Ascites refers to the unusual buildup of fluid within the abdominal cavity. While it can stem from various conditions, it is frequently linked with advanced ovarian cancer. More than one-third of individuals with ovarian cancer experience ascites, sometimes involving several liters of fluid.
How Ascites Forms in Ovarian Cancer
Ascites in ovarian cancer originates from a complex interplay of biological processes, primarily involving the peritoneum, the lining of the abdominal cavity. Cancer cells from the ovarian tumor can shed into this cavity, irritating the peritoneum. This irritation prompts the peritoneum to produce excessive fluid and become more permeable, allowing fluid to leak out of blood vessels.
Elevated levels of vascular endothelial growth factor (VEGF), a protein often produced by tumor cells, contribute to this increased permeability. VEGF makes blood vessels “leaky,” causing fluid and proteins to escape into the peritoneal space. Additionally, ovarian cancer can obstruct the lymphatic system, which drains fluid from the abdomen. This blockage prevents proper fluid absorption, leading to its accumulation.
The fluid that builds up, known as malignant ascites, is an active component of the tumor environment. It contains cancer cells, various proteins, and signaling molecules. This fluid can even facilitate the spread of cancer cells throughout the peritoneal cavity, contributing to new tumor growths.
Recognizing and Diagnosing Ascites
Recognizing ascites begins with noticing changes in the abdomen. Individuals may experience progressive abdominal swelling and tightness, leading to a distended or “bloated” appearance. This can also be accompanied by rapid weight gain due to the accumulating fluid.
The pressure from the fluid can cause discomfort or pain in the abdomen, a feeling of fullness even with little food, and a decreased appetite. Other symptoms can include shortness of breath, as the fluid pushes on the diaphragm and lungs, changes in bowel or bladder habits, and back pain. If these symptoms, particularly persistent abdominal swelling, last for more than two weeks, medical consultation is advised.
Diagnosis typically involves a physical examination where a doctor may detect a “fluid wave” in the abdomen. Imaging tests, such as an abdominal ultrasound or CT scan, are used to visualize the fluid accumulation and identify any underlying masses. A procedure called paracentesis is performed, where a needle is inserted to drain fluid from the abdomen. This fluid is then analyzed for the presence of cancer cells and other markers to confirm the diagnosis and rule out other causes.
Managing Ascites
Managing ascites in ovarian cancer aims to alleviate symptoms and address the underlying cancer. Therapeutic paracentesis is a common approach, where a needle or catheter is used to drain the excess fluid from the abdomen. This procedure provides immediate relief from pressure and discomfort, allowing for easier breathing and improved appetite. While effective for symptom relief, the fluid often reaccumulates, necessitating repeated drainage.
For recurring ascites, a long-term drain or catheter may be surgically placed in the abdomen, allowing for fluid drainage at home. Another option, a peritoneovenous shunt, can divert fluid from the abdomen into the bloodstream, though it carries risks such as infection or blood clots. Diuretics, or “water pills,” may also be prescribed to help the body excrete excess fluid through urination.
Beyond these direct fluid management techniques, treating the underlying ovarian cancer is paramount. Chemotherapy is used to shrink tumors and prevent further cancer spread, reducing ascites formation. In some cases, surgical removal of tumors during debulking surgery can also involve draining ascites fluid.
Living with Ovarian Cancer Ascites
Living with ovarian cancer ascites presents challenges affecting daily life and overall well-being. The physical discomfort from abdominal distention, including pain, tightness, and a feeling of fullness, can make simple activities difficult. This can impact mobility, making it hard to move around, sit comfortably, or even lie down.
Nutritional concerns are also common, as the pressure from the fluid can lead to decreased appetite, nausea, and a feeling of early fullness, which may result in unintended weight loss. Managing these symptoms often involves supportive care, including dietary advice to help maintain adequate nutrition. Pain management strategies are also implemented to improve comfort.
Psychological support is equally important, as dealing with persistent symptoms and a chronic condition can be emotionally taxing. While ascites is a sign of advanced disease and may indicate a less favorable outlook, effective management of the fluid buildup through procedures like paracentesis improves quality of life. This comprehensive approach helps individuals cope with the physical and emotional burden of ascites, allowing for better daily functioning.