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 surgeryDecreased intake of fluids and chronic dehydrationOpioid narcotics for pain reliefSide effects of radiation therapyMetastasis 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 eatingVomiting, including vomiting of foul or fecal contentAbdominal painCramps or colicky discomfort in the abdomenCessation 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 metastasisYour age and general healthAny other health conditions you might have, such as diabetes or heart diseaseYour 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.
