Malignant Bowel Obstruction in End Stage Colon Cancer

Most common in end-stage digestive and gynecological cancers, a malignant bowel obstruction can cause significant and uncomfortable symptoms at end of life. Between 25 and 40 percent of malignant bowel obstructions occur from end-stage colon cancer, followed closely by ovarian cancer in women. Treatment of the obstruction is typically geared toward palliation—or non-curative symptom relief.

What a Malignant Obstruction Is

As opposed to a bowel obstruction in an otherwise healthy adult, malignant obstructions can occur from tumors pressing on the intestines from within or from outside of the digestive tract, or from a physiological inability to move and digest the foods you eat. Further complicating factors might include:

• A history of abdominal or gynecological surgery
• Decreased intake of fluids and chronic dehydration
• Opioid narcotics for pain relief
• Side effects of radiation therapy
• Metastasis within the abdomen (to other organs such as the bladder or rectum)

Although it is not a common or anticipated effect, your survival rate drastically decreases if you have end-stage colon cancer and have been diagnosed with a malignant bowel obstruction. The average length of time from end-stage diagnosis to a bowel obstruction is approximately 13 months according to the National Cancer Institute. The mean survival is short, estimated to be no more than four weeks.

Symptoms 

The symptoms might be easily missed or attributed to treatments or medication. Most commonly reported symptoms of a malignant obstruction include:

• Nausea, especially after eating
• Vomiting, including vomiting of foul or fecal content
• Abdominal pain
• Cramps or colicky discomfort in the abdomen
• Cessation of bowel movements or change in size and frequency (passing small amounts of liquid or gas only)

The symptoms of a malignant obstruction do not typically self-resolve; they continue and progress in nature unless palliative measures are taken.

Diagnosis

X-rays of the abdomen and computed tomography (CT) scans will show the presence of an obstruction in your bowel. Paired with your cancer diagnosis, stage, and symptoms, the diagnosis is usually unquestionable.

Treatment and Palliation of Symptoms

The primary treatment of malignant bowel obstruction is bowel surgery, but your ability to survive and recover from this surgery may vary greatly as your cancer progresses. If you want surgery to remove the obstruction, your healthcare provider must consider your prognosis as well as:

• The extent of your cancer and abdominal metastasis
• Your age and general health
• Any other health conditions you might have, such as diabetes or heart disease
• Your ability to recover from a major operation

If you elect not to have surgery or are not well enough for surgical intervention, your healthcare provider has other options to help increase your comfort and decrease the severity of your symptoms. A nasogastric tube—a thin, straw sized and flexible tube—can be inserted into your nose to your stomach.

A machine that provides gentle suction can be intermittently connected to remove excess acids and stomach content to decrease nausea and vomiting. Your healthcare provider can also prescribe medications to help relieve the colicky pain and cramping in your abdomen, as well as medications to help relieve nausea.

A palliative stent can also be placed endoscopically to hold the colon open, so feces can pass normally.

You can also discuss intravenous fluids and feeding methods with your healthcare provider. It is a highly personal choice, but some people choose to continue hydrating and providing nutrients to the body artificially.

Fluids can also be administered subcutaneously—just under the skin—​to maintain a level of hydration and comfort based on your body's needs and output. Usually, under hospice supervision, some people with malignant obstructions choose to continue eating and drinking a modified diet for comfort measures.