Palliation and symptom control
Conservative and systemic management of bowel obstruction
Bowel obstruction and intestinal failure with stasis are common late events in ovarian cancer and can be difficult to manage.
Chemotherapy, sometimes supported by total parenteral nutrition, may be used in patients for whom a response is thought to be possible. Extensive tumour dissemination combined by an acute systemic inflammatory immunological response can make any surgical intervention in this setting highly challenging with high morbidity and mortality. When undertaken, surgical procedures include en bloc resections of the involved intestinal package and terminal proximal stomas of the ileum or jejunum, since extensive peritoneal involvement and inflammation makes dissection and formation of anastomoses difficult. The resulting ‘short bowel syndrome’ can be difficult to manage, and although feasible, prolonged communitybased total parenteral nutrition has not been fully assessed. Progress in endoscopic techniques such as placement of intestinal stents and gastrostomies have improved care of patients and have reduced morbidity.Symptom management and terminal care
Recurrent ascites or pleural effusions can be relieved by drainage. More permanent measures such as pleurodesis or long-term abdominal drainage catheters for recurrent ascites may be helpful. Vomiting and constipation with bowel dysfunction, due to obstruction or more commonly a ‘paresis’ with stasis due to extensive serosal infiltration, is the most common symptom to manage during end of life care. Medical management of symptoms includes the use of antiemetic and prokinetic drugs, steroids, and octreotide. Careful assessment of fluid and calorie intake is needed and treatment decisions about support need to take account of the disease status, remaining chemotherapy options, and patients’ wishes. The success of ‘end of life’ care, whether at home, in hospital, or in a hospice benefits from the involvement of a multidisciplinary healthcare team that is able to work with the patient to find the most acceptable treatment plan for her.