Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!

For further information, see CMDT Part 15-10: Malignant Ascites

Key Features

  • 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

Clinical Findings

  • 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") 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

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.