The untapped potential of ascites in ovarian cancer research and treatment

Abstract

The build-up of fluid in the peritoneal cavity-ascites-is a hallmark of ovarian cancer, the most lethal of all gynaecological malignancies. This remarkable fluid, which contains a variety of cellular and acellular components, is known to contribute to patient morbidity and mortality by facilitating metastasis and contributing to chemoresistance, but remains largely under-researched. In this review, we will critically analyse the evidence associating ascites with metastasis and chemoresistance in ovarian cancer and provide an update on research in the field. We will argue the case for ascites as a unique and accessible substrate for tracking tumour progression and for translational research that will enhance our understanding of this cancer and lead to improvements in patient outcomes.

Fig. 1. Abdominal accumulation of ascites fluid in ovarian cancer patients.

The fluid contains tumour cells, non-tumour cells, circulating free DNA (cfDNA) and signalling molecules. CD-95L CD-95 ligand, OPG osteoprotegerin.

Fig. 2. Mechanism of ascites build-up in ovarian cancer.

Increased vascular permeability and impaired drainage drive the accumulation of ascites fluid.

Fig. 3. Three different sized spheroids isolated from a patient with low-grade serous ovarian cancer (LGSOC).

a) large spheroid b) medium spheroid c) small spheroid. Spheroids stained with Trypan Blue. Black bar = 100 µM. Unpublished data (B.W.).