Ascites in Ovarian Cancer: Causes and Management | MyOvarianCancerTeam

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Ascites in Ovarian Cancer: Causes and Management

Medically reviewed by Howard Goodman, M.D.
Written by Maureen McNulty
Posted on April 20, 2023

Ascites — the buildup of fluid in the abdomen — is a common sign of ovarian cancer, often showing up as a bloated belly. More than 1 out of 3 women with this type of cancer experience ascites, according to the Ovarian Cancer Research Alliance (OCRA).

Ascites is linked to your cancer stage, which describes how far in the body your cancer has spread. It’s most common in those with advanced-stage ovarian cancer that has spread beyond the ovaries or fallopian tubes. Per OCRA, ascites is found in more than 9 out of 10 women with stage 3 or 4 ovarian cancer.

What Is It Like To Have Ascites?

Ascites may be an early symptom of ovarian cancer. It develops when your body makes extra fluid that stays in between the organs of your abdomen. Ascites can cause your belly area to bulge, and you may feel pain, discomfort, or tenderness in your abdomen. You may be bloated or feel as if you have gained weight.

Many members of MyOvarianCancerTeam have discussed living with ascites. “That was my only symptom,” wrote one member. “One day my clothes fit, and the next day they didn’t. I looked four or five months pregnant.”

Ascites may also be linked to additional conditions that cause fluid to build up in other places. Some people may also have extra liquid in their chest around their lungs, known as pleural effusion. “My lung sac keeps filling up,” one member with ascites commented.

All the extra liquid in your abdomen may press on the surrounding organs, giving them less room. This can lead to additional symptoms, including:

  • Nausea or vomiting
  • Upset stomach
  • Unusual fullness after eating
  • Problems taking a deep breath
  • Increased urination frequency
  • Back pain
  • Constipation
  • Difficulty moving around

“I’m very tired of the ascites,” said one member. “Every time I try to eat a meal, I get so much stomach pain and bloating.” Shared another member, “There’s no comfortable position sitting, standing, or lying down.”

These extra symptoms can reduce your quality of life while living with ovarian cancer.

What Causes Ascites?

Ovarian cancer may lead to ascites because it causes tissues in your abdomen to produce or release more fluid. This can happen in a few ways:

  • Ovarian tumors can lead to increased levels of a molecule that makes walls of your blood vessels “leaky,” allowing fluid to escape into the surrounding tissue.
  • Tumor cells can damage your liver, making it possible for fluid in your liver’s blood vessels to leak out.
  • Cancer could spread to the peritoneum (the lining inside your abdomen), which may encourage this tissue to make more fluid.

Typically, fluid levels in your body are controlled by part of your immune system called the lymphatic system. This system of vessels and organs drains extra fluid out of your tissues. However, ovarian cancer cells can sometimes create a blockage in the lymphatic system, keeping fluid pooled in the abdomen.

Other Potential Causes

Additional health conditions may also cause ascites. If you have an accumulation of fluid, one of these other factors could also be contributing:

  • Heavy alcohol use
  • Hepatitis B or C
  • Liver conditions such as cirrhosis, nonalcoholic fatty liver disease, autoimmune hepatitis, or hemochromatosis
  • Kidney disease
  • Pancreatitis (inflammation of the pancreas)
  • Heart failure
  • Infection

If you have already been diagnosed with ovarian cancer, however, your ascites is most likely caused by your tumor.

Does Ascites Affect Your Prognosis?

Because ascites can be a sign of more advanced cancer, you may have a worse prognosis (course of your condition) if you have this symptom. Higher volumes of ascites are linked with a greater chance that your cancer:

  • Has spread — or will spread — to other tissues
  • Will come back after being treated
  • Is resistant to therapy, making it harder to treat

Having ascites doesn’t necessarily mean you will have a poor outcome, however. Your prognosis also depends on multiple other factors, such as:

  • Your type of ovarian cancer
  • Tumor stage
  • Genetic mutations
  • Overall health
  • Age
  • Other symptoms

Your doctor can help you understand your prognosis and recommend treatment options that are most likely to work for you.

Treating Ascites

Your doctor may recommend several strategies for the management of malignant ascites, depending on its cause.

Cancer Treatments

Your doctor may not recommend ascites treatment if you have early-stage cancer or mild symptoms. In these cases, standard cancer treatments such as chemotherapy can reduce symptoms like ascites along with the cancer itself. Additionally, your doctor may remove ascites fluid during debulking surgery (a procedure to remove as much tumor as possible).

“Chemo worked well for my ascites, but everyone is different,” said one MyOvarianCancerTeam member. “I had terrible ascites when I got diagnosed, but it never returned after my second chemo,” commented another. Yet another stated, “When I had debulking surgery, 2 liters of ascites was removed.”

Diuretics

Also known as water pills, diuretics may help eliminate ascites if this condition is caused by liver damage. These medications help draw out extra water from your tissues so that your body can get rid of it through your urine. However, diuretics are more likely to work for nonmalignant ascites (cases not caused directly by cancer), so they may not be as effective in people with ovarian cancer.

Paracentesis

Paracentesis is a procedure in which extra abdominal fluid is removed using a slender needle or a catheter (thin tube). This common ascites treatment is most often recommended for people with advanced ovarian cancer.

“It’s a relief to get the ascites drained. It doesn’t really hurt you to do it,” wrote a member. Another reported feeling much better after getting paracentesis: “I was actually able to enjoy dinner for a change and take a deep breath.”

Paracentesis is usually safe but can occasionally lead to infection, bleeding, a hole in your intestines, or leaking of fluid near where the needle was inserted. You may need to stay in the hospital while getting this procedure. Paracentesis can also remove protein, which can have an effect on nutritional status.

Ascites can return after treatment, so you may have to undergo multiple rounds of paracentesis to keep your swelling down. One member commented, “I can’t go more than about 10 to 12 days without having the fluid drained.”

Peritoneovenous Shunt

A peritoneovenous shunt (PVS) is a tube that helps fluid flow from your abdomen back into your blood vessels, where it can be carried around your body. This treatment can be helpful when medications don’t control your ascites and you don’t want to repeat paracentesis every time your ascites returns.

A PVS effectively treats ascites for 7 out of 10 people with ovarian cancer. The device sometimes leads to side effects like infection, fluid in the lungs, or a blood clot in the lungs.

Catheter

A catheter is a thin tube that goes from the outside of your skin to the inside of your abdomen. It allows you to drain fluid yourself, so that you don’t need to undergo additional procedures. Researchers have reported that even though catheters lead to infection 11 percent of the time, they often work very well to treat ascites caused by ovarian cancer.

Lifestyle Changes

In general, you can’t prevent ascites while living with ovarian cancer, since it’s often caused by the way cancer spreads within your body. However, ascites can also be caused by problems with other organs such as the liver and kidneys, so keeping these organs healthy may help prevent some cases of ascites.

Some ways to keep these organs health includes:

  • Limiting how much alcohol you drink
  • Avoiding eating too much salt
  • Telling your doctor if you gain more than 10 pounds within a short period of time

Talk With Others Who Understand

MyOvarianCancerTeam is the social network for people with ovarian cancer and their loved ones. On MyOvarianCancerTeam, more than 6,000 members come together to ask questions, give advice, and share their stories with others who understand life with ovarian cancer.

Have you experienced ascites? Which treatments have helped you manage this symptom? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

    Posted on April 20, 2023
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    Howard Goodman, M.D. is certified by the American Board of Obstetrics and Gynecology and specializes in the surgical management of women with gynecologic cancer. Review provided by VeriMed Healthcare Network.. Learn more about him here.
    Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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