Oncological diseases disrupt the function of not only the organ where cancer cells develop. In malignant lesions, complications occur in most cases, which significantly complicate the course of the disease.
The group of these complications includes ascites. This term indicates the accumulation of excess fluid in the abdominal cavity, with such a violation of the stomach can increase several times.
What is this disease?
If a person has cancer, the probability of ascites is 10%.The accumulation of fluid does not occur with all malignant lesions. Most often, ascites accompanies:
- Colorectal cancer.
- Colon and stomach cancer.
- Malignant neoplasms of mammary glands and ovaries.
- Cancer of the pancreas.
Accumulation of a large volume of fluid in the abdominal cavity leads to an increase in intra-abdominal pressure, this causes the diaphragm to move into the chest cavity. Such a pathological abnormality of the internal anatomy limits the respiratory function of the lungs, negatively affects the work of the heart, on the circulation.
Accumulated fluid pushes out the peritoneal organs and, therefore, does not change their functioning for the better. Massive and long-term non-eliminated ascites causes a loss of large amounts of protein.
In connection with all the changes occurring, ascites causes a lot of complications - cardiac and respiratory failure, metabolic disorders. All these pathologies significantly worsen the course of the underlying disease.
Causes of
A small amount of circulating fluid is constantly present in the abdominal cavity of a healthy person.
This fluid prevents the gluing of the internal organs together and allows the intestinal loops to move freely, without friction.
Exudate produced in the peritoneum here and absorbed, that is, the body itself controls the process of producing fluid.
In some diseases, including oncology, the resorptive, secretory and barrier functions of the peritoneal sheets are violated and then the liquid either is produced too much or it is not completely absorbed back.
This leads to the filling of the free space of the abdominal cavity with an increasing amount of exudate, in severe cases its volume reaches up to 25 liters.
In the above cancer, due to the proximity of organs, cancer cells can enter the peritoneum and settle on its visceral and parietal leaf. Developing cancer cells disrupt the resorptive function of the peritoneum, the lymphatic vessels can not cope completely with their task and the produced liquid begins to accumulate.
So gradually formed ascites, the damage of the leaflets of the peritone with malignant cells provokes and the development of carcinomatosis.
As already mentioned, the main cause of the defeat of the peritoneum with oncological diseases is its close contact with those organs where malignant neoplasms are formed.
But in addition to the causes of ascites in oncology also include:
- A tight fit of the abdominal folds to each other. This ensures a rapid capture of cancer cells by a number of lying tissues.
- Abundant location in the peritoneum of the blood and lymph vessels, which only increases and speeds up the transfer of cancer cells.
- Drift of abnormal cells into the peritoneum during surgery.
- Germination of a malignant tumor through the walls of the peritoneum.
To provoke the development of ascites may be a course of chemotherapy, in the last stages the accumulation of fluid occurs often due to cancer intoxication.
When the liver is affected by metastases or in the primary cancer of this organ, the cause of fluid accumulation lies in the other - the venous system of the organ contracts, and the natural outflow from the intestine is disturbed. This kind of ascites, as a rule, is formed quickly and is difficult.
Symptoms of the disease
The formation of abdominal ascites in most patients with cancer is gradual, within a few weeks or even months. Therefore, the first signs of this terrible complication are ignored.
Clinically ascites begins to manifest itself after a large amount of fluid has accumulated in the abdominal cavity, this complication manifests itself:
- Feeling in the abdomen.
- Different in nature and duration of abdominal pain.
- Brything and heartburn.
- Nausea.
Visually, attention can be paid to the gradually increasing abdomen, in the vertical position it hangs down, and in horizontal it spreads out at the sides. Stretching the skin of the abdominal wall allows you to see the network of blood vessels and bulging navel.
The pressure on the chest causes shortness of breath and irregular heartbeat. In ascites, it is difficult for a person to bend down, fasten their shoes, and put on trousers.
Photo of ascites of the abdominal cavity in a male
But still, in ascites, arising as a complication of a malignant lesion, the symptoms that arise in the primary focus come to the fore in people. And more often it is this that leads to the fact that oncological ascites is detected even with a large accumulation of fluid.
Ascites in ovarian cancer and its causes
In cancerous ovarian involvement, the most severe consequences are caused by ascites. The lethal outcome with the accumulation of fluid in the abdominal cavity occurs in 50-60% of cases.
The accumulating fluid in turn increases the swelling of the ovary in size, and this can result in its ruptures and the exit of the exudate into the abdominal cavity. Ascites, formed as a complication of ovarian cancer, lead to swelling of the lower half of the abdomen, the region of the genitals. Swelling goes to the feet.
Fluid accumulation at the beginning does not cause significant changes in the state of health, but then there may be severe pain perceived by the patient as an attack of appendicitis. The development of ascites in ovarian cancer should not be left without attention, the earlier treatment begins, the more likely a favorable outcome of this complication.
Consequences of
Ascites in oncology are dangerous per se, but in addition, it can cause other complications, including:
- Spontaneously developing bacterial peritonitis.
- Respiratory failure.
- Hydrotorax.
- Intestinal obstruction.
