Is ascites last stage of cancer?

Ascites (uh-SIGH-tees) refers to excess fluid in the abdomen. This fluid collects in the space within the walls of the abdomen, between the abdominal organs. It is common in patients with liver disease and cirrhosis, though patients with cancer can also develop ascites.

• What Causes Ascites in Patients With Cancer? Two main reasons cause ascites in patients with cancer.
• First, cancer can spread to the lining of the organs—the peritoneum—and make it leaky, causing malignant ascites,
• Second, cancer can spread to the liver and cause increased pressure in the liver.
• Certain cancers, such as ovarian, pancreatic, liver, and colon cancers, are more likely to cause ascites.

What Are the Symptoms and Complications of Ascites? Patients can experience swelling and tightness of the abdomen, feeling full when eating, nausea, or shortness of breath. The fluid can become infected, which can cause fever and pain. How Do We Diagnose Ascites? Ascites may be suspected because of symptoms and examination findings.

1. Ultrasonography is often the first step.
2. A computed tomography or magnetic resonance imaging scan can provide more information about the underlying cancer.
3. A needle and syringe may be used to remove some of the fluid in a procedure called a paracentesis,
4. Checking this fluid for white blood cells, blood, cancer cells, and bacteria can help determine the cause and diagnose an infection, if present.

Finding cancer cells in the fluid confirms a diagnosis of malignant ascites as opposed to liver damage or other causes. How Do We Treat Ascites in Patients With Cancer? Treatment depends on the cause (cancer spread or liver damage); the severity of symptoms; the cancer type, extent of spread, and suitability of anticancer treatments; and patient preferences.

1. If patients have few symptoms, specific treatment may not be needed.
2. If liver damage is the cause, patients may be prescribed a diuretic (water pill) to increase water in the urine or asked to cut down the amount of salt in their food.
3. If patients have severe tightness in the abdomen or shortness of breath, a paracentesis can remove several liters of fluid in minutes.

A hollow needle is inserted into the fluid and connected to a bottle via tubing. This can provide immediate relief, though fluid can return, often in days to weeks. The procedure can be repeated if needed. If fluid keeps recurring, an alternative may be to place an indwelling flexible catheter into the fluid cavity that can open to the outside through the skin and be drained using a valve.

Patients or caregivers can typically be trained to do this at home. For most patients, development of malignant ascites signals advanced, incurable cancer. Often, there may be no suitable cure for the underlying cancer. However, for some cancers (eg, ovarian cancer, lymphoma), treating the underlying cancer with chemotherapy and/or surgery may control ascites as well.

Published Online: December 19, 2019. doi: 10.1001/jamaoncol.2019.5409 Conflict of Interest Disclosures: Dr Beg reported receiving personal fees from Array BioPharma, Boston Biomedical, Bristol-Myers Squibb, Genentech, and Ipsen, and grants from Merck outside the submitted work.

How long can cancer patient live with ascites?

Malignant Ascites: Diagnosis and Management Ascites refers to fluid that accumulates within the peritoneal cavity. Although ascites is most commonly observed in patients with cirrhosis and resulting portal hypertension (approximately 85% of cases), 7% to 10% of patients with ascites develop secondary to a malignancy.1

The most common malignancies associated with the development of ascites include of the colon/rectum, ovary, breast, lung, pancreas, liver, and lymphoma.2 Approximately 50% of patients with malignant ascites have peritoneal carcinomatosis with an additional 13% of patients having extensive liver metastases resulting in portal hypertension.2 Malignant ascites can develop through several mechanisms: blocked lymphatic channels as a result of malignancy, direct production of fluid into the peritoneal cavity by highly active cancers, and when “functional” cirrhosis develops in patients with extensive hepatic metastases resulting in portal hypertension.The development of malignant ascites carries a poor prognosis, with the median survival reported anywhere between 1 and 4 months.3,4

Patients with malignant ascites clinically present similarly to those with ascites secondary to cirrhosis. These patients might have similar physical exam findings to those with cirrhotics including spider angiomas, distended umbilical veins (caput medusa), sclera icterus, jaundice, anasarca, and a distended abdomen.

Upon closer examination of the abdomen, patients with malignant ascites may have increased dullness to percussion or shifting dullness. Patients can complain of increasing abdominal girth, generalized abdominal pain and shortness of breath. Weight loss is a relatively non-specific symptom, but may be more common in those with an underlying malignancy.

