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Bowel Issues

My mom completed 6 IV Cycles and 3 consolidation IP cycles on JUL-8-2008.  On AUG 8 she had a PETCT which confirmed NED and her CA came in at 12

Early OCT she began having Bowel issues where she had episodes of severe abdomen spasm followed by vomiting after which her spasm resolved.  She had 3 such episodes in Oct.  On Nov 4th she had a complete body CT to see what is happening.  The CT report indicated small area of bowel inflammation with fluid filled bowel loops noted suggesting metastasis disease or inflammation/infection and further evaluation with CA 125 needed. Her CA 125 came in at 9 down from 12

We reviewed this with 2 GYN ONC surgeons who performed her surgery and also her medical oncologist.  All three are of the opinion that this is not metastasis disease and the inflammation is a side effect of IP chemo and a CA of 9 supports this as she is highly sensitive to it.  They said that after a major abdomen surgery they do see bowel issues in patients and occasionally the bowel gets twisted due to which she has such pains and this resolves eventually

When we questioned them about the radiologists comment about metastasis they said that a radiologist just writes down what he sees in the scan and is not the right person to confirm metastasis as he does not have a history of the patient and the treatment undergone

When asked what can be done about the bowel issues she is facing they recommended low fiber diet and gave us anti spasm meds to bee taken when she has flare ups

She had another such episode this week 1 month after the last one.  This time we noted that she had high fiber intake that day.

Does this inflammation and bowel issue resolve eventually or is it a chronic problem that she will continue to have?

What is your take on this whole thing?

Are there any other tests that we should push for to evaluate her current condition?  When we asked if a PET scan is needed they ruled it out saying this is not related to cancer so no PET scan is required
1 Responses
242604 tn?1328121225
Hi there, Thank you for your complete information.
I agree, in general, with your mother's doctors statements.

The most likely diagnosis is an obstruction of the intestine.  From the CT scan, an area of the small intestine shows narrowing and partial blockage.

The bowel is a very long tube that starts at the mouth and ends at the anus.
From the mouth next is esophagus, then stomach, then small intestine (duodenum, jejunum, ileum), then the large intestine (ascending colon, transverse colon, descending colon, sigmoid colon) and finally the rectum and then anus.

Women who experience ovarian cancer can commonly develop blockages or obstructions in any parts of the bowel (except it is rare to have a blockage of the esophagus which is the part of the gastrointestinal tract that traverses the middle of the chest (from mouth to stomach)).

Blockages can occur from three major reasons:
--adhesions which cause the bowel to twist and block off,
-- from a narrowing of a segment of the intestine because of an inflammatory process such as diverticulitis
--cancer recurrence that presses on the bowel or grows into the bowel

Usually the cause of the blockage is clear from context, exam, labs, and xrays.
There are times where the only way to know the cause is to operate.

For your mother, the most likely casue of her blockage is an adhesion(normal CA 125, no tumor seen on scan)

Medically, the first important question for her doctor is, does she need surgery to fix this obstruction.  It sounds like she has a partial blockage - that is most of the time, bowel movements get  through. However, perhaps aggravated by certain foods, she develops a complete blockage.

The signs of complete blockage include:
-abdominal distension
-lack of bowel movements

Many blockages can be managed without surgery with resting the bowel, IV hydration, and sometimes decompression of the bowel by a suction tube in the stomach called a NG tube (nasogastric )..

However, there are times when surgery is necessary to fix the obstruction by resecting the affected segment of intestine. At that time, it will become absolutely what the cause is.

if you google "bowel obstruction" there are several good references.

best wishes
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