Malignant Effusions
Summary of Key Points
Malignant Ascites
• Malignant ascites is a common complication of cancer.
• Malignant ascites accounts for 10% of all cases of ascites.
• Malignant ascites most commonly occurs in patients with ovarian cancer, gastrointestinal malignancies, and carcinoma of unknown primary location.
• Malignant ascites is rarely life threatening, but occurrence signals advanced cancer.
Treatment
• Monitor the situation if the ascites volume is small and/or asymptomatic.
• Consider the patient’s performance status and likelihood of response to systemic therapy in choosing a treatment approach.
• Treatment approaches include use of diuretics, drainage or diversion of fluid, or use of intracavitary therapies.
Evaluation
• Diagnosis more commonly follows a cancer diagnosis.
• The differential diagnosis of pericardial effusion in patients with cancer also includes treatment-related adverse effects such as radiation.
• Fluid sampling for cytology is needed for definitive diagnosis but has low sensitivity; a pericardial biopsy may increase sensitivity.