An abdominal ultrasound can be performed to confirm the presence of ascites within the abdomen. Upon verification of ascites, patients can undergo paracentesis in order to remove ascitic fluid for analysis. RELATED: Role of Genetic Mutations in Metastatic Castrate-Resistant Prostate Cancer Treatment Common studies conducted on ascitic fluid include cell count and differential, albumin, protein, cytology, and cultures.

Does ascites mean cancer has spread?

What causes ascites? – Malignant ascites is caused by cancer that has spread to the lining of the organs inside your abdomen. It can also happen when cancer spreads to the liver. You are more likely to develop ascites if you have one of these cancers:

Breast cancer Colon cancer Gastrointestinal tract cancers, such as stomach and intestinal cancers Ovarian cancer or fallopian tube cancer Pancreatic cancer Uterine cancer

Can you have ascites with stage 1 ovarian cancer?

With a total of 372 ovarian cancer patients, Ayhan et al. found ascites present in 16.7% of patients with stage I or II disease compared to 46.3% of patients with stage III and IV disease.

Does ascites mean end stage?

Chronic liver failure, also called end-stage liver disease, progresses over months, years, or decades. Most often, chronic liver failure is the result of cirrhosis, a condition in which scar tissue replaces healthy liver tissue until the liver cannot function adequately.

Patients with abnormal liver function who develop ascites, variceal hemorrhage, hepatic encephalopathy, or renal impairment are considered to have end-stage liver disease (ESLD). While liver transplantation is a viable treatment option for ESLD, with increasing waiting times for organ transplantation, nearly 17% of patients on the transplant wait list die annually; others are not candidates for a liver transplant.

Patients with ESLD have a constellation of symptoms and disease-related complications that affect survival and health-related quality of life.

How long can you live once ascites starts?

4. Complications, prognosis, and treatment – Despite the fact that patients with ascites constitute a heterogeneous population with different prognosis depending on the degree of liver insufficiency and circulatory dysfunction, the development of ascites is an ominous sign.

The probability of survival at one and five years after the diagnosis of ascites is approximately 50 and 20%, respectively, and long-term survival of more than 10 years is very rare, In addition, mortality rises up to 80% within 6–12 months in patients who also develop kidney failure, Patients with cirrhosis and ascites are also at high risk for other life-threatening complications of liver disease, including refractory ascites, SBP, respiratory distress, worsening of nutritional status, hyponatremia, or HRS.

Accordingly, current guidelines recommend that every patient with ascites should be generally considered for referral for liver transplantation, especially when quality of life is impaired due to refractory ascites, or in the presence of SBE and HRS,

How long can a cancer patient live with ascites without treatment?

