Ascites in stomach cancer occurs in stage 4 disease when the tumor has spread away from the stomach. It is the build up of fluid in your abdomen or tummy.
The malignant fluid is a mixture of cells, protein, water and electrolytes.
Sometimes referred to as "fluid on stomach from cancer", initially you may not have any symptoms at all. You might notice that you are gaining weight as fluid is quite heavy.
As it builds up you may notice that your tummy becomes more distended and people might remark to you about this.
Tiredness is a common symptom, presumably because you are carrying more weight around with you as well as from the tumor itself.
You might find that you are having to pass urine more frequently as your bladder becomes compressed by the surrounding fluid.
Your legs might start swelling and become uncomfortable and heavy.
This is also true of constipation due to the bowel also being compressed.
As the distension worsens, you will likely feel uncomfortable with it, but there are things that can be done to help this.
I expect that you have already been diagnosed with ascites. Your doctor is likely to diagnose this when examining you as there are some very characteristic features that are specific to this.
However, sometimes it is picked up when your doctor organises further tests and these may include an ultrasound scan or through a CT scan of your abdomen.
The accumulation of ascites in stomach cancer occurs for a lot of different reasons, but normally occurs when their is evidence of stomach cancer within the liver.
The liver is a major organ for handling toxins that the body needs removing and also in producing various substances that the body needs.
If these are not handled properly, the small blood vessels and lymphatics leak fluid in to your tummy cavity and this accumulates.
Cancers of any type increase your risk of developing blood clots and occasionally a blood clot can occur in a vein that the liver has. This is called an hepatic vein thrombosis or Budd-Chiari syndrome.
Yes, other conditions can cause this other than stomach cancer.
Common other causes include other forms of cancer, liver cirrhosis due to many different causes, heart failure due to poor pumping of the heart, kidney failure and chronic respiratory illnesses such as COPD and Lung Fibrosis.
So, can you reduce ascites in stomach cancer?
Sometimes reducing your salt intake may help reduce the likelihood of developing this.
Don't put salt on your food or in your cooking unless it is really necessary.
Reducing the amount of fluid you take in may help, but this must always be under the guidance of your doctor as it can make you more ill if it is not monitored.
I have already mentioned about restricting your fluid and salt intake may reduce re-accumulation of ascites in stomach cancer. If this is ineffective or it is too advanced, the main treatment options are:
Diuretics are medicines that stimulate your kidneys to remove fluid.
By doing so, your abdomen may reduce and make you feel more comfortable.
There are many diuretics available for your doctor to try, but the most common one is called Spironolactone.
This needs to be monitored by your doctor to make sure that you are not loosing fluid too quickly and becoming dehydrated.
You are likely to require blood tests to monitor your kidney's and electrolytes as they can become affected by this medication if overused.
Diuretics are not always effective and in this situation you may need to have your fluid drained.
Your ascites can be drained by an experienced health professional inserting a drain in your tummy.
To do this, they will clean the skin on the abdomen, usually in the lower right hand side, with an antiseptic such as Chlorhexidine or Iodine.
Drapes will be placed to protect you and make the area as sterile as possible.
They will then insert a needle under your skin and numb the area with a local anesthetic.
A small cut is made in your skin and a large needle or cannula (sometimes known as a Bananno or pig-tail as it looks like one!) through the cut and in to the abdominal cavity.
They will know when they are in the right spot as this may have been previously marked using an ultrasound.
The person performing your procedure known as a paracentesis will have a syringe attached to the needle.
As they pass the needle in, gentle pressure will be applied and fluid will run in to the syringe when in the right spot.
The fluid is usually a yellow, brown color although it can sometimes have blood in it too.
Once the paracentesis has been performed, a tube is attached to a collecting bag or vessel.
The amount removed is closely monitored to make sure that you don't become unwell during removal.
Like any medical procedure, there is always risk although thankfully unusual.
One of the main risks of draining ascites in stomach cancer is damaging the internal organs of your abdomen, in particular the bowel. This is usually evident when you have the drainage done.
The use of ultrasound and training reduce this risk.
Other risks include bleeding and introducing infection. These risks are minimised by having blood tests beforehand to make sure that your blood clots okay and also careful preparation for the procedure as mentioned above (antiseptics and drapes).
Low blood pressure can occur making you feel dizzy and feint. Your blood pressure is monitored whilst the fluid is drained and you may be given fluids or albumin as an infusion in to your vein during the drainage to help prevent this happening.