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Malignant Ascites Diuretics — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologyMalignant Ascites DiureticsSCE Medical Oncology

A 50-year-old woman with cancer-related ascites has recurrent symptomatic reaccumulation requiring fortnightly paracentesis. Diagnostic cytology was positive for malignant cells. She asks about diuretics. What is the role of diuretics in malignant ascites?

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Correct answer: B — Assess portal hypertension; otherwise prioritise drainage over diuresis

Malignant ascites responds most reliably to drainage; diuretics are considered selectively when portal-hypertensive physiology is present. Use spironolactone when cytology confirms peritoneal malignant ascites: cytology does not predict a portal-hypertensive diuretic response. Use furosemide when cytology confirms peritoneal malignant ascites: loop diuresis is unreliable in permeability- and lymphatic-obstruction-driven fluid. Use combined diuretics after each large-volume paracentesis: routine post-drainage diuretics add renal and electrolyte risk. Use diuretics when serum albumin falls below twenty-five grams per litre: hypoalbuminaemia alone does not identify a diuretic-responsive mechanism.

Reference: Right Decisions NHS Scotland guideline on malignant ascites (Current NHS Scotland guidance, accessed July 2026): https://www.rightdecisions.scot.nhs.uk/acute-oncology-guidelines/oncological-emergencies/malignant-ascites/