Ascites – Holland-Frei Cancer Medicine – NCBI Bookshelf Frank A. Sinicrope, MD, FACP. Malignant ascites can occur in patients with colon, pancreatic, breast, and lung primaries with the development of peritoneal carcinomatosis. The life expectancy of such patients is generally limited to weeks to months after the onset of ascites. Of the three major complications of liver cirrhosis—hepatic encephalopathy, ascites, and variceal hemorrhage—ascites is the most common. The development of ascites in the natural history of chronic liver disease in the absence of malignancy is an important landmark as approximately 50% of patients with ascites succumb in 2 years. The earliest evidence of ascites is an increase in abdominal girth accompanied by weight gain. Ascites is usually evident on clinical evaluation, based on abdominal distention and flank dullness, and is frequently associated with leg edema. The presence of a full and bulging abdomen should lead to percussion of the flanks. If the flank dullness is found, then “shifting” should be checked for. Approximately 1,500 mL of fluid must be present to detect dullness. In supine patients, sacral edema is an important clue. Pain accompanied by ascites suggests a malignant cause for fluid accumulation. Abdominal ultrasonography may be required to determine with certainty if fluid is present in the abdominal cavity. Ultrasonography can detect as little as 100 mL of fluid in the abdomen. Approximately 4% to 10% of patients with ascites also develop pleural effusions, with two-thirds of the effusions being right-sided. Pleural fluid may be present with minimal or no ascites. Inguinal or umbilical hernias may accompany ascites. Peritoneal carcinomatoses causes ascites by the exudation of proteinaceous fluid from tumor cells lining the peritoneum. In rare cases, massive liver metastasis can cause ascites by portal hypertension. Tumor-induced portal vein thrombosis and underlying cirrhosis-related portal hypertension are also responsible for ascites in the patients with portal hypertension. Chylous ascites because of malignant lymphoma is caused by lymphatic obstruction. Malignancy should be suspected as a cause of ascites in patients with a history of cancer. Breast, lung, colon, and pancreatic primary malignancies are most commonly complicated by ascites. Underlying liver disease is the cause of ascites formation in approximately 80% of cases. Approximately 5% of patients have “mixed” (ie, having two or more causes) ascites. and list other causes of ascites. A diagnosis of ascites is suspected on the basis of history and physical examination, but the final confirmation is based on successful abdominal paracentesis. Sampling ascitic fluid in all patients with new-onset ascites is necessary. The practice of ordering every conceivable test on ascitic fluid is strongly discouraged as it can be very expensive and as it may be more confusing than helpful. A cell count with differential, albumin assessment (in addition to serum albumin), and culture in blood culture bottles should be the routine. Cytology of ascitic fluid is an important test in cancer patients. Total protein, glucose, lactate acid dehydrogenase (LDH), amylase, and Gram stain tests are optional. A few other tests (eg, tuberculosis smear and culture; tests for triglyceride and bilirubin) should be ordered in the proper clinical setting. Nonneutrophilic ascitic fluid is transparent and slightly yellow to amber. The opacity of most cloudy fluid specimens is caused by neutrophils. Bloody ascites may result from traumatic tap or from ascites secondary to hepatocellular carcinoma or peritoneal carcinomatosis. Dark brown ascitic fluid may indicate biliary perforation or leak. The upper limit of an absolute polymorphonuclear leukocyte (PMN) count in uncomplicated cirrhotic ascitic fluid is usually 250/mm 3, Any inflammatory process can result in an elevated ascitic-fluid white blood cell (WBC) count. Spontaneous bacterial peritonitis (SBP) is the most frequent cause of an increased WBC count with PMN predominance. Tuberculous peritonitis and peritoneal carcinomatosis give rise to an increased WBC count but with lymphocyte predominance. The serum-ascites albumin gradient (SAAG) has been proved in multiple studies to categorize ascites better than the total protein concentration (transudate/exudate) and other parameters. The difference between the serum and ascitic-fluid albumin concentrations correlates directly with portal pressure. The calculation of the SAAG involves measuring the albumin concentration of serum and ascitic-fluid specimens and subtracting (it is not a ratio) the ascitic-fluid value from the serum value. The serum albumin is nearly always the largest value, barring laboratory error. A SAAG of > 1.1 g/dL is diagnostic of portal hypertension, with 97% accuracy. Conversely, if the SAAG is < 1.1 g/dL, the patient does not have portal hypertension (with 97% accuracy) and malignancy is generally the cause. The etiology of ascites can be classified according to whether the associated SAAG is high or low (see ). Hepatocellular carcinoma, massive liver metastases, and malignant lymphoma causing ascites by lymphatic obstruction, are generally not associated with positive cytology. Positive cytology of ascitic fluid for malignant cells should only be expected in cases with peritoneal carcinomatoses. Chylous ascites has a high triglyceride concentration, usually higher than the serum. A triglyceride level should be obtained routinely in the presence of milky ascitic fluid. An ascitic-fluid bilirubin level greater than the serum level of bilirubin suggests a bile leak into the ascitic fluid. The serum-ascites albumin gradient can be very helpful diagnostically, as well as in therapeutic decision making. Patients with low-SAAG ascites (malignant ascites falls into this category) usually do not have portal hypertension and do not respond to salt restriction or to diuretics, except in cases of nephrotic syndrome. The mainstay of the treatment of nonovarian (lung, breast, colon, and pancreatic) peritoneal carcinomatosis is outpatient therapeutic paracentesis as these patients have a poor prognosis. For malignant ascites, the frequency of large-volume paracentesis is dictated by the patient's symptoms. Patients with an ovarian malignancy may respond well to surgical debulking and chemotherapy. Antituberculous therapy is the mainstay of treatment for tuberculous ascites. High-SAAG ascites usually responds well to diuretics and measures for maintaining sodium balance. Fluid loss and weight change are directly related to sodium balance. A realistic dietary sodium restriction of 2 g/d (= 2,000 mg/d = 88 mmol/d) should be the goal. Fluid restriction is not necessary when treating most patients who have cirrhotic ascites. Approximately 10% of patients with cirrhotic ascites are refractory to standard medical treatment with diuretics and salt and fluid restrictions. Patients who cannot tolerate diuretics because of complications are also regarded as having refractory ascites. Large-volume paracentesis is safe and effective for the treatment of refractory ascites. The incidences of hyponatremia, hypotension, hepatic encephalopathy, and renal impairment are lower for patients treated with paracentesis than for those treated with diuretics. The current recommendations are that intravenous albumin should be administered when large-volume paracentesis is repeatedly performed. Peritoneovenous shunting has fallen out of favor as a consequence of excessive complications and poor patency rates. Transjugular intrahepatic portosystemic shunts (TIPS) can also be considered in patients with refractory ascites. Finally, liver transplantation is the only lifesaving therapy for all patients who present with refractory ascites and severe liver dysfunction in the absence of underlying malignancy. : Ascites - Holland-Frei Cancer Medicine - NCBI Bookshelf

Has anyone survived ascites?

Follow-up was until death or at least 17 months after diagnosis of ascites. There were 23 patients who were still alive at the end of the study (follow-up range 17–52 months). The overall median survival after the diagnosis of malignant ascites was 5.7 (95% confidence interval 3.54–7.93) months.

How fast does ascites progress?

Ascites is a buildup of fluid in the abdomen. It can happen when the liver is not working properly. Fluid fills the space between the organs and abdominal lining, leading to swelling and pain. Ascites is a common symptom of cirrhosis, which is scarring on the liver.

As fluid accumulates in the abdomen, a person can feel bloated and uncomfortable. The fluid can also press on the lungs, causing shortness of breath. Depending on the cause of a person’s ascites, a doctor can treat the condition with lifestyle changes, diuretics, and antibiotics. They may need to drain the fluid with a needle in some cases.

Read more to learn about what causes ascites, common symptoms, how to treat it, and more. Ascites is the medical term for a buildup of fluid in the abdomen. It can happen when the blood pressure of the portal vein — which runs from the digestive organs to the liver — gets too high.

1. This increased pressure reduces kidney and liver function, causing fluid to accumulate.
2. The condition occurs in 80% of people with liver problems or cirrhosis.
3. Excess fluid in the abdomen can cause swelling, making the abdomen feel tight and uncomfortable.
4. The symptoms of ascites can develop over a few weeks or even days.

While it may be minor at first, the swelling can become more severe. Symptoms associated with ascites may include :

abdominal painbloating constipation indigestion loss of appetitefrequent urination feeling breathless fatigue back painswelling in legs and feet

Although ascites may look similar to belly fat, a doctor will be able to differentiate the two. Ascites and fat move and feel different. A doctor may examine a person’s abdomen when lying down and standing. The shape of the abdomen may suggest that it contains fluid rather than fat.

A person with ascites may also have a distended abdomen, which is hard and swollen. They may also experience rapid changes in weight and body shape. These changes happen far more quickly than the rate at which a person typically gains body fat mass. In most cases, ascites itself is not life threatening.

However, the cause may be a more serious condition that may be life threatening, such as liver failure. For people who have ascites as a complication of cirrhosis, mortality ranges from 15% in 1 year to 44% in 5 years. If ascites is left untreated, an individual may have complications.

What is the chance of survival with ascites?

Epidemiology – Patients with cirrhotic ascites have a 3-year mortality rate of approximately 50%. Refractory ascites carries a poor prognosis, with a 1-year survival rate of less than 50%. Males have little intraperitoneal fluid, females have approximately 20 mL, depending on the phase of their menstrual cycle.

Does chemo get rid of ascites?

Treating fluid in the abdomen Advanced cancer can sometimes cause fluid to build up in the tummy (abdomen). The medical name for this is ascites. Treatments to remove the fluid or prevent it from building up include having a tube inserted, water tablets or having chemotherapy.

What cancer is more common ascites?

Abstract – Ascites is the pathological accumulation of fluid within the abdominal cavity. The most common cancers associated with ascites are adenocarcinomas of the ovary, breast, colon, stomach and pancreas. Symptoms include abdominal distension, nausea, vomiting, early satiety, dyspnea, lower extremity edema, weight gain and reduced mobility.

There are many potential causes of ascites in cancer patients, including peritoneal carcinomatosis, malignant obstruction of draining lymphatics, portal vein thrombosis, elevated portal venous pressure from cirrhosis, congestive heart failure, constrictive pericarditis, nephrotic syndrome and peritoneal infections.

