Malignant Bowel Obstruction in Advanced Gynecologic Cancers: An Updated Review from a Multidisciplinary Perspective

Abstract

Malignant bowel obstruction (MBO) is a major complication in women with advanced gynecologic cancers which imposes a significant burden on patients, caregivers, and healthcare systems. Symptoms of MBO are challenging to palliate and result in progressive decompensation of already vulnerable patients with limited therapeutic options and a short prognosis. However, there is a paucity of guidelines or innovative approaches to improve the care of women who develop MBO. MBO is a complex clinical situation that requires a multidisciplinary approach to ensure the appropriate treatment modality and interprofessional care to optimally manage these patients. This review summarizes the current literature on the different approaches targeting MBO management including surgical intervention, chemotherapy, total parenteral nutrition, and pharmacological treatment. In addition, the impact of MBO management on patients' quality of life (QOL) is examined. This article focuses on the challenges in developing evidence-based treatment guidelines for MBO and barriers in clinical trial design for MBO and proposes strategies to advance the MBO management. Collaboration is essential to design studies that may improve the overall care and quality of life for these patients. Prospective data are needed to inform clinical practice, establish a new benchmark for evidence-based MBO management, and better understand the biology of MBO.

Epithelial ovarian cancer

“…MBO management is not well defined and includes potential surgical or radiology intervention, medical support and the ethical dilemma of total parenteral nutrition (TPN). Efforts are on-going to offer a multidisciplinary management including surgery, chemotherapy, radiation, interventional radiology and include patients' preferences 138,139 . In this setting, the question of TPN remains difficult as the selection of patients who will benefit from TPN is not well described and the majority of patients will die from cancer process, not starvation 140 .…”

Epithelial ovarian cancer: Evolution of management in the era of precision medicine

“…This requires careful conservative management, with attention to diet, fluid intake, bowel rest, and avoidance of a high‐fiber diet. Occasionally, if obstruction is caused by single‐level obstruction, palliative or defunctioning surgery may provide relief …”

“…Occasionally, if obstruction is caused by single-level obstruction, palliative or defunctioning surgery may provide relief. 153 The management of recurrent, clear cell, low-grade serous and mucinous carcinomas present more of a therapeutic dilemma because of a lack of responsiveness to conventional chemotherapy. In this setting, the options considered are the potential for surgery or radiation and the availability of clinical trials.…”

Fallopian Tube Tumor Mimicking Primary Gastrointestinal Malignancy

“…Distant metastasis often occurs in the liver, brain, or lung [ 4 - 6 ]. Gynecological malignancies in their advanced stages are known to cause bowel obstruction and, most commonly it will cause bowel involvement with extrinsic compression, adhesion, or carcinomatosis [ 7 ]. It is unusual for gynecological malignancy to present with gastrointestinal (GI) bleeding mimicking primary colon cancer as it has been reported very few times in the literature, with one case of metastatic ovarian carcinoma presenting as sigmoid colon malignancy [ 6 ].…”