JAMA ONCOLOGY PATIENT PAGE Ascites, or Fluid in the Belly, in Patients With Cancer

What Is Ascites? Ascites(uh-SIGH-tees)referstoexcessfluidintheabdomen.Thisfluid Paracentesis for Ascites Paracentesis is the process of using a catheter or syringe to drain collectsinthespacewithinthewallsoftheabdomen,betweentheab- excess fluid that has collected in the abdominal cavity. dominal organs. It is common in patients with liver disease and cirrho- sis, though patients with cancer can also develop ascites. Possible sites of paracentesis What Causes Ascites in Patients With Cancer? Twomainreasonscauseascitesinpatientswithcancer.First,cancercan spread to the lining of the organs—the peritoneum—and make it leaky, ASCITIC causing malignant ascites. Second, cancer can spread to the liver and FLUID cause increased pressure in the liver. Certain cancers, such as ovarian, pancreatic, liver, and colon cancers, are more likely to cause ascites.

What Are the Symptoms and Complications of Ascites? Patients can experience swelling and tightness of the abdomen, feel- ing full when eating, nausea, or shortness of breath. The fluid can become infected, which can cause fever and pain.

How Do We Diagnose Ascites? Ascites may be suspected because of symptoms and examination findings. Ultrasonography is often the first step. A computed to- Diagnostic paracentesis Therapeutic paracentesis A syringe is used to collect a small A catheter is used to drain some mography or magnetic resonance imaging scan can provide more amount of fluid to use in tests to or all of the ascitic fluid to help information about the underlying cancer. A needle and syringe may diagnose the cause of ascites. relieve discomfort. be used to remove some of the fluid in a procedure called a para- centesis. Checking this fluid for white blood cells, blood, cancer cells, If fluid keeps recurring, an alternative may be to place an in- and bacteria can help determine the cause and diagnose an infec- dwelling flexible catheter into the fluid cavity that can open to the tion, if present. Finding cancer cells in the fluid confirms a diagno- outside through the skin and be drained using a valve. Patients or sis of malignant ascites as opposed to liver damage or other causes. caregivers can typically be trained to do this at home. For most patients, development of malignant ascites signals How Do We Treat Ascites in Patients With Cancer? advanced, incurable cancer. Often, there may be no suitable cure Treatment depends on the cause (cancer spread or liver damage); for the underlying cancer. However, for some cancers (eg, ovarian the severity of symptoms; the cancer type, extent of spread, and suit- cancer, lymphoma), treating the underlying cancer with chemo- ability of anticancer treatments; and patient preferences. therapy and/or surgery may control ascites as well. If patients have few symptoms, specific treatment may not be needed. If liver damage is the cause, patients may be prescribed a diuretic(waterpill)toincreasewaterintheurineoraskedtocutdown FOR MORE INFORMATION the amount of salt in their food. • Cancer.Net If patients have severe tightness in the abdomen or shortness www.cancer.net/coping-with-cancer/physical-emotional-and- of breath, a paracentesis can remove several liters of fluid in min- social-effects-cancer/managing-physical-side-effects/fluid- utes. A hollow needle is inserted into the fluid and connected to a abdomen-or-ascites bottle via tubing. This can provide immediate relief, though fluid can • JAMA Patient Page: Abdominal Paracentesis return, often in days to weeks. The procedure can be repeated if https://jamanetwork.com/journals/jama/fullarticle/181607 needed.

Authors: Arjun Gupta, MD; Ramy Sedhom, MD; Muhammad S. Beg, MD The JAMA Oncology Patient Page is a public service of JAMA Oncology.The Published Online: December 19, 2019. doi:10.1001/jamaoncol.2019.5409 information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information Author Affiliations: Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins concerning your personal medical condition, JAMA Oncology suggests that you University, Baltimore, Maryland (Gupta, Sedhom); The University of Texas consult your physician. This page may be photocopied noncommercially by physicians Southwestern Medical Center, Dallas (Beg). and other health care professionals to share with patients. To purchase bulk reprints, Conflict of Interest Disclosures: Dr Beg reported receiving personal fees from Array email [email protected]. BioPharma, Boston Biomedical, Bristol-Myers Squibb, Genentech, and Ipsen, and grants from Merck outside the submitted work. No other disclosures were reported. Section Editor: Howard (Jack) West, MD.

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