Clinical Challenges

Management of Malignancy-Related Ascites

Anne Marie C. Flaherty

catheter, malignancy
ONF 2015, 42(1), 96-99. DOI: 10.1188/15.ONF.96-99

A 65-year-old Polish immigrant named T. J. was diagnosed with metastatic colon cancer in January 2012 when he presented with obstructing sigmoid colon cancer and liver metastases. A diverting colostomy as well as biopsy of his liver metastases was performed and chemotherapy with FOLFOX (5-fluorouracil [5-FU], leucovorin, oxaliplatin) and bevacizumab was initiated. After three months, he transitioned to maintenance therapy with infusional 5-FU and bevacizumab until he progressed in August 2012. Oxaliplatin was reintroduced and he responded until he developed progressive neuropathy in November and his therapy was changed to FOLFIRI (5-FU, leucovorin, irinotecan) and bevacizumab. T. J. developed liver progression after three months and, because he was Kras wild type, irinotecan and panitumumab were initiated. Liver-directed therapy also was pursued and he underwent radioembolization with yittrium-90 followed by chemoembolization with irinotecan-eluded beads. At the time of these procedures, T. J.'s portal and hepatic venous systems were patent (i.e., no thrombosis or obstruction causing portal hypertension).

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    References

    Ayantunde, A. A., & Parsons, S. L. (2007). Pattern and prognostic factors in patients with malignant ascites: A retrospective study. Annals of Oncology, 18, 945-949. doi:10.1093/annonc/mdl49
    Runyon, B. A. (2014). Malignant-related ascites. Retrieved from www.uptodate.com/contents/evaluation-of-adults-with-ascites
    Runyon, B. A., Hoefs, J. C., & Morgan, T. R. (1988). Ascitic fluid analysis in malignancy-related ascites. Hepatology, 8, 1104-1109. doi:10.1002/hep.1840080521
    Runyon, B. A., Montano, A. A., Akriviadis, E. A., Antillon, M. R., Irving, M. A., & McHutchison, J. G. (1992). The serum-ascites albumin gradient is superior to the exudat-transudate concept in the differential diagnosis of ascites. Annals of Internal Medicine, 117, 177-183. doi:10.7326/0003-4819-117-3-177
    Ayantunde, A. A., & Parsons, S. L. (2007). Pattern and prognostic factors in patients with malignant ascites: A retrospective study. Annals of Oncology, 18, 945-949. doi:10.1093/annonc/mdl49
    Bard Access Systems. (2012). Aspira® drainage system. Retrieved from http://www.myaspira.com/clin_clinicians.php
    Becker, G., Galandi, D., & Blum, H. E. (2006). Malignant ascites: A systemic review and guidelines for treatment. European Journal of Cancer, 42, 589-597.
    Behrendt, R. (2008). Management of malignant ascites: Current treatment options. Oncology Nursing News, 2, 1-16.
    Behrendt, R. (2014). Understanding treatment options for patients with pleural effusions and malignant ascites. Retrieved from https://event.webcasts.com/viewer/event.jsp?ei=1044450
    CareFusion. (2014). PleurX® resources. Retrieved from http://bit.ly/1B3QhtD
    Cavazzoni, E., Bugiantella, W., Graziosi, L., Franceschini, M., & Donini, A. (2013). Malignant ascites: Pathophysiology and treatment. International Journal of Clinical Oncology, 18, 1-9.
    Courtney, A., Nemcek, A. A., Rosenberg, S., Tutton, S., Darcy, M., & Gordon, G. (2008). Prospective evaluation of the PleurX catheter when used to treat recurrent ascites associated with malignancy. Journal of Vascular and Interventional Radiology, 19, 1723-1731.
    Chung, M., & Kazuch, P. (2008). Treatment of malignant ascites. Current Treatment Options in Oncology, 9, 215-233.
    Mullard, A. P., Bishop, J. M., & Jibani, M., (2011). Intractable malignant ascites: An alternative management option. Journal of Palliative Medicine, 14, 251-253.
    O'Neill, M. J.,Weissleder, R., Gervais, D. A., Hahn, P. F., & Mueller, P. R. (2001). Tunneled peritoneal catheter placement under sonographic and fluoroscopic guidance. American Journal of Roentgenology, 177, 615-618.
    Rosenthal, D. A. (2009). Management of malignant ascites. Retrieved from http://bit.ly/1yxoq71
    Runyon, B. A. (2014). Malignant-related ascites. Retrieved from http://bit.ly/1uhHajz
    Runyon, B. A., Hoefs, J. C., & Morgan, T. R. (1988). Ascitic fluid analysis in malignancy-related ascites. Hepatology, 8, 1104-1109. doi:10.1002/hep.1840080521
    Runyon, B. A., Montano, A. A., Akriviadis, E. A., Antillon, M. R., Irving, M. A., & McHutchison, J. G. (1992). The serum-ascites albumin gradient is superior to the exudat-transudate concept in the differential diagnosis of ascites. Annals of Internal Medicine, 117, 177-183.
    Schumacher, D. L., Saclarides, T. J., & Staren, E. D. (1994). Peritoneovenous shunts for palliation of the patient with malignant ascites. Annals of Surgical Oncology, 1, 378-381.
    Shuman, L. S. (2008). Tunneled catheter placement in the management of malignant ascites and pleural effusions. Journal of Lancaster General Hospital, 3-4, 136-138.
    Tapping, C. R., Ling, L., & Razack, A. (2012). PleurX drain use in the management of malignant ascites. British Journal of Radiology, 85, 623-623.