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Mesothelioma Peritoneal Effusion

Peritoneal effusion is a large collection of fluid between the layers of the peritoneum in the abdominal cavity. Oftentimes, this is a key symptom of peritoneal mesothelioma.

Key Points

  • 1

    Peritoneal effusion is excess fluid found in the abdominal cavity.

  • 2

    Peritoneal effusion can be treated with paracentesis.

  • 3

    Paracentesis is a common treatment to improve symptoms of peritoneal effusion.

  • 4

    Clinical trials continue to search for alternative treatment methods.

Peritoneal effusion, or ascites, is a common symptom of peritoneal mesothelioma. It can also present its own symptoms, such as chest pain, abdominal swelling and difficulty breathing. The condition cannot be cured, but there are palliative treatment options available for patients to manage the symptoms of the condition.

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What Is Peritoneal Effusion?

Fluid is normally found in the abdominal cavity to lubricate the linings of organs within the cavity, such as the liver, pancreas, kidneys and intestines. The amount of peritoneal fluid that can be found in the body differs based on overall health, gender or other factors. For example, healthy women often have more peritoneal fluid than men in good health, but the exact amount can vary depending on a woman’s menstrual cycle.

When peritoneal effusion occurs, excess fluid builds up between the layers of the peritoneum. Peritoneal effusion is oftentimes the result of a more serious health concern. Effusion in the peritoneum can occur as a symptom of peritoneal mesothelioma, a cancer caused by exposure to asbestos. Ascites are also commonly linked to cirrhosis of the liver or problems with the lymph nodes, resulting in lymphatic obstruction.

If fluid begins to build up in the abdominal area, it can indicate the presence of malignant cells like peritoneal mesothelioma. In fact, 10% of peritoneal effusion cases are caused by cancer, and mesothelioma accounts for 1% of those cases.

Symptoms of Peritoneal Effusion

The symptoms of peritoneal effusion can range from mild symptoms such as bloating, to more serious symptoms like difficulty breathing and abdominal swelling. When excess fluid builds up in the lining of the peritoneum, individuals may experience the following.

Peritoneal Effusion Symptoms
  • Abdominal swelling
  • Ankle or leg swelling
  • Bloating
  • Chest pain
  • Constipation
  • Difficulty breathing
  • Fatigue
  • Loss of appetite
  • Nausea
  • Weight gain

These symptoms may vary depending on how much ascitic fluid is present in the area. Pressure on the abdomen due to effusion can cause increased pain and worsened symptoms. Typically, if ascites are present as a result of mesothelioma or another malignancy in the abdominal cavity, the prognosis is poor. Symptoms may worsen as the cancer progresses or may be more severe if a patient is diagnosed with late-stage mesothelioma.

Diagnosing Peritoneal Effusion

Peritoneal effusion, which can generally be described as a form of abdominal distension, is most typically linked to a cancer diagnosis. The process of assessing peritoneal effusion can include monitoring symptoms like weight gain and an everted umbilicus (protruding belly button), which may indicate pressure in the abdomen. Patients may have to visit multiple specialists, including a gastrointestinal specialist, in order to accurately diagnose effusion.

Peritoneal effusion can typically be diagnosed with a fluid wave test. This test requires patients to lay on their back while a medical professional presses into the mid-abdomen. They will then tap opposite sides of the abdomen to see if an impulse is felt, which can indicate the presence of ascites.

After a fluid wave test, specialists can confirm a diagnosis of peritoneal effusion with further testing. Peritoneal effusions are most often diagnosed with an abdominal ultrasound after a physical exam, but imaging tests, like X-rays or CT scans, can also be used if the patient has been diagnosed with peritoneal mesothelioma.

Along with diagnosing the effusion itself, it’s important for physicians to recognize the underlying cause of the effusion to determine the proper treatment. While paracentesis is a common treatment for peritoneal effusion, it is also used as a diagnostic tool to test for peritoneal mesothelioma. Specialists collect fluid samples from the affected area with a hollow needle or catheter to determine whether the abdominal cavity contains cancerous cells.

Due to the rarity of mesothelioma, especially when there is no known history of asbestos exposure, various case studies have proven the importance of performing a peritoneal biopsy to ensure an accurate diagnosis. In addition to confirming an effusion diagnosis, medical professionals may also diagnose mesothelioma as a “wet type,” “dry type” or “mixed type.”

Types of Peritoneal Mesothelioma
  • Wet Type: When patients experience wet type mesothelioma, ascites are present with minimal pain. Patients may also develop nodules on organs and swelling of the intestines.
  • Dry Type: Dry type peritoneal mesothelioma indicates the absence of ascites. This means the area is painful with large tumors.
  • Mixed Type: A mixed type diagnosis of peritoneal mesothelioma shows a combination of areas with effusion, along with dry, painful tumors.

Prognosis for Mesothelioma Peritoneal Effusion

Though peritoneal effusion can be managed through treatment, there is no cure, as it is typically the result of a greater health concern. Because of this, patient prognosis is largely determined by the main diagnosis, such as malignant peritoneal mesothelioma. While peritoneal mesothelioma patients have the best overall survival rates of mesothelioma patients, those with peritoneal effusion typically present a poorer prognosis.

When looking at the prognosis for patients with peritoneal effusion from all types of malignancies, the average survival is 20 weeks from the time of diagnosis. As with all mesothelioma cases, the prognosis will differ on a case-by-case basis.

The average life expectancy for peritoneal mesothelioma patients is one year, which is dependent on the stage and treatment method for the patient. Due to advancements in treatment, such as immunotherapy, surgery and chemotherapy, patients are experiencing longer life expectancies overall, with half of patients surviving 5 years or longer.

Treating Peritoneal Effusion

Although malignant peritoneal effusion cannot be cured, the condition can be managed through palliative treatment. These treatments often improve the quality of life for patients, as they manage their pain and can reduce discomfort associated with fluid buildup.

One of the most common treatments for peritoneal effusion is a palliative surgery called paracentesis. The surgery treats effusion of the peritoneum by draining the fluid with a hollow needle. By draining the fluid, pressure is taken off of the abdomen, relieving symptoms like abdominal pain and difficulty breathing.

The surgery is minimally invasive and can be paired with a CT scan to help guide the needle to the affected area. A local anesthetic is used to numb the area to prepare for the needle to be inserted. Once the needle is inserted, the extraction takes place and is typically pain-free. A bandage is placed over the insertion site and patients may experience slight drainage from the site for a few days after the procedure. For patients who may need multiple treatments due to fluid accumulation, a permanent tunneled peritoneal drainage catheter may be used to continually drain fluid from the abdominal cavity.

The side effects of peritoneal effusion treatment, whether it is via a paracentesis or permanent tunneled peritoneal drainage catheter, are usually minimal as the treatment is minimally invasive. However, there are still side effects of which patients should be aware, including:

  • Infection
  • Kidney malfunction or failure
  • Puncture of the bowel, bladder or blood vessels
  • Shock
  • Transfer of cancer cells

Treatment side effects may be worse for older patients or patients with more advanced mesothelioma. Patients should discuss all treatment side effects with a medical professional before beginning treatment to determine what options are best for their case.