- Bruce A Runyon, MD
Bruce A Runyon, MD
- Section Editor — Cirrhosis and Its Complications
- Clinical Professor of Medicine
- University of New Mexico, Division of Gastroenterology and Hepatology
- Special Hepatology Consultant to the Indian Health Service
- Northern Navajo Medical Center, Shiprock, New Mexico
- Section Editors
- Lawrence S Friedman, MD
Lawrence S Friedman, MD
- Section Editor — General Gastroenterology
- Professor of Medicine
- Harvard Medical School
- Tufts University School of Medicine
- Eduardo Bruera, MD
Eduardo Bruera, MD
- Section Editor — Non Pain Symptoms: Assessment and Management
- Professor of Oncology
- University of Texas, MD Anderson Cancer Center at Houston
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
- Deputy Editors
- Kristen M Robson, MD, MBA, FACG
Kristen M Robson, MD, MBA, FACG
- Assistant Professor
- Tufts University School of Medicine
- Diane MF Savarese, MD
Diane MF Savarese, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Oncology and Palliative Care
- Clinical Instructor of Medicine
- Harvard Medical School
Among patients with ascites in the United States, most (85 percent) have cirrhosis and portal hypertension . Malignancy-related ascites is much less common, accounting for or contributing to ascites formation in approximately 7 percent of patients . 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".)
ETIOLOGY AND PATHOGENESIS
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 . Malignant disease can cause ascites by at least six mechanisms (table 1) . 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 :
●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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- ETIOLOGY AND PATHOGENESIS
- Influence of tumor type
- Patients with underlying liver disease
- CLINICAL MANIFESTATIONS
- Physical examination
- Imaging tests
- Abdominal paracentesis
- - Appearance
- - General ascitic fluid tests
- - Cytology
- - Unproven or unhelpful tests
- Omental biopsy
- General approach
- - Paracentesis
- - Diuretics
- - Shunts
- - Nutritional issues
- Tumor-targeted treatment
- Other treatments
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS