Paracentesis can help to keep a patient with mesothelioma comfortable and give them some relief from the ascitic build-up, but it isn’t a cure.

Ascitic fluid is a lubricant that collects between the peritoneal linings. These linings separate the abdominal organs from the abdominal wall to protect both. When the ascitic fluid becomes a problem is when over an ounce gets trapped between. It causes a painful build-up and stress on the organs in the abdomen, which can then lead to damage. 

Peritoneal mesothelioma can cause this ascitic fluid to build between the two layers. 

For doctors to analyze this fluid or to remove it entirely, they must remove it from the abdomen via a hypodermic needle. This procedure is called a paracentesis and is minimally invasive and usually, patients will be able to go home shortly after being drained.

This issue with ascites is common in mesothelioma patients as tumors in the abdominal cavity can cause damage to the lining, blockages, and weaken the cells responsible for keeping fluid from leaking. This procedure can help to keep the patient comfortable and give them some relief from the ascitic build-up, but it isn’t a cure. 

Analyzing the fluid and taking a sample of affected tissue are the only ways to help diagnose the patient with peritoneal mesothelioma. Even then, a sampling of the fluid alone will not typically be enough to sustain a diagnosis.

Palliative Paracentesis

Palliative treatments tend to be popular amongst patients with mesothelioma as they offer some relief from painful symptoms and improve their standard of living. Because this kind of treatment is simply to provide comfort and relief, it isn’t going to keep the ascites from returning eventually. 

In fact, ascites are so commonly recurrent in patients with peritoneal mesothelioma, that palliative paracentesis becomes a common procedure. Most doctors will opt to have the patient keep a catheter to make it easy for continual draining procedures. This continuous draining can improve the patient’s comfort and ensure they can go about their lives as normally as possible. 

However, if a tumor has developed and is causing the issues with the ascites, then it is unlikely paracentesis will be as helpful as other treatments. In this case, it is recommended for patients who qualify, that before undergoing chemotherapy or radiation to treat their mesothelioma they have the tumor removed. The removal of the tumor combined with one of these other cancer treatments has been shown to stall ascites in over 90% of peritoneal mesothelioma sufferers. 

The number of ascites you have in your system will largely determine how eligible you are for this procedure, as well as how often it will need to be done. If you only have mild ascites that don’t show up except for via ultrasound, you likely won’t be eligible.

Moderate to severe levels of ascites as well as visible distension of the belly will be considered cause for paracentesis. 

Surgical Procedure

It isn’t a lengthy surgery, requiring a half hour or less of your time to complete and you’ll be cleared to go home afterward. They will likely do an ultrasound of the area to see what the amount of ascitic fluid looks like, to get an idea of how much they’ll need to extract.

Doctors will also need to have a clear idea of your medical history, what medications you’re taking, to be sure none of them will cause any issues with bleeding or contradict the fluids they may need to give you while the surgery is taking place. 

The patient will need to have their bladder emptied and then will need to be laid at a specific angle so the fluid will all collect in the lower part of their belly.

Once the area and the needle have been thoroughly cleaned it will be inserted into the cavity to begin draining. The cavity can either be drained slowly via a gravitational draining or sucked out via a syringe or a pump attached to a bottle. The draining must be done relatively slowly as too much too fast can result in shock. 

Once the draining is complete, the surgical site will need to be cleaned and bandaged. The patient may have to receive a catheter if it happens that they will need to be trained continuously. Once the doctor is sure the patient’s electrolytes and blood pressure are stable, and the patient isn’t feeling lightheaded, they will be free to go home. Don’t be afraid to speak up if any dizziness or discomfort continues after the procedure. 

Even though it isn’t an invasive procedure, there can still be risks associated with the paracentesis procedure. The possibility of infection is still high so you should keep the injection site clean and sterile. If the doctor is not as versed in the procedure, they may even cause possible perforations in the abdominal organs accidentally. Hypotension is also common, which is why blood pressure should be monitored before and after the procedure. 

Other Forms of Treatment

Paracentesis is only really considered as a way to help with discomfort and difficulty in day to day life. If your distension is bad enough they will typically recommend you frequently undergo this form of treatment, but it will not act as a cure for the underlying cause. For healthier patients, a combination of this and other cancer treatments may be the best way to reduce discomfort and treat peritoneal mesothelioma. 

It is a rare disease but can be difficult to treat if not caught early. Be sure to speak with your doctor on what treatment options will be best for your stage and level of discomfort. Doctors will typically assess the size of your tumor, how it responds to different treatments such as chemotherapy or radiology, and even toss around the possibility of a peritonectomy should the situation be truly severe. 

If you are struggling to breathe due to an excess of fluid in the abdominal cavity, talk to your doctor right away.

They will likely set up an ultrasound to assess the severity of the situation and treatment options will be considered from there.

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