Ascites is an inflammatory process that induces the abnormal accumulation of a large amount of fluid into the peritoneal cavity. This pathological condition is observed in many neoplasms harboring peritoneal dissemination, a common feature in advanced ovarian cancer. In almost all patients, recurrent disease is accompanied by the accumulation of malignant ascites and is associated with chemoresistance and poor prognosis. The malignant ascites comprises a reservoir of a complex mixture of cellular components and soluble factors which provides a pro-inflammatory and tumor-promoting microenvironment for cancer cells. Moreover, tumor cells exhibit cancer stem-like phenotypes, acquire enhanced resistance to therapies, and higher capacity for metastatic spread and recurrent disease. The accessibility to malignant ascites and its cellular components makes it a unique source to track tumor progression and a key element to overcome chemoresistance.
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