Depending on the clinical presentation and expected survival, a diagnostic evaluation is usually indicated as it will impact both prognosis and the treatment approach. Key tests include serum albumin and protein and a simultaneous diagnostic paracentesis, checking ascitic fluid, WBCs, albumin, protein and cytology.

1. Median survival after diagnosis of malignant ascites is in the range of 1 to 4 months; survival is apt to be longer for ovarian and breast cancers if systemic anti-cancer treatments are available.
2. The word ascites is of Greek origin (askos) and means bag or sac.
3. Ascites is defined as the pathological accumulation of excessive fluid within the peritoneal cavity.1 Ascitic fluid can put pressure on the diaphragm and cause difficulty in breathing.

Healthy men have little or no intraperitoneal fluid, but women may normally have as much as 20 mL depending on the phase of the menstrual cycle. Malignant ascites, the subject of this review, is a manifestation of end-stage events in a variety of cancers and is associated with significant morbidity.

Can you have ascites and no cancer?

Abstract – Background: Ascites is an accumulation of serous fluid in the abdominal cavity. It can be caused by both malignant and non-malignant conditions and produces distressing symptoms. There have been no qualitative studies looking at the experiences of patients with non-malignant ascites.

• Aims: To explore the experiences of patients living with non-malignant ascites and its management.
• Also, to explore the views of these patients about services available to them.
• Method: Phenomenological qualitative research study using digitally recorded semi-structured interviews.
• Setting and participants: Six adult patients with non-malignant ascites who were receiving paracentesis to manage their symptoms in an acute hospital day unit.

Results: Participants experienced a wide variety of physical symptoms. They discussed how the ascites impacted on their social lives. They had views on diuretics, low sodium diet and paracentesis as methods of symptom management. Participants’ confidence in staff performing paracentesis was a common finding, particularly as ultrasound was rarely used.

While only some were suitable for liver transplant, all discussed their future care needs. Conclusion: Participants’ experiences of non-malignant ascites are that it has a considerable effect on their quality of life. Patients like the system of day case admission for drainage, but question whether this is sustainable.

Advanced practitioners can successfully provide a paracentesis service for these patients in hospitals and potentially this is transferable to hospices. Patients seemed happy to consider the option of semi-permanent drains and pumps as methods of managing ascites.

What are the three stages of ascites?

Introduction – The presence of ascites is considered to be a significant landmark in liver cirrhosis, as it is associated with decompensation and 50% mortality over 2 years, In addition, the evolution of ascites is connected to a poor quality of life, higher risk of infection, and renal failure,

The classification of ascites is based on the amount of fluid in the abdominal cavity: grade 1 ascites, or mild ascites, detectable by ultrasound examination; grade 2 ascites, or moderate ascites, characterized by a mild symmetrical abdominal distension; and grade 3 ascites, or large ascites, with significant abdominal distension,

Cirrhotic patients with ascites are at high risk of developing various complications of liver disease, including spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS), It has been shown that the 1-year probability of survival in patients with uncomplicated ascites is 85%, compared to 25.6%, 31.6% and 38.5%, in patients with hyponatremia, refractory ascites and HRS, respectively,

1. The International Club of Ascites has documented that patients with ascites grade 1 do not require specific treatment, but should be followed-up carefully and advised to reduce their sodium intake, since they usually progress to the development of grade 2 ascites,
2. European Association for the Study of the Liver (EASL) guidelines have reported that there is no data on the evolution of grade 1 ascites, nor it is known whether its treatment modifies its natural history,

Furthermore, there are no data on how frequently patients with grade 1 develop grade 2/3 ascites, Therefore, there is a great need for a better understanding of the natural history of ascites grade 1 in liver cirrhosis. To this end, the current study aimed to assess grade 1 ascites as a representative risk factor for the development of grade 2/3 ascites in patients with cirrhosis, to evaluate the main comorbid disorders which come along with ascites progression, and to identify the predictive factors for survival in this setting.

Can ascites just stop?

Ascites is another problem caused by high pressure in the veins of the liver. Fluid leaks out of the liver and into the belly, and your belly begins to fill up. This can make your abdomen enlarge like a balloon filled with water. Your legs and scrotum can get swollen too.

1. This can be very uncomfortable.
2. Eating can be a problem because you have less room for food.
3. Even breathing can be a problem, especially when you are lying down.
4. But the most dangerous problem associated with ascites is infection, which can be life-threatening.
5. Ascites may go away with a low-salt diet, and by taking diuretics (water pills) ordered by your provider.

