Management of Malignancy-related Ascites

Anne Marie C. Flaherty, MSN, RN, APNc, AOCNS®


Oncol Nurs Forum. 2015;42(1):96-99. 

In This Article


Ascites had been classified as transudative and exudative based on protein analysis of the ascites to distinguish whether the ascites were primarily driven by portal hypertension versus peritoneal carcinomatosis. The serum ascites albumin gradient (SAAG) is a more accurate method to identify portal hypertension. SAAG is determined by subtracting the albumin level in the ascites from the serum albumin level, both obtained on the same day (Runyon, 2014). Low-gradient SAAG ascites (< 1.1 g/dl) are associated with peritoneal carcinomatosis, which is the most common cause of malignant ascites, and account for 53% of cases. Low-gradient SAAG ascites were previously classified as exudative ascites and are most commonly seen in patients with ovarian cancer, bladder cancer, peritoneal mesothelioma, and other solid tumors without significant liver metastases (Runyon, 2014). High-gradient SAAG ascites (≥ 1.1 g/dl) are associated with liver metastases and portal hypertension and account for 13% of cases. This type of malignant ascite was previously referred to as transudative ascites and most often are seen in patients with liver metastases, cirrhosis, hepatocellular cancer, and portal vein thrombosis (Runyon, 2014). Another 13% of cases are attributed to both peritoneal carcinomatosis and liver metastases, and the remaining cases are from other causes (Runyon, Hoefs, & Morgan, 1988). Ascites from peritoneal carcinomatosis develops as a result of increased capillary permeability, blockage of lymphatic vessels, and decreased efflux from the peritoneal cavity. Ascites associated with massive liver metastases are a consequence of portal hypertension, which alters intestinal capillary pressure and permeability and causes compression of the portal veins (Rosenthal, 2009).