Written By: Devin Golden
Peritoneal Mesothelioma Ascites
Ascites is one of the symptoms of peritoneal mesothelioma. Ascites is the buildup of fluid in the peritoneum, which is the lining of the abdominal cavity. This fluid buildup can cause abdominal distention and severe discomfort.
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
Medically Reviewed By
Karen Ritter, RN BSN
Registered Nurse
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What Is Peritoneal Mesothelioma Ascites?
Peritoneal mesothelioma ascites is fluid buildup caused by tumors in the peritoneum. Another term for peritoneal mesothelioma ascites is peritoneal mesothelioma effusion.
Some patients call this symptom peritoneal effusion because it’s similar to pleural mesothelioma effusion, which is fluid buildup in the pleura (lining of the lungs). Pleural mesothelioma effusion is the medical term for the symptom of pleural mesothelioma.
However, there’s a separate condition called peritoneal effusion that is unrelated to peritoneal mesothelioma. This is why doctors call the buildup of fluid in the peritoneum peritoneal mesothelioma ascites.
Normal peritoneal fluid is clear or pale yellow in color. Peritoneal ascites color is bloody when caused by cancers such as mesothelioma.
What Causes Peritoneal Mesothelioma Ascites?
Peritoneal mesothelioma ascites have numerous potential causes. Let’s first explain the biology of the peritoneum, also called the peritoneal cavity, which is the thin layer of tissue lining the abdominal cavity. The peritoneum has two tissue linings: the parietal peritoneum (outer lining) and the visceral peritoneum (inner lining). Between these two linings is fluid.
When peritoneal mesothelioma tumors form, there’s less space in the peritoneum for the fluid. This leads to extra fluid collecting in the remaining space and pressing against the linings of the peritoneum.
Tumors and cancer cells can block lymphatic vessels from funneling fluid out of the peritoneum. This can lead to excess fluid buildup. Peritoneal tumors can also irritate the lining of the abdomen causing excess fluid production.
What Else Can Cause Ascites?
There are a few other causes of ascites aside from peritoneal mesothelioma cancer. According to the website Cancer Therapy Advisor, ascites is most often a symptom of cirrhosis, which is a liver disease characterized by degeneration of cells, inflammation, and thickening of tissue. Approximately 85% of ascites cases are due to cirrhosis.
There are also other cancers capable of causing ascites. They include:
- Ovarian cancer
- Breast cancer
- Liver cancer
- Pancreatic cancer
- Lymphoma (a blood cancer)
- Colorectal cancer (colon cancer or rectal cancer)
The liver, ovaries and pancreas are all in the abdominal cavity, which explains how they can cause ascites. According to Cancer Therapy Advisor, around half of people with malignant ascites have a cancer that spreads to the peritoneum. . This is called “peritoneal carcinomatosis.”
How Often Does Ascites Occur in Peritoneal Mesothelioma?
Ascites is the most common symptom of peritoneal mesothelioma, according to one study. In the study of 81 cases, ascites occurred in 62 (77%). Ascites can cause abdominal distention (swelling), which in another study occurred in around 70% of patients.
There’s a high likelihood of having ascites if you have peritoneal mesothelioma cancer. Abdominal pain, which can also be caused by ascites, occurs in more than 60% of peritoneal mesothelioma cases. Other symptoms – such as weight loss, fever and vomiting, which are nonspecific symptoms – occur in fewer cases, according to studies.
Symptoms of Peritoneal Mesothelioma Ascites
The main symptoms of peritoneal mesothelioma ascites are abdominal distention, swelling of the abdomen, and abdominal pain. As fluid and tumors build in the peritoneal cavity, they push against the abdomen. This causes swelling, along with pain.
Other symptoms of peritoneal ascites are:
- Nausea
- Loss of appetite
- Trouble breathing
- Fatigue
- Loss of appetite
As distention and pain worsens, it may be a sign of peritoneal mesothelioma becoming more advanced.
How to Diagnose Peritoneal Mesothelioma Ascites
Ascites is a common symptom of peritoneal mesothelioma. Diagnosing ascites can be part of the process of diagnosing peritoneal mesothelioma. Imaging tests, like CT scans and ultrasounds of the abdomen, are the first steps in learning if you have peritoneal mesothelioma ascites.
A peritoneal mesothelioma fluid analysis, also known as peritoneal mesothelioma effusion cytology, is used to test ascites fluid for malignant cells. If this test is positive for malignant cells then doctors will order a tissue biopsy to determine if there is a diagnosis of peritoneal mesothelioma.
Testing Ascites for Peritoneal Mesothelioma
The only way to diagnose peritoneal mesothelioma is with a tissue biopsy. A laparoscopy and laparotomy are two surgeries used to remove samples of tissue from the peritoneum to test for cancerous mesothelial cells. However, a fluid biopsy may be used before a tissue biopsy to uncover more evidence of peritoneal mesothelioma, such as ascites.
