Managing Severe Ascites in Late-Stage Liver Cancer

When a patient with advanced liver cancer develops significant ascites, it typically indicates a serious progression of the disease. At this stage, a comprehensive treatment approach based on the underlying causes is essential. Here are the key scenarios and management strategies:

1. Hypoalbuminemia-induced Ascites

One of the common causes of ascites in liver cancer patients is low levels of albumin in the blood. In such cases, intravenous albumin supplementation combined with diuretic therapy can help reduce fluid buildup. In more severe cases, therapeutic paracentesis—removal of excess fluid from the abdominal cavity—may be performed to provide symptom relief and improve comfort.

2. Ascites Due to Peritoneal Infection

If the ascites becomes infected, a condition known as spontaneous bacterial peritonitis (SBP), antibiotic therapy is necessary. Alongside infection control, albumin infusion and diuretics are used to manage fluid retention. Prompt treatment is crucial to prevent complications such as kidney failure or sepsis.

3. Malignant Ascites from Peritoneal Metastasis

When liver cancer spreads to the abdominal lining, it often results in malignant ascites, which is typically bloody. This type of ascites is more challenging to treat and often responds poorly to standard therapies. Some patients may benefit from intraperitoneal chemotherapy, where anti-cancer drugs are directly administered into the abdominal cavity to target metastatic lesions and reduce fluid accumulation.

4. Portal Hypertension from Hepatic Vein Invasion

If the cancer has invaded the portal vein, it can lead to increased pressure within the portal venous system, resulting in refractory ascites. Management includes albumin infusions, diuretics, and medications such as terlipressin to lower portal pressure. Terlipressin not only helps reduce fluid buildup but also supports kidney function by enhancing urine output.

In summary, managing ascites in late-stage liver cancer requires a tailored and multidisciplinary approach. Symptom control, quality of life improvement, and complication prevention are the main goals. Patients should work closely with their healthcare team to determine the most appropriate treatment plan based on their individual condition.