Ascites in Advanced Gastric Cancer

Ascites is the abnormal buildup of excess fluid in the abdominal (peritoneal) cavity. Almost 80% of all ascites cases are considered to be caused by cirrhosis of the liver and at least 10% of cases are counted for advanced cancer disease. Ascites caused by cancer is called malignant ascites. It has a high incidence in patients of advanced ovarian, endometrial (the lining of the womb), breast, stomach, colon, lymphoma and pancreatic cancers. We'll focus this article on malignant ascites in advanced gastric cancer or swollen stomach cancer.

Stomach cancer, also called gastric cancer, is a malignant tumor originating from the inner layer of the stomach. Over time, the cancer may spread throughout the stomach and to other organs; particularly the esophagus, pancreas, intestine, lungs, lymph nodes, and the liver.

Symptoms of ascites

Mild ascites usually does not show any symptom, but as it progressed, increased abdominal size are commonly seen. Other symptoms associated with ascites in advanced gastric cancer and other diseases are:

  • Swollen stomach and distended abdomen
  • Abdominal pain, discomfort and bloating
  • Feel very tired (lethargic)
  • Breathlessness due to increased pressure on the diaphragm
  • Dyspnea
  • Nausea or vomiting
  • Indigestion
  • Reduced appetite
  • Weight gain due to the accumulation of fluid
  • Sense of fullness or bloating
  • Ankle and feet swelling
  • Constipation
  • Hemorrhoids (a condition that causes painful swelling near the anus)

Causes of swollen stomach cancer (ascites)

Causes of malignant ascites in advanced gastric cancer patients:

  • The result of peritoneal deposits that irritates and blocks the peritoneum in reabsorbing fluid. This is combined with the decreased protein in the blood - due to several factors i.e. malnutrition, liver damage, etc. - upsetting the body's fluid balance and causing fluid to move out of the blood vessels into the body tissues, including the abdomen.
  • Increased venous pressure caused by malfunctioning of the liver or the heart, which obstructs the blood flow forcing fluid to move out from the blood vessels into the abdominal cavity. See also Chronic Liver Disease: Abdominal Fluid Retention and Swelling in the Ankles and Heart Problems: Water Retention in Legs, Feet, Liver, Abdominal, Lungs
  • Other possible cause of water retention in advanced stomach cancer patients is insufficiency of the lymphatic system in draining off excess fluid from the body because some of the lymphatic channels are blocked by cancer cells.

Ascites in patients with pancreatic cancer

One of common manifestations of final stage pancreatic cancer is ascites, although it counts for only 20% of pancreatic cancer patients, partly because the patients do not live long enough to develop it. Its cause is multifactorial.

Management of ascites

Ascites itself is not a disease. It is simply a symptom manifested by certain health conditions. Hence, the best treatment for ascites is to treat its underlying cause directly. Peritoneal carcinomatosis, ascites in advanced gastric cancer and other malignant ascites may be treated by surgical resection of the cancer and chemotherapy.

However, in some cases, the disease may have progressed into more advance stage that it can not be treated. In those cases, the only treatment for swollen stomach (ascites) symptom is through palliative treatment. The goal of treatment is just to relieve symptoms associated with ascites such as shortness of breath, abdominal pain, decreased appetite, movement difficulty and bloating even after eating very little food.

Palliative treatment

Some diuretics such as spironolactone (Aldactone) and furosemide (Lasix) may be prescribed to reduce pressure and promote urine passing thus slow down the build up of the ascitic fluid. Reducing the amount of sodium and restricting the intake of fluids are also suggested.

However, the most common cause of ascites in advanced gastric cancer or swollen stomach cancer is a blockage by peritoneal deposits. Diuretics or other drugs don’t usually help reduce this type of malignant ascites since it is not caused by increased venous pressure. Even if diuretics help some patients, the risk of severe dehydration from these drugs in palliative patients often outweighs the benefit of it. Thus, the only effective solution is through quality nursing care coupled with paracentesis when required.

Paracentesis is a procedure to remove large amounts of fluids by aseptically puncturing the abdominal wall with a cannula, which is attached to an ascitic tube (drain). The ascitic fluid then drains out of the abdomen and collects inside a drainage bag. Up to 4 to 5 liters of fluid can be drained safely through this procedure every time. It is done under local anesthesia. The drain may need to stay in place for a while (as long as 3 days) depends on the amount of ascitic fluid.

Potential complications of paracentesis

  • Risk of infection especially peritonitis
  • Perforation of bowel, other visceral organs, or tumor mass because of insufficient data on the location, type and size of the ascitic fluid
  • Fluid volume depletion and protein loss
  • Even with these potential complications, the symptomatic palliation from this procedure almost always outweighs its risk. To reduce the risk of infection, aseptic technique is adapted with care. It can also be done under ultrasound guidance to avoid risk of perforation of body organs.

Treatment may be not necessary if the ascites is mild and does not cause any discomfort.

In rare instances, surgery may be needed to control the ascites in advanced gastric cancer and other types of ascites. Such procedure involves putting a shunt permanently into an appropriate location to reduce the portal pressure or to drain the ascitic fluid directly from the abdomen into a large vein. It is done under a general anesthetic and involved several risk of complications.

Quality nursing care

  • Ascites can add a lot of load to the body and hamper the movement, thus it is necessary to help patients with ascites in positioning and mobilization.
  • The weight of ascitic fluid may impair bowel movement and cause constipation, hence aggressive bowel care is needed to prevent or manage constipation.
  • The burden of ascitic fluid may also lead to nausea and vomiting. Lying on the right side with the top of the bed elevated may reduce the symptoms. Medications that promote upper gastrointestinal motility (e.g., metoclopramide) are also suggested.

Oxygen therapy, along with other medical interventions such as opiods and paracentesis, is often suggested for patients suffering dyspnea, shortness of breath or other breathing problems.

The side effects of treatment for swollen stomach cancer or ascites in advanced gastric cancer and other diseases may be uncomfortable, thus you should learn the risks and benefits before taking any available treatment.