management of malignant ascites. Decreasing permeability of vessels by inhibiting the tyrosinase kinase activity of vascular endothelial growth factor VEGF receptors has recently been shown to inhibit the formation of malignant ascites in animal models.

Furthermore, survival was increased in SKOV3 mice. This conclusion is further supported by a second study in mice using VEGF-neutralizing antibodies. Encouraging results have also been reported with the intraperitoneal instillation of the metalloproteinase Batimastat.

No reaccumulation of ascites occurred after that single dose in 5 of the 23 patients, and these 5 survived for up to days. Seven other patients died without reaccumulation. Nausea and vomiting were noted in the first 24 hours after batimastat treatment, but overall tolerance was good, and no significant acute peritoneal reactions were reported.

Opposite results, however, were obtained in an animal study in which treatment caused dramatic tumor cell consolidation and less dispersed ascites cells compared with controls, but did not reduce ascites. Recently, monoclonal antibody therapy has been used in treating malignant ascites with some success. Five patients with colon or ovarian cancer or mesothelioma were treated with intraperitoneal monoclonal antibody radiolabelled with I.

Octreotide, a somatostatin analogue, has been used in the symptomatic management of bowel obstruction, uncontrolled diarrhea and fistulae. It decreases the secretion of fluid by the intestinal mucosa, and increases water and electrolyte reabsorption.

Ascities is a common finding in gastrointestinal malignancies. The effective management of ascities is necessary in treating the symptoms of these patients. We most use ascitic fluid drainage as the most common intervention. Other treatment modalities are specific for the type of malignancies present in the body.

Radio- and immunotherapy and other anti-tumor therapies have been used, but none are fully successful in the management of ascites in these patients. National Center for Biotechnology Information , U. Journal List Ann Saudi Med v. Ann Saudi Med. Muhammad W. Saif , Imran A. Siddiqui , and Muhammad A. Imran A. Muhammad A.

Author information Copyright and License information Disclaimer. Correspondence: Muhammad W. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Ascites is the pathological accumulation of fluid within the abdominal cavity.

Pathophysiology The most common causes of ascites are related to portal hypertension, which is usually related to liver cirrhosis. Open in a separate window. Figure 1. Clinical manifestations The usual clinical presentation is a protuberant abdomen with discomfort, difficulty in breathing, fever and pain.

Table 1 Grades of ascites. Diagnosis Lab findings Routine blood work may be inconclusive, while some tests suggest specific etiologies. Table 2 Analysis of ascitic fluid. Routine tests Optional tests Unusual tests Cell count and differential Glucose concentration Tuberculosis smear and culture Albumin concentration LDH concentration Cytology Total protein concentration Gram stain Triglyceride concentration Culture in blood culture bottles Amylase concentration Bilirubin concentration.

Fluid analysis Ascitic fluid analysis is essential for the diagnosis of malignant ascites. Table 3 Classification of ascites by serum albumin ascites gradient. Management Management of patients with ascities in GI malignancies is controversial.

Table 4 Improvement following paracentesis. Diet Low sodium diet is the first step towards the management of ascites. Diuretic therapy There are no randomized controlled trials assessing the efficacy of diuretic therapy in malignant ascites. Table 5 Diuretics: Mode of action and toxicity profile. Carbonic anhydrase inhibitors Acetazolamide, dorazolamide Inhibits activity of carbonic anhydrase Proximal tubular cells.

Metabolic acidosis, neuropathy Osmotic diuretic Mannitol A non-reabsorbable polysaccharide that acts as an osmotic diuretic, inhibiting sodium and water reabsorption Proximal tubule and more importantly, the loop of Henle Hypovolemia, dehydration.

Tenckhoff catheter This catheter is surgically placed through the wall of the abdomen to provide a point for the dialysis solution to enter and leave the peritoneal cavity during peritoneal dialysis. Paracentesis vs PVS placement There is no difference in survival or quality of life between patients treated with repeated abdominal paracentesis and patients treated with a PVS. Paracentensis Peritoneovenous placement Abdominal girth No significant decrease Significant decrease Hematocrit No significant decrease Significant decrease Blood urea nitrogen, creatinine No significant change Tended to decrease Median no.

Image-guided biopsies When used in the context of multidisciplinary team discussion, image-guided biopsy using ultrasound US or computed tomography CT guidance is of value in planning the management of women with suspected ovarian cancer and peritoneal carcinomatosis PC of uncertain etiology.

Recommendations Although abdominal paracentesis, diuretics and peritoneovenous shunting are commonly used procedures in management of malignant ascites, the evidence for these treatment options is weak. Newer pharmacological approaches in the management of malignant ascites Intraperitoneal Immunotherapy Interferon alpha One study reported that there was resolution of malignant ascites in 3 of 10 patients treated with intraperitoneal interferon alpha-2b.