What are your options if you have bowel obstruction due to advanced cancer?
The most common types of cancer which can cause bowel obstruction are advanced ovarian and advanced colorectal cancer.
Obstruction will present with abdominal pain, cramping-colic pain and nausea and vomiting. It can be confirmed with an abdominal x-ray.
For many patients their immediate thought might be to turn to surgical options. However, clinical trials have shown medication to be frequently superior to surgery, with less complications and better quality of life. Surgery, to relieve the obstruction, will only benefit a select group of patients with mechanical obstruction.
What medications are available?
It is important to discuss your treatment options with your palliative care team. Treatments should be individualised with your treatment goals in mind.
The biggest challenge with bowel obstruction is that you will have nausea and vomiting, medications need to be prescribed to address this. You will need something that helps to decrease secretions e.g. Buscopan; something to decrease nausea and vomiting e.g. Maxalon or Haloperidol. If you have complete bowel obstruction, then Maxalon is contra-indicated; something for pain e.g. Morphine. Corticosteroids can be helpful as they decrease both nausea and vomiting and relieve obstruction by reducing the local swelling caused by the tumour masses. If you are vomiting too frequently that you can’t hold down your medication it will be worthwhile speaking to your doctor about a syringe driver to deliver your medication. The benefit is that you will not need to be admitted to hospital and can continue to stay at home or hospice.
Mouth care is very important it you are experiencing these complications. Suck on ice chips or take small sips of fluid if you have a dry mouth. Use Chapstick or Vaseline to keep your lips moist. If you are hungry then take small amounts of food. Most people with bowel obstruction find that they have up to a 50% decrease in appetite.
If medication fails, then surgical intervention might be an option e.g. venting gastrostomy or PEG. In 2020 nasogastric tubes are no longer considered as a second line option due to the complications that come with it. It should only be used as temporary measure to relieve pressure. A better option is a PEG tube which can be inserted under local anaesthetic. This will both relieve pressure and reduce nausea and vomiting and can be used for artificial nutrition. Once inserted, and you and your care giver know how to use it and take care of it, you will be allowed to go home.
What about artificial nutrition and hydration?
TPN is not routinely recommended. It can be useful in certain cases where the long-term prognosis is good. However, for end of life care it is an unnecessary intervention.
For hydration, drips and CVP lines are not necessary. If dehydration is a problem, then fluids can be given under the skin via syringe.