What Are the Treatments for Bowel Obstruction With Colon Cancer?

Colon cancer refers to cancer that originates in the colon. Ninety-five percent of colon cancer cases begin with polyps in the colon called adenomas, which grow in the colon's lining before slowly spreading to the colon or rectum. Approximately 10 percent of colon cancer patients experience bowel obstruction, and bowel obstruction is usually associated with late stage or end stage colon cancer.

Goal of Treatment

• Generally, colon cancer is not curable and the treatment for the bowel obstruction is designed not to cure the obstruction but to improve quality of life. Bowel obstruction has a devastating impact on quality of life. The intestine is not designed to compensate for an immovable obstruction, such as that caused by tumors or cancer cells. The normal process of fluid absorption and secretion is unable to occur as a result of the obstruction, which exacerbates the problem and causes increased secretion of fluid. This increased fluid creates symptoms, including further blockage or dilation of the intestine, nausea, vomiting and cramping. The cramping then causes further secretions, which causes the cycle to begin again. The patient usually becomes dehydrated and death may occur quickly without treatment. The primary goal of this treatment is to compensate for the obstruction, manage the secretions, and minimize symptoms.

Palliative Care

• The main goal of palliative, or pain management patient care, is to attempt to achieve as normal a function as possible in the unobstructed colon. The ability to do this depends on the size of the obstruction. In metastatic colon cancer, often there are multiple areas of obstruction, but there still may be many feet of the intestine that are not obstructed. Surgically inserting stents to open small areas of obstruction to allow fluids to pass normally may help the remainder of the intestine function, achieving a reduction in symptoms.

Octreotide

• Octreotide has been cited in the "Journal of Palliative Care" as the most important drug used in the treatment for bowel obstruction. The purpose of the drug is to reduce secretions of fluids into the colon and intestine. Generally, the drug has few negative side effects and can significantly reduce symptoms, including nausea and vomiting associated with a bowel obstruction. The downside to the drug is cost--it is very expensive.

Promotility Agents or Antiemetics

• If there is no cramping associated with the bowel obstruction, promotility agents, such as the drug Metoclopramide, are used to help the colon and intestine function. These agents help material move throughout the colon and large intestine more freely, and encourage the muscles of the intestine to push material long. If cramping is associated with the bowel obstruction, antiemetics are used to prevent motion through the bowels and contracting of the intestine, once patients are no longer eating or drinking. This allows the colon to rest to reduce the cramping, intestinal secretions and nausea.

Other Treatments

• Nasogastric, or NG tubes, can be placed in the colon to allow feeding and decompression. These NG tubes can reduce nausea. A drug called Simethicone can be used to encourage burping to allow for the release of intestinal gas. A low-fiber diet is also recommended in order to minimize the frequency of emptying the bowels. End stage or terminal patients with complete blockage who do not eat at all may vomit periodically, but will not need to empty their bowels. Opiods and other pain relievers may also be given to deal with pain management.