A bowel obstruction — the partial or complete blockage of the small or large intestine — sometimes occurs in people with cancer. In people with cancer, tumor growth may be the primary cause of an obstruction, but other causes are often found. According to the National Cancer Institute, these include:

• Narrowing of the intestine from inflammation or damage to the bowel
  
• Scar tissue from previous abdominal surgery
  
• Hernias
  
• Twisting of the bowel (volvulus)
  
• Pressure on the bowel from outside the intestinal tract
  
• Factors that interfere with the function of muscles, nerves and blood flow to the bowel

Radiation to the abdominal cavity can also cause a bowel obstruction.

An obstruction, regardless of cause, will require immediate medical attention, for both diagnostic procedures and treatment.

Symptoms

Symptoms of bowel obstruction will depend, to some degree, on the location of the obstruction — small or large intestine, as well as the degree of obstruction, ranging from partial to complete. Please note that it is not necessary to have all of the symptoms of obstruction before seeking help. If you have abdominal pain that doesn't go away in a day or so, contact your health care provider immediately.

Small intestine obstruction symptoms include:

• Abdominal pain and cramping, often coming in "waves"
• Nausea and vomiting
• Bloated abdomen
• Usually, no gas passing rectally

Large intestine obstruction symptoms include:

• Bloated abdomen
• Abdominal pain ranging in severity from mild to severe
• Rectal bleeding
• Constipation
• Occasionally, leaking of stool from the rectum
• Fever, rapid pulse, dehydration
• Changes in hair and/or nails

If any of these symptoms don't resolve within a day or so, immediate medical attention is needed. Your physician will look for the cause of your symptoms, working to determine if you have a blockage and if so, where the blockage is and its causes. She or he will use some or all of these techniques:

• Talking with you about your symptoms, surgical history and other medical conditions
• A physical exam
• A rectal exam
• Abdominal x-rays
• Barium enema
• Blood tests
• Endoscopy
• CT Scan
• Urine analysis

Treatment

Once your health care provider has determined the probable cause and source of obstruction, steps toward confirming diagnosis and treatment can begin. Depending on the specific cause of your obstruction and your overall condition at the time of diagnosis, various approaches, most of which require hospitalization, may be tried to relieve the obstruction:

• If the obstruction is only partial, a nasogastric tube will be inserted through the nose and into the stomach. This can help remove built-up fluid and gas, helping the colon to relax (similar to unkinking a garden hose), and possibly eliminate the need for surgery.
  
  
  • In some cases, where the blockage is suspected to be in the lower section of the large intestine, a tube can be inserted rectally into the bowel. If successful, this produces the same result as the nasogastic tube.
    
    
• If obstruction is complete, surgery will often be necessary to remove the blockage. Sometimes surgery is also required for partial blockages, to correct the cause of the obstruction and prevent repeated episodes of obstruction. Sometimes surgery may make it necessary to remove a section of the colon, and provide patients with a temporary colostomy, which can later be reversed.
  
  
• For some patients, especially those with advanced cancer, surgery may not a good choice. In those instances, placement of a stent (a self-expanding tube placed at the site of the obstruction, designed to keep intestine open) may be the best choice of treatment. A stent can help people relieve discomfort and pain, and allow eating and drinking again. Placing a stent is a major surgery, and a recovery period must follow.
  
  
  • For some patients, a gastrostomy — the surgical creation of a permanent opening from the abdomen into the stomach for the insertion of a feeding tube — may be the recommended treatment.

Questions for Your Doctor

In treating a bowel obstruction your health care team may include an internist, a gastroenterologist, an oncologist and/or a surgeon.

1. How long will my recovery from treatment take?
   
   
2. Is it likely that I will have further bowel obstructions? Is there anything I can do to help prevent obstruction?
   
   
3. What medications should I take to help manage my side effects from surgery and other treatment? How long will I need to take these medications?
   
   
4. What choices do I have for treatment of a bowel obstruction?

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