Malignant Ascites

Aslam, Naeem; Marino, Christopher R.

doi:10.1001/archinte.161.22.2733

Cited by 69 publications

(24 citation statements)

References 25 publications

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“…1 It can either present at baseline or evolve during the disease course in patients with advanced ovarian or gastrointestinal malignancies and other non-oncologic etiologies (eg, cirrhosis, portal hypertension, Budd-Chiari syndrome). 2 The etiology of ascites can be multifactorial, but typically is due to the imbalance between the production and reabsorption of fluid. 2 It is known that, in cancer-related ascites, fluid accumulation is due to impaired drainage from the peritoneal cavity secondary to tumor size and increased filtration from disruption of oncotic pressures.…”

Section: Introductionmentioning

confidence: 99%

“…2 The etiology of ascites can be multifactorial, but typically is due to the imbalance between the production and reabsorption of fluid. 2 It is known that, in cancer-related ascites, fluid accumulation is due to impaired drainage from the peritoneal cavity secondary to tumor size and increased filtration from disruption of oncotic pressures. 3 Common presenting symptoms include abdominal distention, shortness of breath, diminished appetite, fatigue, and lower-extremity edema.…”

Section: Introductionmentioning

confidence: 99%

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Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Hicks

Chou

Capanu

et al. 2016

Clinical Colorectal Cancer

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This was a cohort analysis evaluating patients with pancreatic adenocarcinoma who presented with or developed ascites. Among the 180 patients analyzed, the use of serial paracenteses and indwelling catheters is a common practice to effect symptom palliation. The complication rate was higher in patients with indwelling catheters. Analyzing ascitic fluid and calculating the serum ascites albumin gradient can help attribute the etiology of the ascites and potentially identify which patients may benefit from diuretics or other intervention. Background Ascites develops in a subset of patients with pancreatic adenocarcinoma (PAC) at presentation or as the disease advances. Limited data exist on the prognostic importance of malignant ascites in PAC. Our hypothesis is that this information will provide an understanding of the natural history and facilitate management decisions. Methods We conducted a retrospective analysis of 180 patients treated at Memorial Sloan Kettering Cancer Center diagnosed between January 1, 2009 and December 31, 2014, with PAC and with ascites either at presentation or that developed during the disease course. Results For the 180 patients, the overall survival was 15 months. The time from diagnosis to ascites presentation was 11 months, and the survival time after ascites development was 1.8 months (range, 1.6–2.3 months; 95% confidence interval). Of 62 patients (34%) who had ascitic fluid analyzed, 36 (58%) had positive cytology. Fifty-one (82%) patients had a serum ascites albumin gradient ≥ 1, and 11 (18%) had serum ascites albumin gradient < 1. Sixty-four (36%) patients had their ascites managed solely by serial paracenteses. A total of 116 patients required a catheter; of these, 108 (93%) had a Tenckhoff catheter, 4 (3%) a Pleurx catheter, 4 (3%) a pigtail catheter, and 1 (1%) a Denver catheter. Eight (7%) patients required 2 catheters to be placed, and in 6 (5%), Tenckhoff catheters had to be removed. The main observed complications were spontaneous bacterial peritonitis in 7 (11%) managed with paracenteses versus 26 (23%) who had a catheter placed, catheter malfunction in 8 (7%), and acute renal failure in 6 (3%). After ascites development, 79 (44%) patients received active anti-cancer therapy, and 101 (56%) patients were managed with supportive care alone. Conclusions In patients with PAC who presented with or developed ascites, serial paracenteses and indwelling catheters are common methods used for providing symptomatic relief. The complication rate was higher with indwelling catheters, primarily related to infection (eg, bacterial peritonitis). Overall, ascites has a significantly negative prognostic import with a short median survival.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Hicks

Chou

Capanu

et al. 2016

Clinical Colorectal Cancer

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“…In patients with ascites, third-space retention of an administered drug is associated with prolongation of the terminal drug half-life in plasma, presumably owing to the slow reentry of the sequestered drug into the bloodstream [15]. This effect may intensify the toxicities in patients with ascites, who frequently show more severe toxicities than patients without ascites [16,17]. In the present study, the frequency of hand-foot syndrome was higher than that in previous studies [1,2].…”

Section: Discussionmentioning

confidence: 53%

Retrospective analysis of clinical results and predictors of response in chemo-na�ve patients with advanced gastric cancer treated with S-1, an oral fluoropyrimidine derivative, as single-agent chemotherapy

et al. 2004

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“…Exudative or transudative ascities on the basis of total protein content (≥2.5 or <2.5 g/dL, respectively,10 is hampered by a large overlap between malignant and non-malignant ascites. Up to 25% of patients with cirrhosis (mostly those with cardiac cirrhosis) can have high protein levels in ascites, and 18% of malignant ascites can be low in protein levels by nature 11…”

Section: Diagnosismentioning

confidence: 99%

“…The serum-to-ascites albumin gradient (SAAG) accurately identifies the presence of portal hypertension and is more useful than the protein-based exudate/transudate concept 12. The SAAG is easily calculated by subtracting the ascitic fluid albumin value from the serum albumin value, which is obtained on the same day.…”

Section: Diagnosismentioning

confidence: 99%

Management of Ascites Due to Gastrointestinal Malignancy

2009

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Ascites is the pathological accumulation of fluid within the abdominal cavity. The most common cancers associated with ascites are adenocarcinomas of the ovary, breast, colon, stomach and pancreas. Symptoms include abdominal distension, nausea, vomiting, early satiety, dyspnea, lower extremity edema, weight gain and reduced mobility. There are many potential causes of ascites in cancer patients, including peritoneal carcinomatosis, malignant obstruction of draining lymphatics, portal vein thrombosis, elevated portal venous pressure from cirrhosis, congestive heart failure, constrictive pericarditis, nephrotic syndrome and peritoneal infections. Depending on the clinical presentation and expected survival, a diagnostic evaluation is usually indicated as it will impact both prognosis and the treatment approach. Key tests include serum albumin and protein and a simultaneous diagnostic paracentesis, checking ascitic fluid, WBCs, albumin, protein and cytology. Median survival after diagnosis of malignant ascites is in the range of 1 to 4 months; survival is apt to be longer for ovarian and breast cancers if systemic anti-cancer treatments are available.

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Malignant Ascites

Cited by 69 publications

References 25 publications

Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Pancreas Adenocarcinoma: Ascites, Clinical Manifestations, and Management Implications

Retrospective analysis of clinical results and predictors of response in chemo-na�ve patients with advanced gastric cancer treated with S-1, an oral fluoropyrimidine derivative, as single-agent chemotherapy

Management of Ascites Due to Gastrointestinal Malignancy

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