Paracentesis for Mesothelioma
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Paracentesis is a procedure to drain fluid from the abdominal cavity. Peritoneal mesothelioma causes fluid buildup, called ascites, which results in pain, swelling, discomfort, and restricted mobility and activity. Paracentesis is a simple procedure used to relieve these symptoms and to collect a sample for diagnostic tests.
What Is a Paracentesis?
A paracentesis is a procedure that uses a needle with or without a catheter to withdraw fluid from the abdominal cavity. The buildup of fluid in the abdomen is called ascites.
Although it is sometimes called abdominal paracentesis, this is redundant. The term paracentesis refers to the abdomen.
What Is the Purpose of a Paracentesis?
There are a few reasons to perform paracentesis drainage of ascites:
- To remove fluid to relieve symptoms of the underlying condition causing ascites
- To remove fluid for diagnostic purposes, to determine what is causing ascites
- Often for both purposes, to diagnose a condition and help the patient feel more comfortable
Ascites generally causes abdominal distension, pain, weight gain, shortness of breath, and general discomfort. Depending on the underlying cause, there may be other symptoms.[1]
Who Needs a Paracentesis?
If you have peritoneal mesothelioma, you might need this procedure to drain fluid for symptom relief or to confirm the diagnosis. Peritoneal mesothelioma is a rare cause of ascites. Other diseases that cause abdominal fluid buildup and that might require paracentesis drainage include:
- Cirrhosis, other liver diseases, and chronic alcohol abuse
- Kidney failure
- Heart failure
- Obesity
- Type 2 diabetes
- Severe malnutrition
- Pancreatitis
How Is a Paracentesis Done?
A paracentesis is a relatively simple surgical procedure. This procedure only requires a local anesthetic and is performed by inserting a needle into the abdomen to drain the fluid. Paracentesis can be performed in the hospital or a doctor’s office.[2]
What Happens During the Procedure
The needle may be inserted with the assistance of an imaging scan, such as an ultrasound. While imaging scans are not always necessary during the procedure, it helps avoid puncturing blood vessels or organs like the intestines.
When ascites is severe, the needle may be attached to a vacuum bottle. This allows as much as several liters of fluid to be drained from the abdomen. If large amounts of fluid must be drained, the patient may also receive intravenous fluids to prevent a dangerous drop in blood pressure.
How Painful is a Paracentesis?
Paracentesis is minimally painful. You will receive a local anesthetic to numb the area before the doctor inserts the needle and catheter. You might experience some pressure and discomfort, but it should not hurt once the anesthetic begins to take effect.
How Long Does a Paracentesis Take?
The length of the procedure varies, depending on how much fluid must be drained. Typical times range between twenty and thirty minutes.
How Paracentesis Is Used for Mesothelioma Patients
The peritoneum is a double layer of tissue that surrounds the abdominal cavity and the organs inside. This layer is part of the mesothelium and is affected in some cases of mesothelioma.
Although mesothelioma is rare, peritoneal mesothelioma is the second most common type of this cancer. Like pleural mesothelioma, which affects the mesothelium in the chest cavity, asbestos exposure is the primary risk factor for peritoneal mesothelioma.
One of the potential complications of this cancer is a buildup of fluid between the two layers of the peritoneum. Called ascitic fluid, at normal levels, it provides lubrication and has an anti-inflammatory role. An abnormal buildup of the fluid is called ascites.[3]
The mesothelioma cells may cause this condition because they produce large amounts of ascitic fluid. Mesothelioma tumors can also clog up the cells in the abdominal wall, which would normally resorb the ascitic fluid.
A paracentesis may be done for a patient with mesothelioma for several reasons:[4]
- 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 for cancer cells.
- This will allow doctors to diagnose peritoneal mesothelioma, rule it out, or find another underlying cause of the ascites.
- Paracentesis is used in mesothelioma patients to relieve symptoms.
- This procedure does not treat the cancer itself; instead, it treats the ascites, a complication of peritoneal mesothelioma. Draining the fluid reduces pain and discomfort and allows the patient to breathe more easily.
A patient at any stage of mesothelioma may receive paracentesis. Unfortunately, relief may only be temporary. Fluid often refills the cavity.
Over time, this fluid may fill in smaller spaces, making draining with paracentesis less effective. As peritoneal mesothelioma advances, controlling ascites may become increasingly difficult.
Potential Complications of Paracentesis
The risks associated with paracentesis are low. The procedure is simple and does not require general anesthesia. Rare complications include infection, leaking at the needle insertion site, internal bleeding, puncturing blood vessels, low blood pressure, and perforation of organs like the stomach, bladder, or intestines.[2]
Another potential complication of paracentesis for cancer patients is seeding along the insertion site. This occurs when cancer cells line the area where the needle is inserted.
The abdomen can collect a significant amount of fluid, causing considerable discomfort. If you are living with peritoneal mesothelioma or have symptoms of ascites, a paracentesis may help.
Recovering from a Paracentesis
This is a minor surgical procedure, so recovery time is quick unless you have complications. Your doctor will explain how to manage the wound and watch for signs of infection.
After having the fluid drained, you need to take steps to reduce the risk of recurring ascites. This may include limiting liquid intake and significantly reducing salt in your diet.
This procedure can help your doctor make a diagnosis. It may also help you feel better once the fluid is removed. Talk to your doctor about your options. Ask questions about undergoing a paracentesis before deciding your next step.
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Dr. Paul Sugarbaker is a leading expert in surgical oncology. He specializes in the surgical treatment of gastrointestinal cancers, peritoneal mesothelioma, and peritoneal metastases. He developed and advanced an important treatment procedure for peritoneal cancers and metastases known as HIPEC. The innovative strategy uses surgery followed by the circulation of heated chemotherapy drugs in the abdomen. Dr. Sugarbaker currently heads up the Peritoneal Surface Malignancy Program and the Center for Gastrointestinal Malignancies at Washington Hospital Center. He also works out of a private practice, Sugarbaker Oncology Associates.