But sometimes a provider must drain the fluid from the belly using a special needle. If you have ascites and you suddenly get a fever or new belly pain, go to the emergency room immediately. These could be signs of a serious infection that can be life-threatening.

Can ascites cause sudden death?

Abstract – Ascites is the most common decompensating event in patients with cirrhosis and one that is associated with the highest mortality. The main mechanisms in the development of ascites are portal (sinusoidal) hypertension and sodium retention due to vasodilatation and activation of neurohumoral sodium-retaining systems.

Although ascites per se is not a cause of death, covert or overt infections (e.g., spontaneous bacterial peritonitis) will lead to worsening vasodilatation resulting in renal failure and death. First-line therapies for new onset ascites (diuretics) and refractory ascites (serial large-volume paracenteses) act downstream of the pathogenic cascade and are mainly symptomatic.

Transjugular intrahepatic portosystemic shunt acts on the pathophysiological mechanisms and its earlier placement in patients with refractory ascites should be considered. Efforts to avoid drugs/procedures that will lead to worsening vasodilatation in patients with cirrhosis and ascites are essential.

When should I worry about ascites?

When to Contact a Medical Professional – If you have ascites, contact your health care provider right away if you have:

Fever above 100.5°F (38.05°C), or a fever that does not go awayBelly painBlood in your stool or black, tarry stoolsBlood in your vomitBruising or bleeding that occurs easilyBuild-up of fluid in your bellySwollen legs or anklesBreathing problemsConfusion or problems staying awakeYellow color in your skin and the whites of your eyes (jaundice)

Is ascites ever normal?

What Is Ascites? – Ascites can cause liver disease and cirrhosis, and death. The organs of the abdomen are contained in a sac or membrane called the peritoneum. Normally the peritoneal cavity contains only a small amount of fluid, although in women this can vary (by 20ml, or less than an ounce) depending on the menstrual cycle,

“Ascites is the term used to denote increased fluid in the peritoneal cavity, a situation that is not normal. There are a variety of diseases that can cause the fluid to accumulate and the reasons that ascites occurs may be different for each disease. Cancer that spreads to the peritoneum can cause direct leakage of fluid, while other illnesses cause an excess accumulation of water and sodium in the body.

This fluid can eventually leak into the peritoneal cavity. Most commonly, ascites is due to liver disease and the inability of that organ to produce enough protein to retain fluid in the bloodstream as well as an obstruction to flow through the scarred cirrhotic liver,

Normally, water is held in the bloodstream by oncotic pressure. The pull of proteins keeps water molecules from leaking out of the capillary blood vessels into surrounding tissues. As liver disease advances, the liver’s ability to manufacture proteins is decreased, so oncotic pressure decreases because of the lack of total protein in the body, and water leaks into surrounding tissues.

In addition to ascites, the extra fluid can be appreciated in many other areas of the body as edema (swelling). Edema can occur in the feet, legs, chest cavity, and a variety of other organs, and fluid can accumulate in the lungs, Symptoms caused by this excess fluid will depend upon its location.

Does ascites always mean liver damage?

Causes – Cirrhosis of the liver is the most common cause of ascites, but other conditions such as heart failure, kidney failure, infection or cancer can also cause ascites.

How many times can ascites be drained?

5. Community management of LTADs – 5.1 Community teams should be informed of the decision to proceed with LTAD insertion in advance, and have access to support and advice in secondary care when required (see online supplemental file 1 for community standard operating procedure).5.2 Patients should have approximately 2–3 drainage procedures/week with up to 2 L of ascites being removed on each occasion, with a maximum 5 L of ascites drained/week.

1. This will be sufficient for most patients.5.3 Caregivers can be trained in LTAD drainage when appropriate/willing.5.4 Patients undergoing community drainage of ascites do not require human albumin solution replacement.
2. Multidisciplinary working between hepatology, community, primary and specialist palliative care, and family caregivers is essential to the successful management of a patient with an LTAD.

This is a complex patient group with multiple distressing symptoms increasing as end of life approaches. The management of the LTAD is a component of community nursing care that should be incorporated into the provision of end of life care for this patient group.

1. Following LTAD insertion, the patient’s GP and the community nursing team should be informed to ensure continuity of care between hospital and community.
2. Most community nursing teams are familiar with LTAD as they are used in malignant ascites, however, experience in advanced cirrhosis is very limited.

