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Peritoneal mesothelioma is a cancer of the lining of the abdominal cavity, called the peritoneum. This cancer can cause many symptoms, including the buildup of fluid between the two layers of the peritoneum. This fluid causes pain, swelling, and discomfort, and it restricts mobility and activity. A relatively simple procedure, called a paracentesis, can be used to drain the fluid and relieve symptoms.

Paracentesis may also be used as a diagnostic procedure, to collect fluid for testing by a pathologist. It is also a procedure that can be used to treat fluid buildup caused by a number of conditions, not just mesothelioma. Risks associated with a paracentesis are minimal and recovery time is fast. It is a simple and quick procedure that can bring a lot of relief to patients suffering from peritoneal mesothelioma.

Fluid in the Peritoneum

The peritoneum is a double layer of tissue that surrounds the abdominal cavity and the organs in the abdominal cavity. It is part of the mesothelium of the body and is affected in some cases of mesothelioma. Cancer of the peritoneum is the second most common type of mesothelioma, and it is very rare. Like pleural mesothelioma, which affects the mesothelium in the chest cavity, peritoneal mesothelioma is most often associated with asbestos exposure as a cause.

One of the potential complications of this type of cancer is a buildup of fluid between the two layers of the peritoneum. The fluid is called ascitic fluid and at normal levels it provides lubrication and has an anti-inflammatory role in the abdomen. An abnormal buildup of the fluid is called ascites. Cancer in the abdomen may cause this condition because the tumors disrupt the lymphatic system, which would normally control fluid buildup. Mesothelioma tumors also weaken the cells in the wall of the abdomen, which would typically block the buildup of ascitic fluid.

Ascites is not only caused by peritoneal mesothelioma. In fact there are many more common causes of it, including cirrhosis of the liver or other types of advanced liver disease, congestive heart failure, and infections. Ascites can range from mild to severe. When mild it may be undetectable, but as it gets worse it can cause severe distension, or swelling, of the abdomen. Patients with ascites describe feeling full all the time and a worsening sense of heaviness and pressure. Ascites may also cause shortness of breath as the fluid presses up on the diaphragm.

The Paracentesis Procedure

A paracentesis is a relatively simple surgical procedure that only requires local anesthetic and is performed by inserting a needle into the abdomen to drain the fluid. The procedure can be done in the hospital or a doctor’s office. The patient either sits or lies down and has a needle inserted into the abdomen after the injection of a local anesthetic to numb the area.

The insertion of the needle may be done with the assistance of an imaging scan, like an ultrasound. This is not always done, but it can help the doctor avoid puncturing blood vessels or organs like the intestines. When ascites is severe, there is a lot of fluid to drain. The needle must be attached to a vacuum bottle to drain up to four liters, or a gallon, from the abdomen. When there is a lot of fluid that needs to be drained the patient may also receive intravenous fluids to prevent shock or a dangerous drop in blood pressure.

The length of the procedure varies depending on how much fluid must be drained, but typical times are between 20 and 30 minutes. Recovery does not take long, but a patient may stay in the doctor’s office or hospital for an hour or two to be monitored for any potential complications caused by the paracentesis.

Paracentesis for Mesothelioma

Paracentesis may be done for a patient with mesothelioma for one or more reasons. If the patient has not yet been diagnosed with mesothelioma, the fluid withdrawn can serve as part of the diagnosis. A pathologist can examine the fluid to look for cancer cells to either, diagnose peritoneal mesothelioma, rule it out, or find some other underlying cause of the ascites.

In addition to an initial diagnosis, paracentesis is used in mesothelioma patients to relieve symptoms. It is not a procedure that will treat the cancer itself; it only treats the ascites that is a complication of peritoneal mesothelioma. Draining the fluid can reduce pain, the discomfort of swelling, and can help a patient breathe more easily. Paracentesis may be used for a patient at any stage of mesothelioma, but the relief may be temporary. The fluid often refills the cavity, and over time may fill in smaller and smaller spaces, which makes draining it out through paracentesis more difficult. As peritoneal mesothelioma advances, controlling ascites may become more difficult.

Potential Complications

The risks associated with paracentesis are low. This is a fairly simple procedure that does not require general anesthesia. Some of the rare but possible complications are infections, leaking at the site of the needle insertion, internal bleeding, puncturing of a blood vessel, perforation of organs like the stomach, bladder or intestines, and low blood pressure.

Another potential complication for someone with cancer undergoing a paracentesis is seeding along the insertion site. This occurs when cancer cells line the part of the abdomen in which the needle was inserted. The risk of this happening can be lowered by using radiation therapy in and around the insertion area. This may kill any cancer cells that have seeded.

If you are living with peritoneal mesothelioma, or you have symptoms of ascites, but don’t know what the underlying cause is, a paracentesis may help. It can help your doctor make a diagnosis and help you feel better once the fluid is removed. The abdomen can collect a lot of fluid and this can cause a considerable amount of discomfort. Talk to your doctor about your options and ask any questions you have about undergoing a paracentesis before making any decisions about what to do next.

Page Edited by Dave Foster

Dave has been a mesothelioma Patient Advocate for over 10 years. He consistently attends all major national and international mesothelioma meetings. In doing so, he is able to stay on top of the latest treatments, clinical trials, and research results. He also personally meets with mesothelioma patients and their families and connects them with the best medical specialists and legal representatives available. Connect with Patient Advocate Dave Foster

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