Ascites or malignant ascites is an accumulation of fluid in the abdominal cavity caused by an imbalance of plasma flow into and out of the blood vessels and the lymphatic vessels. Cancer cells infiltrating the abdomen are the primary cause of this imbalance in women with ovarian cancer. Ascites is detected by a noticeable abdominal swelling, swelling of the ankles, abdominal pain, vomiting, nausea, early fullness, heartburn and anorexia. It is confirmed by a CT scan, MRI and protein blood tests.
Ascites buildup is extremely uncomfortable. Patients can initially be offered diuretics, analgesics and antiemetics to ease symptoms.
The pressure caused by ascites can be further relieved by draining the fluid using a procedure called paracentesis. This is usually performed on an out-patient basis at your local cancer clinic or hospital. After an optimal point is determined by an ultrasound, the area of the abdomen is frozen and a needle is inserted. It is connected to a bottle under vacuum and the fluid flows readily. A healthy person has approximately 50-100ml of fluid in the peritoneal cavity. Advanced cancer can result in producing 10 or more litres of fluid. Although the patient feels immediate relief from this drainage, the effect seldom lasts more than two weeks.
A day surgery procedure is also available in certain cases of refractory (non-responsive) malignant ascites, whereby a catheter is permanently inserted into the abdomen allowing for drainage at home. This is extremely helpful in freeing up hospital resources and more importantly, putting symptom control into the hands of the patient.
I have accompanied an ovarian cancer patient to the clinic for ascites drainage on several occasions and can attest to her relief and general ease from the procedure. I have also seen a patient perform the “in-home” drainage with the help of her son – it too was relatively effortless and provided immediate comfort. Patients who have had a drain inserted should pay special attention to the site for signs of infection or bleeding.
Ascites buildup can be a cause of nausea – antiemetics and liquid whole meal replacements can help. Please see the Nausea tab for other suggestions.
Ascites should not be confused with simple fluid retention or edema. Ascites is a critical condition which requires medical attention. Furthermore, patients should not lower their fluid intake without the permission of their doctor.
Patients are encouraged to wear supportive stockings, keep their feet elevated and eat small meals frequently.
Today, the only lasting resolution of malignant ascites comes from effective chemotherapy. However, there is always Hope. There are many clinical trials underway studying new and improved methods/drugs for the treatment and management of malignant ascites including the use of a diphtheria toxin and so-called monoclonal and trifunctional antibodies. Please see the Clinical Trials tab for further information about how to find a clinical trial in your area.
We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.