Ascites is called effusion of the liquid component of blood or lymph into the abdominal cavity. This process can occur with various diseases and pathologies, but it is most typical for liver diseases. In addition, ascites in cancer is quite common, and especially chylous ascites (formed during obstruction of the vessels of the lymphatic system).
Fifty percent of cases of ascites in cancer develop as a result of carcinomatosis of the parietal and visceral peritoneum. This process ultimately leads to blockage (obstruction) of the lymphatic vessels.
The frequency of the latter among all malignant neoplasms ranges from fifteen to fifty-five percent. The most likely development of ascites in tumors of the ovaries, endometrium, stomach, mammary glands, bronchi and other organs and tissues.
About fifteen percent is formed with a tumor of the liver parenchyma. Compression of the venous system of this organ leads to a rapid formation of effusion in the abdominal cavity, in addition, in such patients a not pronounced hepatomegaly is formed.
The pathogenesis and symptoms of ascites in cancer
Ascites, its symptoms are characteristic - a sharp increase in the abdomen, as well as the total weight of the patient. Increased pressure in the abdominal cavity leads to a high level of standing of the diaphragm, which, in turn, causes the symptoms of gastroesophageal reflux (belching with acid and heartburn, nausea and vomiting), orthopnea and dyspnea, a syndrome of a compressed stomach (fast food satiety and nausea).
During a physical examination, a small amount of ascitic fluid (up to 200 milliliters) is almost impossible to detect. An effusion with a volume of five hundred to a thousand milliliters is detected visually as a result of protrusion of the abdominal lateral flanks, the symptom of fluctuation is positive. A "moving" dullness characteristic of ascites is observed over the flanks when changing the position of the body during percussion.
Ascites in cancer caused by blockage of the venous system in the liver is manifested by the expansion of the superficial veins of the abdominal wall. In the later stages, the formation of a “jellyfish head” is characteristic (protrusion of the anterior abdominal wall in ascites with dilated and pronounced veins on it).
An extraperitoneal complex of symptoms is also revealed: fluid in the pleural cavity, displacement of the apical impulse of the heart, as well as edema of the lower part of the teal (mainly limbs and lower abdomen).
In the terminal stages of cancer, moderate ascites does not worsen the patient’s condition and does not pose a life threat, therefore, only diuretic drugs are administered that enhance the excretion of fluid from the body and thus reduce the abdominal effusion.
If ascites is diagnosed, treatment is performed with veroshpiron (spironolactone), which is recognized as the "medical standard" in the treatment of such conditions. The purpose of this drug in combination with furosemide (loop diuretic), allows you to additionally remove from the body up to 1000 milliliters of fluid per day.
With pronounced ascites and the presence of pain and tachypnea, abdominal paracentesis is performed (puncture of the abdominal wall to drain the cavity). Drainage is carried out for at least six hours and until the moment when the ascitic fluid ceases to flow into the tank. The resulting liquid is sent for analysis, examining it for total protein content, for the fractional composition of LDH and the quantitative content of leukocytes. In addition, perform the sowing of the liquid on a nutrient medium.
A pronounced positive effect gives an effect on the etiological factor (directly on the tumor itself). Thus, the leading link in pathogenesis is eliminated and ascites in cancer recedes.