The Mesothelioma SOS Glossary - Ascites

Ascites is the accumulation of fluid in the peritoneal (abdominal) cavity, and is typically associated with peritoneal mesothelioma. Ascites is classified into three different grades. Grade 1 ascites is visible only on ultrasound and is typically mild. Grade 2 is detectable on physical examination and is associated with the bulging of the flank and dull pains. Grade 3 ascites is directly visible, and can be confirmed by a fluid thrill, or the movement of fluids under the skin’s surface. Doctors note that grade 1 ascites can be hard to notice, yet as ascites become more severe, abdominal distension will worsen. Most patients with peritoneal mesothelioma will complain of increasing abdominal heaviness and pressure, as well as shortness of breath due to pressure on the diaphragm. Patients may also notice the swelling of lower extremities, as well as chronic fatigue and weight loss. Doctors will typically order an ultrasound in patients with peritoneal mesothelioma to help identify the structure of the ascites as well as the amount of fluid that needs to be drained. The amount of fluid can accumulate over time, sometimes up to 25 liters.  In those with severe ascites, therapeutic paracentesis may be needed to drain the fluid. Paracentesis is typically done as an out-patient procedure, and there is usually very little risk of infection or bleeding. To drain fluid buildup, doctors will first disinfect the abdomen before inserting a fairly large needle. The fluid is then removed by a vacuum bottle. The procedure is usually not painful, and patients require no anesthetic. Although it can be difficult for patients with peritoneal mesothelioma to avoid ascites, doctors recommend that salt restriction may be the best baseline step in therapy, as salt acts as a diuretic.