Fluid in the Abdomen (Ascites) in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.
Ascites is the build-up of fluid in the space surrounding the organs in the abdomen. When ascites is caused by cancer doctors call it Malignant Ascites. Malignant Ascites is most common in people with the following cancers:
- Breast cancer
- Colon cancer
- Gastrointestinal tract cancers, such as stomach and intestinal cancers
- Ovarian cancer
- Pancreatic cancer
- Uterine cancer
Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.
Ascites generally causes a lot of discomfort.
Individuals with ascites may experience the following symptoms:
- Abdominal swelling
- Ankle swelling
- Changes to the belly button
- Decreased appetite
- Haemorrhoids, which causes painful swelling near the anus
- Nausea or vomiting
- Sense of fullness or bloating
- Sense of heaviness
- Shortness of breath or dyspnoea
- Weight gain
Your child’s doctor may ask you about any recent symptoms your child has exhibited and do a physical examination of their abdomen to diagnose ascites.
The doctor may also schedule one or more of the following tests:
- Computerised Tomography (CT or CAT Scan)
- Paracentesis – the removal and analysis of fluid from the abdomen with a needle.
If the ascites is not causing discomfort, no treatment may be required, as any form of treatment is merely to relieve the symptoms that are causing discomfort.
Some of the treatment for ascites may have unpleasant side effects, so it is important that you discuss all the risks and benefits of each option before deciding on a treatment plan for your child.
The options to help relieve ascites include:
Chemotherapy: Chemotherapy is rarely used to manage ascites, but can be used for individuals with certain cancers, such as lymphoma or breast and ovarian cancers.
Diuretics: Prescribing diuretics for your child, which can help reduce the amount of water in the body. Diuretics are effective and don’t cause side effects for most people, but can cause the following side effects in some individuals:
- Loss of sleep
- Low blood pressure
- Problems with self-esteem
- Skin problems
Paracentesis via Catheter: If ascites is causing breathing problems or diuretics stop working, your child may need the fluid drained via a needle into the abdomen (paracentesis). If your child needs paracentesis often, they may need a special tube called a catheter placed in their abdomen to help make fluid removal easier, even when they are at home.
Salt & Fluid Reduction: Reducing the amount of salt your child eats, as well as the amount of liquids they normally drink. This regimen is unpleasant and difficult to follow for many people with cancer.
Shunt: Your child may require a device called a shunt to bypass or divert fluid from one place to another, but this is very rare.