Ascites, anyone?

[Seaglass77]

I was diagnosed de novo in June 2019. Verzenio and Letrazole worked great and I was NED til my oncologist decided I no longer needed the Verzenio. Long story short, my liver Mets have gone crazy and I’m dealing with ascetis. I had 2litres drained 9 days ago and can feel it building again. Onc is talking chemo now. Anyone else struggling with ascites?

[stardust1965]

I am so sorry you are dealing with this complication. It does seem strange that your onc thought Letrozole was all that was needed given you were having such good results on the combination. I hope you can get your liver mets under control with new a treatment plan. I have no experience of ascites but wanted to wish you well.

Vicki

[Debbigbang]

Wow, not sure why the onocologyst cut that off. I would maybe ho a lower dose if anything? The NED is wonderful, however cancer is still floating around and something needed to make sure it doesn't stick. I don't have any experience with that. I am on letrozole with ibrance about to 3rd cycle. Just wanted to wish you good luck !!

[Bestbird]

I am sorry to hear you are dealing with ascites and agree with the other responders that it's unusual for a doctor to remove a patient from a working treatment unless they were having significant side effects and the dosage couldn't be lowered (Verzenio comes in multiple doses). I'd strongly recommend obtaining a second opinion about your treatment, and having the ascites sent for pathology because it's possible that the subtype of cancer may have changed (i.e. from hormone receptor positive to hormone receptor negative).

Below is a list of options for draining ascites from my book, "The Insider's Guide to Metastatic Breast Cancer" which is also available as a complimentary .pdf. The Guide also provides a list of medications that might help treat ascites, although systemic therapy that works will be key. For information about approved therapies, contending with side effects, and cutting edge research, visit insidersguidemnc.com

In patients with cancer-related ascites, diet restrictions and/or diuretics might not be effective, although there have been some exceptions. Paracentesis (a procedure whereby fluid is taken out using a long, thin needle put through the belly) may be the first-line ascites treatment. If needed, a catheter (either indwelling or a peritoneovenous shunt) may be left in place to drain so that fluid can be removed in such a manner that the patient does not need to undergo repeated procedures. Some patients have reported that draining the ascites daily instead of every few days provides them with superior relief. From: emedicinehealth.com/ascites...

Treatment options for draining abdominal ascites often entail the use of an indwelling catheter, paracentesis, or peritoneovenous shunting.

Indwelling (Pleurx or Aspira) Catheter: This is the surgical insertion, under general anesthesia, of a small tube placed temporarily into the abdominal space that allows the patient or his/her family member to drain the fluid into a bottle as needed. Patients with an indwelling catheter are fully mobile and are not “attached” to the draining bottle except when draining the fluid. If there is no more drainage at all, the catheter is removed either in the doctor’s office or an outpatient procedure. The Pleurx catheter works via suction, and the newer gentler model is the Aspira catheter, which may be a bit less uncomfortable because uses gravity instead of suction for draining.

Paracentesis: Under sterile conditions, a needle is placed into the peritoneal space and fluid is withdrawn. Paracentesis may be a viable first step if the ascites accumulates quickly and the abdominal distension causes pain or shortness of breath. Because the peritoneal fluid contains albumin, if large amounts of fluid (more than 5 liters) are withdrawn, an albumin transfusion may be needed. If warranted, the catheter maybe left in place to drain, so that fluid can be periodically removed, and the patient does not need to undergo repeated procedures. Paracentesis may be done more than once, but if it becomes a frequent necessity for symptom control, other options may be considered.

Peritoneovenous shunting: This is a surgical operation that may on occasion be used in patients who are not candidates for, or who have failed treatment with, paracentesis or indwelling catheters. Peritoneovenous shunting entails the use of a tube for draining fluid back into the veins, instead of draining fluid externally as is done with indwelling catheters.