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Bowel obstruction
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Bowel obstruction

Hi Doctor,

My recurrences have always been in the form of bowel obstructions, which were resolved with chemo. At those times, my CA125 count was around 600, I didn't have any bowel movements whatsoever, I didn't have gases and I certainly didn't do feces. My abdomen was distended and I did vomiting.

Right now, my abdomen is not distended, my last CA125 count was 140 (CA125 has always been an accurate marker for me), I didn't loose much weight, I feel strong, I frequently have gases and I already did feces twice (not diarrhea) and did diarrhea for a couple of times, and I also feel my intestines moving strongly. However, everytime I try to take some liquids (soup water) my abdomen gets distended. Once I stop the liquids ingestion my abdomen gets normal after a couple of days. I don't have vomiting, although I had have before chemo and during chemo's first cycle. I'm on the 2nd cycle of Cabo+Gemzar combination, which ends on next wednesday. Nothing is shown on CT and X ray only shows some narrowing in my bowel. I'll do a PET scan next week and will have new CA125 count.

It seems that although the chemo has helped (CA125=148 prior to it and 140 after chemo's 1st cycle) with symptoms improvement on 2nd cycle(stoped vomiting, did feces, having gases, feeling better and well) my partial bowel obstruction persists. I'm hospitalized for more than 2 months now, I'm on TPN and my blood analysis is normal.

In your opinion, what should I do: 1. keep on chemo? 2. Go into surgery? In case of adhesions, what are the chances of bowel unblocks by itself? How can I know BO cause?
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Dear VCF,
I am so sorry to hear about your troubles. I cannot give you a comprehensive opinion without seeing your films or knowing more about all that you have been through. However i can give you some general rule of thumbs when it comes to the experience of bowel obstruction in the setting of ovarian cancer:

Intestinal blockages that can be fixed by surgery are isolated. that is : the intestine is normal except for one or two areas where the bowel has become blocked. in that case, the affect piece of intestine can be surgically cut out and the bowel can be put back together. Sometimes the affected bowel can be removed but the bowel cannot be put back together and a person ends up with a colostomy (large bowel) or ileostomy (small bowel) which means that the intestine (bowel) is brought up to the skin and a bag is put over it to collect the bowel movements.

Many times for women with ovarian cancer, there are many areas that are blocked or narrowed by cancer. The cancer may just be coating the external surface of the intestine without actually blocking it off. But this external coating prevents the bowel from moving (peristalsis)

It is also possible to get what is called a gastric outlet obstruction where the cancer has caused a coating around the stomach so that it cannot distend. that causes vomiting when you try to eat anything. It may be that you have a gastric outlet obstruction.

If the x rays do not show a discreet area of blockage, it is better to treat this with chemotherapy. it may not be possible to fix this with surgery.

You should definitely ask your doctor these questions.

I would recommend staying with the carbo-gemzar for at least 3 cycles to see if it is helping
best wishes to you

2 Comments
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sounds like it could be adhesions.   Can they see those in Cat scans?
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A related discussion, What happens next was started.
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