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Malignancy-related ascites

Bruce A Runyon, MD
Section Editors
Lawrence S Friedman, MD
Eduardo Bruera, MD
Don S Dizon, MD, FACP
Deputy Editors
Kristen M Robson, MD, MBA, FACG
Diane MF Savarese, MD


Among patients with ascites in the United States, most (85 percent) have cirrhosis and portal hypertension [1]. Malignancy-related ascites is much less common, accounting for or contributing to ascites formation in approximately 7 percent of patients [1]. Some patients have two causes for ascites formation (eg, cirrhosis plus peritoneal carcinomatosis).

This topic will review malignancy-related ascites. A general approach to the evaluation of patients with ascites, the management of patients with ascites in the setting of cirrhosis, and less common causes of ascites are presented separately. (See "Evaluation of adults with ascites" and "Ascites in adults with cirrhosis: Initial therapy" and "Ascites in adults with cirrhosis: Diuretic-resistant ascites" and "Chylous, bloody, and pancreatic ascites".)


Malignancy-related ascites may be seen with several tumors, including malignancies of the ovary, breast, colon, lung, pancreas, and liver. In addition, lymphoma can be complicated by chylous ascites. There is a common misconception that malignancy-related ascites is synonymous with peritoneal carcinomatosis [2]. Malignant disease can cause ascites by at least six mechanisms (table 1) [3]. Thus, the phrase "malignancy-related ascites" is a more appropriate descriptor than "malignant ascites" since it includes all of these causes.

Influence of tumor type — Ascites typically develops in the setting of recurrent and/or advanced cancer. Patients may have a history of metastases to the peritoneum or liver, enlarged abdominal lymph nodes, or a large tumor burden prior to the development of ascites. The origin of the primary tumor has an impact on the sites of abdominal metastases and the etiology of the ascites [3]:

Malignancies of ovarian and urinary bladder origin as well as peritoneal mesothelioma tend to cause peritoneal carcinomatosis. In such cases, the accumulation of fluid is the result of blockage of the draining lymphatic channels (which normally keep the amount of intraperitoneal fluid low) and increased vascular permeability.

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Literature review current through: Nov 2017. | This topic last updated: Mar 30, 2017.
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