Management of Malignant Bowel Obstruction Associated With GI Cancers

Abstract

For many patients with GI malignancies, the seeding of the abdominal cavity with tumor cells, called peritoneal carcinomatosis, is a common mode of metastases and disease progression. Prognosis for patients with this aspect of their disease remains poor, with high disease-related morbidity and complications. Uniform and proven practices that provide optimal palliative care and quality of life for these patients are needed. The objective of this review is to critically assess the current literature regarding palliative strategies in the management of peritoneal carcinomatosis and associated symptoms in patients with advanced GI cancers. Despite encouraging results in the select population where cytoreductive surgery and intraperitoneal chemotherapy are indicated, the majority of patients who develop peritoneal carcinomatosis in the setting of GI cancers have poor prognosis, with malignant bowel obstruction representing a common terminal phase of their disease process. For all patients with peritoneal carcinomatosis, aggressive symptom control and early multimodality palliative care as further outlined should be sought.

Cecal Volvulus as a Rare Complication of Osimertinib Dosed at 160 mg in Patients With EGFR-Mutant Non-small Cell Lung Cancer

“…Known risk factors for cecal volvulus include chronic constipation, distal colon obstruction, high-fiber diets, ileus, prior colonoscopy, and late pregnancy (8). While malignant large bowel obstruction is a common complication of advanced gastrointestinal and ovarian malignancies, (10,11) reports of malignancy-associated cecal volvulus are extremely rare and limited to case reports (12,13). In an older case series of 37 patients with cecal volvulus seen during a 20 year period at surgical departments in Sweden, only two patients were found to have underlying gastrointestinal cancer at the time of surgical resetion (14).…”

Nausea and Vomiting Not Related to Cancer Therapy: Intractable Problem or Clinical Challenge?

“…N&V = nausea and vomiting; CINV = chemotherapy-induced nausea and vomiting; QOL = quality of life. Information from Collis & Mather, 2015 ; Ferguson et al, 2015 ; Franke et al, 2017 ; Glare et al, 2011 ; Harder et al, 2019a .…”

“…Patients with pelvic or abdominal tumors, particularly advanced ovarian or GI cancer, are most likely to develop malignant bowel obstruction (MBO) accompanied by new continuous nausea, colicky abdominal pain, intermittent vomiting, bloating, and no flatus or bowel movements for 72 hours ( Franke, Iqbal, Starr, Nair, & George, 2017 ). Subacute or intermittent MBO are common, and patients without crampy abdominal pain may have a functional ileus rather than a mechanical MBO.…”

“…A plain x-ray of the abdomen (kidney, ureters, and bladder [KUB]) may distinguish constipation with stool seen in the bowel from MBO, with distended bowel loops above an obstruction and nothing distally ( Ferguson et al, 2015 ; Franke et al, 2017 ). Oral contrast can improve the ability to verify the level and extent of obstruction.…”

Using Global Criteria to Detect Malnutrition: Application in Disease States

“…Pancreatic exocrine insufficiency related to pancreatic cancer, pancreatic resection, or asynchrony as a result of gastrointestinal tract resections (including gastrectomy and esophagectomy) contribute to malabsorption in patients with cancer . Additionally, malabsorption may occur because of short‐bowel syndrome as a result of tumor debulking or tumor bypass surgeries, gastrointestinal decompression in the setting of bowel obstruction, and past medical histories significant for gastric bypass surgery and pancreatitis . Radiation and chemotherapy can impact absorption and present as both an acute and latent side effect of treatment .…”