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Peritoneal mesothelioma is cancer that originates in the lining of the abdominal cavity, also called the peritoneum. This cancer can cause the buildup of fluid between the two layers of the peritoneum. This fluid causes pain, swelling, discomfort, and restricted mobility and activity. Doctors may use a procedure called a paracentesis to drain the fluid and relieve symptoms.
A relatively simple procedure, doctors may also use paracentesis to collect fluid to use in diagnosis. Paracentesis can also treat fluid buildup caused by a number of conditions. Risks associated with a paracentesis are minimal and recovery time is fast.
Fluid in the Peritoneum
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 mesothelioma. Like pleural mesothelioma, which affects the mesothelium in the chest cavity, peritoneal mesothelioma is most often associated with asbestos exposure.
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. Cancer in the abdomen may cause this condition as tumors disrupt the lymphatic system, which normally controls fluid buildup. Mesothelioma tumors also weaken the cells in the abdominal wall, which would typically block the buildup of ascitic fluid.
Ascites is not only caused by peritoneal mesothelioma. In fact, it has more common causes, including cirrhosis of the liver or other advanced liver disease, congestive heart failure, and infections. Ascites can range from mild to severe. When mild, it may be undetectable. However, as the condition worsens, it can cause severe distension, or swelling of the abdomen. Patients with ascites describe feeling full all the time and a sense of heaviness and pressure. Ascites may also cause shortness of breath as the fluid presses against the diaphragm.
The Paracentesis Procedure
A paracentesis is a relatively simple surgical procedure. This procedure only requires local anesthetic and is performed by inserting a needle into the abdomen to drain the fluid. A paracentesis can be performed in the hospital or a doctor’s office.
The needle may be inserted with the assistance of an imaging scan, such as an ultrasound. While imaging scans are not always used 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 dangerous drop in blood pressure.
The length of the procedure varies depending on how much fluid must be drained. Typical times range between 20 and 30 minutes. Procedure recovery is quick, although a patient may stay in the doctor’s office or hospital for an hour or more for monitoring.
Paracentesis for Mesothelioma
Paracentesis may be done for a patient with mesothelioma for several 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 for cancer cells. This will allow doctors to diagnose peritoneal mesothelioma, rule it out, or find another underlying cause of the ascites.
In addition to an initial diagnosis, paracentesis is used in mesothelioma patients to relieve symptoms. This procedure does not treat the cancer itself. Instead, it treats the ascites that is a complication of peritoneal mesothelioma. Draining the fluid reduces pain and discomfort and allows the patient to breathe more easily. Paracentesis may be used for a patient at any stage of mesothelioma, but relief may 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.
The risks associated with paracentesis are low. The procedure is simple and does not require general anesthesia. Rare complications include infection, leaking at the site of the needle insertion, internal bleeding, puncturing blood vessels, low blood pressure, and perforation of organs like the stomach, bladder or intestines.
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 risk can be lowered by using radiation therapy in and around the insertion area, killing any cancer cells that may have seeded.
If you are living with peritoneal mesothelioma or have symptoms of ascites, a paracentesis may help. This procedure can help your doctor make a diagnosis. It may also help you feel better once the fluid is removed. The abdomen can collect a significant amount of fluid, causing considerable discomfort. Talk to your doctor about your options. Ask questions about undergoing a paracentesis before deciding your next step.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.