Bowel obstruction typically occurs in people with advanced and recurrent ovarian cancer. When cancer spreads to the abdominal cavity, tumors may block a person’s intestines, causing digested food and waste to become stuck.
Research suggests that bowel obstruction occurs in 25–60% of people who receive treatment for gynecological cancers.
This complication is associated with lower survival rates among people with cancer. Experts consider it the most common cause of death in individuals with ovarian cancer.
This article discusses bowel obstruction in ovarian cancer, including its signs and symptoms and the treatment options. It also looks at the survival rates of people with ovarian cancer who experience this complication.
Bowel obstruction occurs in between 5.5% and 51% of people with ovarian cancer and may be more likely to occur in advanced or recurrent ovarian cancer. Obstruction occurs because tumors and enlarged lymph nodes compress the bowels, typically the small intestine, causing digested food and waste to become stuck.
Ovarian cancer is the
Doctors describe cancer as being at an advanced stage when the cancer cells have already spread to nearby and distant areas. Ovarian cancer may spread to adjacent organs such as the uterus and fallopian tubes. Cancer cells may also travel and “seed” in the abdominal and pelvic organs through the peritoneal fluid and peritoneum.
Learn more about the stages of ovarian cancer.
Tumors may also infiltrate the muscles, nerves, or mesentery, which is a folded band of tissue connecting the intestines to the major vessels of the abdomen. Edema of the bowel wall, fecal impaction, and drugs that cause constipation may also lead to or worsen bowel obstruction.
Generally, bowel obstruction is associated with a median overall survival of about 90 days in people with ovarian cancer.
People with recurrent ovarian cancer have a median survival of 45–169 days following the diagnosis.
The symptoms associated with bowel obstruction are often subacute, meaning that they may take some time to appear. They include:
- nausea and vomiting
- pain
- absence of gas or stool
- inability to eat
- abdominal swelling or distention
- abdominal cramps
- bloating
- feeling sick or unwell
- constipation
- changes in stool color or consistency e.g. liquid stools (diarrhea)
Low grade fever and a fast heartbeat may also be present.
In people with partial bowel obstruction, the symptoms may be intermittent.
In most cases, people with ovarian cancer and bowel obstruction have a low level of physical health and a limited life expectancy.
As a result, the primary goals of treatment are to maintain the person’s quality of life, control or manage the symptoms, and prolong life.
Bowel rest
Doctors may recommend resting the bowel for several days. During this time, doctors restrict a person from consuming anything by mouth. They will give the person IV fluids instead until the blockage clears.
Surgery
Surgery carries risks and may cause complications and death. However, it may be an option for people with a good overall health status. The surgical options include:
- bowel resection
- anastomosis
- bypass surgery
- stoma formation for ileostomy or colostomy
- placement of percutaneous endoscopic gastrostomy (PEG), a flexible feeding tube placed in the stomach
In individuals with a localized blockage, a doctor may use endoscopy to place a small tube called a stent. The stent should keep the bowel open and relieve the symptoms.
Medical management
Depending on their symptoms, a doctor may suggest different management for people who are not candidates for surgery.
They may suggest gastrointestinal decompression or drainage using a nasogastric tube. This may be helpful for people who are vomiting a lot or persistently.
Sometimes, doctors may recommend palliative chemotherapy. The purpose of this treatment is not to cure a person’s cancer but to manage distressing symptoms and improve the quality — and, ideally, the length — of life.
Total parenteral nutrition
Malnutrition affects about
Parenteral nutrition involves administering nutrients, such as carbohydrates, protein, fats, and minerals, to people using IV fluids.
A 2019 study found that individuals who received palliative home parenteral nutrition had a survival rate of
Medications
Instead of an operation, a doctor may prescribe different medications to help relieve the symptoms of bowel obstruction. Medications include:
- Steroids: These may help relieve the obstruction by reducing inflammation in the bowels.
- Somatostatin and its analogs: Drugs such as octreotide acetate (Sandostatin) are artificial forms of the hormone somatostatin, and doctors can use them to treat watery diarrhea.
- Anti-secretory drugs: These medications reduce the secretions of acids in the stomach.
- Pain relievers: Doctors may prescribe over-the-counter or prescription medications such as opioids to help with severe pain.
- Anti-emetics: These drugs help prevent nausea and vomiting.
A doctor will ask questions about the person’s symptoms and overall bowel function and then perform a physical exam to diagnose bowel obstruction. They may also ask about the person’s medications and fluid intake.
In some cases, imaging tests may be necessary to confirm the diagnosis. These include:
- plain abdominal X-rays
- barium enema
- CT scan
Bowel obstruction is a significant cause of morbidity and death in ovarian cancer. A person should immediately seek medical care if they notice symptoms of bowel obstruction, such as:
- abdominal pain
- nausea and vomiting
- lack of appetite
- abdominal swelling or distention
- severe constipation
Bowel obstruction is a common complication that occurs in the advanced stages of ovarian cancer. Despite surgical and medical interventions, research links bowel obstruction with a median survival of just 3 months after diagnosis.
At this stage, treatment aims to improve a person’s quality of life and comfort. Depending on the extent of the disease and the person’s health status, the healthcare team will recommend various treatments, ranging from surgery to medical management and medications.