- Umbilical hernia and its entrapment. Rectal prolapse.
- Hepatorenal syndrome.
All listed complications should be treated as soon as possible, otherwise they significantly increase the person's health and can lead to his death.
Diagnosis
Patients with cancer should always be monitored by a doctor, and the oncologist, depending on the location of the neoplasm should already assume the likelihood of complications.
It is possible to suspect ascites by external signs, complaints of the patient, palpation and percussion of the abdomen is of no small importance.
Mandatory appointment of instrumental methods:
- ultrasound. In addition to fluid, this research can reveal the presence of tumors, their location, changes in the structure of internal organs.
- Tomography. This method is necessary to determine the amount of fluid and its location in the abdominal cavity.
- Laparocenesis. After anesthesia, a puncture of the abdominal wall is carried out just below the navel and pumping out the liquid. The procedure is prescribed with a therapeutic and diagnostic purpose. Part of the exudate is sent for analysis, where the presence of albumins, glucose, cell cell types, pathogenic microflora is conducted.
Stages of
Depending on the amount of accumulated exudate, three stages of ascites are identified:
- Transient ascites - fluids in the abdominal cavity not more than 400 ml. At this stage, there can be only bloating.
- Moderate ascites is exposed when the exudate in the abdominal cavity is not more than 5 liters. At this stage, the complication is manifested by clinical symptoms in the form of disruption of the digestive organs, dyspnea. In the absence of treatment of ascites, peritonitis, respiratory and heart failure may develop.
- Strong or resistant ascites is characterized by accumulation of up to 20 liters of fluid. The patient's condition is severe, the work of vital organs is significantly impaired.
How to treat abdominal ascites in oncology?
Ascites of the abdominal cavity, developing as a complication of cancer, should be treated in conjunction with the underlying disease.
It is also important to start eliminating excess excess fluid in the first two weeks of its formation, as delaying therapy leads to the development of a mass of complications. Excess fluid can be removed by puncturing and pumping it - laparocentesis, by taking diuretics.
Compliance with a special diet will help reduce intra-abdominal pressure, reduce the likelihood of further production of excessive exudate.
Chemotherapy is effective only if ascites is provoked by intestinal cancer. With cancer of the stomach, ovaries and uterus, the use of chemotherapy does not give a positive result.
Laparocentesis
Laparocentesis of the abdominal cavity in ascites is a puncture of the peritoneal wall with a special instrument and sampling of the liquid for analysis or its pumping out.
Usually, with oncological disease laparocentesis is prescribed, if there is no effect from the use of diuretics, another indication is intense ascites.
The procedure occurs in several stages under local anesthesia:
- The patient is in a sitting position, the surgeon treats with an antiseptic and then with an anesthetic a presumed puncture site.
- First, after the injection of an anesthetic, the cut of the abdominal wall, muscles is done. Conduct it on the white line of the abdomen, receding from the navel down by 2-3 cm.
- The final puncture is performed by rotational movements with the help of a trocar. A flexible tube is connected to the trocar, through which the liquid will flow.
- If the puncture is correct, an intense fluid trickle will be released.
- Pumping of excess fluid is very slow, it is necessary to constantly monitor the patient's condition. As the fluid is removed, the nurse must tighten the belly with a sheet or a towel, this is necessary in order for the pressure in the abdominal cavity to drop slowly.
- After evacuation of the exudate, a sterile bandage is applied to the wound.
Laparocentesis allows you to remove up to 10 liters of fluid at a time. But in this case, the patient is shown the introduction of albumins and other medications in order to reduce the likelihood of developing renal failure.
If necessary, temporary catheters can be placed in the peritoneum, the accumulating liquid will flow away from them. The installation of catheters greatly facilitates the well-being of cancer patients, but it threatens with the fall of blood pressure and the formation of adhesions.
Laparocentesis may not always be performed. Contraindications for the puncture include:
- Adhesive disease of the abdominal organs.
- Severe flatulence.
- The recovery period after the operated ventral hernia.
Laparocentesis is performed on an outpatient basis. After the procedure and with a satisfactory state of the patient, he can be released home.
Diuretics
Diacarb, Furosemide or Veroshpiron are prescribed from diuretics to oncological patients with developing ascites in a long course.
It is also possible to combine two diuretics and drink them, even if at the beginning of treatment there is no visible diuretic effect.
When using diuretics, it is necessary to take and preparations containing potassium, otherwise it can provoke the development of disturbances in water-electrolyte metabolism.
Dietary food
Properly organized nutrition with ascites of the abdominal cavity will help reduce fluid accumulation.
It is necessary to minimize the addition of salt to the dishes and to limit the intake of liquid. But it is worth considering that the body can not be without salt.
It is useful to introduce in the diet products rich in potassium:
- Spinach.
- Carrots. Baked potatoes.
- Fresh green peas.
- dried apricots.
- Raisins.
- Grapefruit.
- Asparagus.
- Oat groats.
The diet should be designed in such a way as to comply with the limitations of the underlying disease.
How many patients live?
The development of ascites not only seriously worsens the state of health of the cancer patient, but also increases the course of the underlying disease.
Video about abdominal ascites: