Management of bowel obstruction in advanced and terminal cancer patients

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Abstract
Background: Bowel obstruction is a common and distressing outcome in patients with abdominal or pelvic cancer. Patients and methods: Patients may develop bowel obstruction at any time in their clinical history, with an incidence ranging from 5.5% to 42% in ovarian carcinoma and from 10% to 28.4% in colorectal cancer. The causes of the obstruction may be benign postoperative adhesions, a focal malignant or benign deposit, relapse or diffuse carcinomatosis. The symptoms which are almost always present are intestinal colic (reported in 72%–76% of patients), abdominal pain due to distension, hepatomegaly or tumor masses (in 92% of patients) and vomiting (68%–100%) of cases. Conclusion: While surgery must remain the primary treatment for malignant obstruction, it is now recognised that there is a group of patients with advanced disease or poor general condition who are unfit for surgery and require alternative management to relieve distressing symptoms. A number of treatment options are now available for the patient with advanced cancer who develops intestinal obstruction. In this review of the literature, the indications for surgery will be examined, the use of nasogastric tube and percutaneous gastrostomy evaluated and the place of drugs for symptom control described.