Document Detail

The current and future management of malignant ascites.
MedLine Citation:
PMID:  12708713     Owner:  NLM     Status:  MEDLINE    
Malignant ascites occurs in association with a variety of neoplasms. It is a frequent cause of morbidity and presents significant problems for which there are no clear management guidelines. In this article we discuss various modalities which are available including diuretic therapy, paracentesis, peritoneovenous shunts and intraperitoneal chemotherapy. There are no randomized trials of diuretic drugs to assess their efficacy in malignant ascites. Phase II data suggest that they are effective in approximately one-third of patients with malignancy, and their efficacy may be determined by plasma renin/aldosterone concentrations. Paracentesis provides relief in up to 90% of patients; because of varying reports of hypovolaemia, some advocate simultaneous intravenous fluid infusion. Permanent percutaneous drains may prevent the need for repeated paracentesis, although there is potential for infection. A peritoneovenous shunt also prevents the need for repeated paracenteses, whilst maintaining normal serum albumin concentrations. Blockage occurs in 25% of shunts, which are contraindicated in the presence of heavily bloodstained ascites because of the risk of occlusion. The preclinical and clinical experience with anti-angiogenic agents such as the matrix metalloproteinase inhibitors and the VEGF antagonists suggests that these agents may have a role in the treatment of malignant ascites.
E M Smith; G C Jayson
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinical oncology (Royal College of Radiologists (Great Britain))     Volume:  15     ISSN:  0936-6555     ISO Abbreviation:  Clin Oncol (R Coll Radiol)     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-23     Completed Date:  2003-07-31     Revised Date:  2008-03-10    
Medline Journal Info:
Nlm Unique ID:  9002902     Medline TA:  Clin Oncol (R Coll Radiol)     Country:  England    
Other Details:
Languages:  eng     Pagination:  59-72     Citation Subset:  IM    
Department of Palliative Medicine, Christie Hospital, Withington, Manchester, U.K.
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MeSH Terms
Antineoplastic Agents / administration & dosage
Ascites / etiology,  physiopathology*,  therapy*
Diuretics / therapeutic use
Drainage / methods
Endothelial Growth Factors / antagonists & inhibitors
Infusions, Parenteral
Intercellular Signaling Peptides and Proteins
Lymphokines / antagonists & inhibitors
Matrix Metalloproteinases / antagonists & inhibitors
Neoplasms / complications,  therapy*
Octreotide / therapeutic use
Peritoneovenous Shunt
Radioisotopes / administration & dosage
Vascular Endothelial Growth Factor A
Vascular Endothelial Growth Factors
Reg. No./Substance:
0/Antineoplastic Agents; 0/Diuretics; 0/Endothelial Growth Factors; 0/Intercellular Signaling Peptides and Proteins; 0/Lymphokines; 0/Radioisotopes; 0/Vascular Endothelial Growth Factor A; 0/Vascular Endothelial Growth Factors; 83150-76-9/Octreotide; EC 3.4.24.-/Matrix Metalloproteinases

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