Ascites, Malignant

Two-thirds of cases are due to peritoneal carcinomatosis from adenocarcinomas of the

• Ovary

• Uterus

• Pancreas

• Stomach

• Colon

• Lung

• Breast

One-third of cases are due to lymphatic obstruction or portal hypertension from

• Hepatocellular carcinoma

• Diffuse hepatic metastases

Nonspecific abdominal discomfort and weight loss

Increased abdominal girth

Nausea or vomiting caused by partial or complete intestinal obstruction

Abdominal CT

• Useful to demonstrate primary malignancy or hepatic metastases

• Seldom confirms diagnosis of peritoneal carcinomatosis

Paracentesis demonstrates

• Low serum ascites–albumin gradient (< 1.1 mg/dL)

• Increased total protein (> 2.5 g/dL)

• Elevated WBC (often both neutrophils and mononuclear cells but with a lymphocyte predominance)

Ascitic fluid cytology is positive in 95%

Laparoscopy is diagnostic in patients with negative cytology

Diuretics not useful in controlling ascites

Periodic large-volume paracentesis for symptomatic relief; for patients approaching end of life, indwelling (PleurX^TM) peritoneal catheters can be left in place for vacuum-assisted drainage of treatment-resistant, recurrent malignant ascites

Intraperitoneal chemotherapy sometimes used

Prognosis is extremely poor: only 10% survival at 6 months

Ovarian cancer is an exception; with surgical debulking and intraperitoneal chemotherapy, long-term survival is possible