Based on REDUCe study data, 4 we would recommend two to three nursing visits per week with 1–2 L being drained at each visit with initially a maximum of 5 L being drained each week (see online supplemental file 1 ) for community standard operating procedure).This will be sufficient for most patients.

A small proportion of patients (13% in the REDUCe study), 4 who remain symptomatic from ascites despite drainage of 5 L/week in the community should undergo supplementary LVP in hospital (via the LTAD using drain specific adaptors), with HAS replacement as per LVP protocol.16 48 In this small subset of patients who require LVPs in hospital despite 5 L/week community drainage, higher volume community LTAD drainage can be considered on a case-by-case basis, in discussion with the consultant/community teams.

Community nurses should be provided with a named contact from the hospital hepatology team to address queries for care provision in the community. This allows management of increasing symptom distress as disease progresses, facilitates individualised care and supports the community teams thus reducing unplanned hospital visits.

1. Family caregivers if available and able to be involved with drainage can be supported to do so by the community nurses and hospital team.
2. Use of long-term outpatient HAS remains contentious.
3. Two recent studies gave conflicting results, those with advanced ascites less likely to benefit.54 55 LTAD is a palliative intervention, focus being on symptom control, improving HRQoL and moving care to the community.

Currently, therefore, outpatient HAS cannot be routinely recommended in this cohort. In the REDUCe study, there was a decrease in week 2 serum albumin (g/L) (median, IQR) compared with baseline in the LTAD group as regular HAS was not administered: 29.5 (27.5–31.5) vs 33.33–36 However, serum albumin levels then remained stable until end of study.4 Week 12 serum albumin and serum creatinine were similar in both LTAD and LVP groups.4 Figure 2 summarises the process for LTAD selection and management and table 2 lists the do’s and don’ts.

What are the last stage of cancer?

What are the signs of approaching death? – Death from cancer usually happens after a person becomes weaker and more tired over several weeks or months. Though it is not always possible to predict how long someone will live, these are the common signs and symptoms that suggest a person with cancer may be entering the final weeks of life:

Worsening weakness and exhaustion A need to sleep much of the time, often spending most of the day in bed or resting Weight loss and/or muscle loss as part of cachexia Little or no appetite and difficulty eating or swallowing fluids Decreased ability to talk and concentrate Little interest in doing things that they used to find important Loss of interest in the outside world, news, politics, entertainment, and local events Wanting to only have a few people nearby and limiting time spent with visitors

These are the common signs and symptoms that suggest a person may be entering the last days of life:

Breathing may slow, sometimes with very long pauses between breaths Noisy breathing, with congestion and gurgling or rattling sounds. These sounds happen because the person is unable to clear fluids from the throat. The sounds may concern you or other people visiting, but the person who is dying is not aware of them. Cool skin that may turn a bluish, dusky color, especially in the person’s hands and feet A dry mouth and lips Loss of bladder and bowel control Decreased amount of urine Restlessness or repetitive, involuntary movements Confusion about time, place, and identity of people, including family members and close friends Seeing or hearing people or things who are not there. This is common and usually normal. It is not a reason to worry unless these hallucinations scare or upset the person who is ill. These dream-like experiences often include traveling, preparing for travel, or being welcomed by people who have died. A tendency to drift in and out of consciousness and gradually becoming less and less responsive to touch or voice.

Every person is different. The signs and symptoms that people experience vary. And the order in which signs and symptoms occur can be different. Talk with your loved one’s health care team about any signs or symptoms that concern you.

Has anyone survived ascites?

Follow-up was until death or at least 17 months after diagnosis of ascites. There were 23 patients who were still alive at the end of the study (follow-up range 17–52 months). The overall median survival after the diagnosis of malignant ascites was 5.7 (95% confidence interval 3.54–7.93) months.

Can you survive ascites?

A note from Cleveland Clinic – Ascites is a sign of liver damage. People who have cirrhosis may develop ascites. With the right treatments and diet changes, you can manage ascites and feel your best. Restricting your salt intake is one of the most effective treatments for ascites.

What is the chance of survival with ascites?

Epidemiology – Patients with cirrhotic ascites have a 3-year mortality rate of approximately 50%. Refractory ascites carries a poor prognosis, with a 1-year survival rate of less than 50%. Males have little intraperitoneal fluid, females have approximately 20 mL, depending on the phase of their menstrual cycle.

Valentina Sotomayor