What Is Ascites and How is it Managed with Cancer?

Acites - Definition, Causes, and Treatments

Close-up of woman with hands on her belly.
What is ascites, why does it happen, and how is it treated?. Credit: Elke Selzle/Getty Images

What is ascites, why does it occur, and how is it treated?

Definition: Ascites

Ascites is a condition in which excess fluid accumulates in the abdominal cavity.

Causes

The most common causes of ascites are liver disease, heart disease, and cancer. Cancers where ascites frequently occurs include ovarian cancer, breast cancer, pancreatic cancer, colon cancer, and uterine cancer.

Symptoms

If the accumulation of fluid is relatively mild, it produces few or no symptoms.

However, when advanced, ascites can lead to:

  • Severe abdominal distention and bloating
  • Malabsorption of food
  • Breathing difficulties (caused by the inability to draw a full breath)
  • Pain
  • A change in the shape of the belly button
  • Nausea and vomiting
  • Loss of appetite

Diagnosis

Ascites can be diagnosed most often with a history and physical exam followed by an X-ray or ultrasound.

Ascites in Ovarian Cancer

Ascites is unfortunately too common with ovarian cancer, and malignant ascites (ascites with cancer cells in the fluid) is present in at least 10% of people with recurrent ovarian cancer.

Can cause ascites in several ways:

  • By blocking lymphatic drainage in the abdomen.
  • By damaging the liver which results in a low albumin (protein) level in the blood.
  • By blocking the drainage system of the liver.
  • By the direct effect of widespread metastatic cancer in the abdomen (ovarian cancer often has widespread metastases on the surface (serosa) of organs in the abdomen.

    Management and Treatment of Ascites

    Treating ascites focuses on treating the underlying problem.  When ascites is due to cancer, the focus is on palliative care and reducing symptoms.  If ascites is not causing symptoms, it does not need to be treated.

    If the fluid is causing symptoms, a paracentesis may be done.

      This involves threading a needle through the abdominal wall and into the peritoneal cavity to draw off fluid.  This fluid can be looked at in the lab for confirmation of the cause if needed.

    A problem with paracentesis is that the fluid often builds back up fairly rapidly.  If this continues to occur, a tube (shunt) can be placed into the abdominal cavity to continuously drain the fluid.

    Some people are helped by restricting their salt intake or using diuretics (water pills) although these may have side effects as well.

    Targeted Therapies for Ovarian Cancer With Ascites

    Medications which have been found to be somewhat helpful for ascites due to ovarian cancer include the monoclonal antibody Removab (catumaxumab), the angiogenesis inhibitor Avastin (bevacizumab) and the VEGF inhibitor Eylea (afibercept.)  These medications may help with the symptoms of ascites and decrease the frequency of paracentesis needed to drain the fluid, but they do not improve the survival rate.

    Coping/Support

    If you or a loved one are coping with ascites due to cancer, it's likely the cancer is very advanced.

      You may have been wondering about whether or not hospice is an option.  You may be wondering, "Is death painful?" 

    Talking about end of life concerns will be the most difficult talk you will ever have, but is one of the most important things you can do to make sure you or a loved one are cared for in the way you would choose. Here are some conversation starters for talking about end of life wishes. Reach out to your doctor as well. This is often a time where everyone is afraid of talking about the elephant in the room, worrying that they will upset another.  With heartfelt discussion and a little planning, many people are able to enjoy their friends and family and experience joy, even if a cure is out of sight.

    Pronunciation: ah-sy-tees

    Common Misspellings: asytees, asitees

    Sources:

    American Society of Clinical Oncology. Fluid in the Abdomen or Ascites. Updated 08/15/2015. http://www.cancer.net/navigating-cancer-care/side-effects/fluid-abdomen-or-ascites

    Maeda, H., Kobayashi, M., and J. Sakamoto. Evaluation and treatment of malignant ascites secondary to gastric cancer. World Journal of Gastroenterology. 2015. 21(39):10936-47.

    Smolle, E., Taucher, V., and J. Haybaeck. Malignant ascites in ovarian cancer and the role of targeted therapeutics. Anticancer Research. 2014. 34(4):1553-61.

    Continue Reading