Malignant ascites is a condition which occurs in people with breast, lung, colon and pancreas primary cancers, with peritoneal cancer developing. For a patient with malignant ascites the life expectancy is about a few months after beginning of the disease. Apart from ascites with cancerous origin another background cause of ascites is liver cirrhosis. Of all the complications of liver cirrhosis which are variceal hemorrhage, hepatic encephalopathy and ascites the most common is ascites.
The earliest symptom in ascites is increased abdominal girth which is with weight gain. Ascites is seen clinically as a distention in abdomen, flank dullness which is shifting in nature and edema in the lower limbs. There is usually bloated abdomen, feeling of fullness, nausea and vomiting (usually symptoms that accompany gastrointestinal disease) breathlessness and weakness. When patients are left on supine position for a long time sacral edema is noticed. When ascites is accompanied by pain malignancy is suspected as the cause of ascites.
Ultrasound examination of the abdomen is the most effective means of diagnosis of malignant ascites. It can detect as small as 100ml of fluid present in the abdominal cavity. Also about 10% of patients who has ascites often develop right side pleural effusion, hernias of inguinal or umbilicus may also follow ascites.
Ascites is often caused by proteinous exudates from cancer cells which line the peritoneum. Metastasis from liver by portal hypertension can also cause ascites. Portal vein thrombosis with underlying portal hypertension is also a cause of ascites.
Another method of diagnosis of this condition is full blood count which will show increase in blood components that will identify inflammation.
When malignant ascites is diagnosed treatment is required to begin to help the general state of the patient since these symptoms that come with ascites are discomforting to the patient. The treatment is not for the cure of the condition but to eliminate the symptoms and make the patient feel better.
Treatment of malignant ascites can be by the use of diuretics which reduces the quantity of fluid in the abdomen and also possibly control stomach bloating. The mostly used diuretic is spirolactone which not only removes water from the body but is a potassium sparing diuretic which makes it appropriate since it preserves the potassium of the body thereby retaining the normal potassium quantity required as much as possible.
Another method of treatment is paracentesis which is the use of drainage by either a tube or a needle from the abdominal cavity. This method is effective in bringing relief to the patient but does not cure the disease also. Other means is diet by reducing water and sodium intake which helps the total fluid quantity in the abdominal cavity.
The prognosis of malignant ascites is poor; the patients live about 1to 4 months after the diagnosis of malignant ascites. The life expectancy of these patients is low because of the involvement of underlying primary cancer and the infection of the peritoneum whose general infection within a few days leads to toxic state and then death.