Paracentesis is a procedure used to remove ascites, or peritoneal effusion. Doctors use a hollow needle and a drainage tube to remove fluid from the peritoneal cavity. This fluid is then tested for the presence of peritoneal mesothelioma cells.
A paracentesis drains the fluid and collects a sample to look for signs of cancer using pathology tests. A study published in Cytopathology analyzed the effectiveness of paracentesis for peritoneal effusion cytology. Testing detected peritoneal mesothelioma cells in 34% out of 46 samples of peritoneal ascites fluid.
Another study tested 61 samples of peritoneal fluid and detected peritoneal mesothelioma in around 50% of them.
Treatment of Peritoneal Mesothelioma Ascites
There are a few treatment options for peritoneal mesothelioma ascites, and they can also treat peritoneal mesothelioma cancer in general.
Paracentesis can be used as a treatment for peritoneal mesothelioma ascites along with helping diagnose the cause of the symptom. Since paracentesis drains excess fluid from the peritoneal cavity, it can reduce pain and swelling of the abdomen. This can relieve symptom discomfort and improve a patient’s quality of life.
Patients can undergo multiple paracentesis procedures to continue removing fluid buildup. It’s a low-invasive procedure and is often manageable for most people with peritoneal mesothelioma cancer.
Other treatment options for peritoneal mesothelioma ascites include:
- Cytoreductive surgery with HIPEC
- A permanent intraperitoneal catheter to drain fluid
Cytoreductive Surgery With HIPEC
Cytoreductive surgery with HIPEC is the main surgical procedure for peritoneal mesothelioma. Cytoreductive surgery with HIPEC is an aggressive surgery with hopeful survival rates – at some cancer centers 5-year survival rates of nearly 50%.
Cytoreductive surgery is a “debulking” procedure where doctors look for and remove all visible signs of cancer. HIPEC is a heated chemotherapy technique where the abdominal cavity is washed in liquid chemotherapy to kill any remaining cancer cells.
Cytoreduction often involves a “peritonectomy.” This is the removal of the peritoneum. By removing the peritoneum, there’s no longer a risk of fluid building up in the cavity. This effectively treats ascites.
Permanent Intraperitoneal Catheter for Ascites Drainage
A permanent intraperitoneal catheter might be suggested by a doctor when fluid buildup continues to occur – and rapidly. Most doctors will try a paracentesis first before using an intraperitoneal catheter. By placing the catheter, the ascites is constantly drained from the peritoneum.
Frequently Asked Questions About Peritoneal Mesothelioma Ascites
Does Mesothelioma Cause Peritoneal Effusion?
Mesothelioma can cause peritoneal effusion, also known as ascites. Peritoneal mesothelioma is a rare cancer forming in the peritoneal cavity. The cancer can cause fluid buildup in this cavity. This fluid buildup is known as peritoneal effusion, or ascites. The correct medical term for this peritoneal mesothelioma symptom is ascites, but many call it “peritoneal effusion” due to the similarities between the pleural mesothelioma symptom: pleural effusion.
How Can You Tell if You Have Peritoneal Mesothelioma Ascites?
The signs of peritoneal ascites include: weight gain, abdominal swelling, abdominal pain, loss of appetite and fatigue. The main two symptoms are abdominal swelling (also called abdominal distention) and abdominal pain, as the fluid buildup will lead to bulging of the abdomen.
How Is Peritoneal Mesothelioma Ascites Treated?
A fluid-drainage procedure called a paracentesis is the main way doctors treat peritoneal mesothelioma ascites. Paracentesis drains fluid from the peritoneal cavity to relieve swelling and pain in the abdomen. This improves quality of life for patients. Paracentesis can also be used to get fluid samples from the peritoneum and test for peritoneal mesothelioma cells. Other treatment methods for ascites are an intraperitoneal catheter to constantly drain fluid and an aggressive surgery called cytoreduction with HIPEC, which often removes the peritoneum altogether.
Sources & Author
- Malignant peritoneal mesothelioma: a multicenter study on 81 cases. Annals of Oncology. Retrieved from: https://www.annalsofoncology.org/article/S0923-7534(19)38755-1/pdf. Accessed: 03/16/2023.
- Ascitic Fluid Analysis in the Differential Diagnosis of Ascites: Focus on Cirrhotic Ascites. Journal of Clinical and Translational Hepatology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521252/. Accessed: 03/17/2023.
- Malignant Ascites: Diagnosis and Management. Cancer Therapy Advisor. Retrieved from: https://www.cancertherapyadvisor.com/home/cancer-topics/general-oncology/malignant-ascites-diagnosis-and-management/. Accessed: 03/17/2023.
- Malignant peritoneal mesothelioma: a review. Annals of Translational Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497105/. Accessed: 03/16/2023.
- The value of cytology in distinguishing malignant mesothelioma: An institutional experience of 210 cases reclassified according to the International System for Reporting Serous Fluid Cytopathology (ISRSFC). Cytopathology. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/cyt.12996. Accessed: 03/17/2023.
