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Unexplained ascites

My mother was recently admitted to the hospital with about 20 lbs of unexplained ascites in the abdomen, which followed what she describes as an excruciating pain the night of July 3 that disappeared when she went to the bathroom the following morning.  

She has no fever or elevated white count. In the past week she has had 1)a pelvic/abdominal ultrasound; 2) a chest XRay; 3) CT scans of the abdominal region; 4) a pelvic exam. All come up clear, with no signs of cancer/masses. A test of the peritoneal fluid says: 1) rare atypical cells present; and 2) reactive melothelial cells. The doctor says this fluid test indicates no malignant cells present but has ordered another test, due in a few days.

She was given a CA-125, which came back "high"; I do not know how high and am waiting to find that out. She has an extensive history of family cancer, including ovarian cancer in her sister and breast cancer in her mother (both deceased); her brother has colon cancer now, and another brother died 2 years ago of brain cancer.

This morning the doctor has ordered an MRI.

We are obviously concerned about cancer, given the symptoms and cancer history.
1 Responses
233190 tn?1278553401
Hello - thanks for asking your question.

With unexplained ascities and an elevated CA-125 level, the obvious concern is for ovarian cancer.  The sensitivity of the ultrasound for detecting ovarian cancer ranges from 60-100 percent, so the test is not totally conclusive.  I would concur with the MRI as the next step to make sure that ovarian cancer is not present.

Without knowing the characteristics of the ascitic fluid (protein, serum-ascities albumin gradient, cell count etc.), it is impossible to say what exactly is causing the ascites.  Causes can range from liver dysfunction, pancreatitis, congestive heart failure, infection, or kidney disease.

However, with the family history of cancer and the CA-125 level, I would make sure that ovarian cancer is not present.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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