Management of intestinal obstruction in the patient with ovarian cancer

Intestinal obstruction in the patient with ovarian cancer is a difficult situation for both patient and physician. In women presenting with ovarian cancer, obstruction is almost never complete. These women should undergo aggressive bowel surgery only if it is part of an optimal surgical cytoreduction. Women known to have ovarian cancer who develop intestinal obstruction have a poor prognosis: Few will live more than a year from the time of obstruction. Some, however, have an excellent performance status, and would be relatively unimpaired were it not for their obstruction. These women, who usually have a discrete obstruction and still display some response to chemotherapy, may benefit from surgical correction of the obstruction. Women who are not candidates for surgery can be effectively palliated pharmacologically so that they are comfortable with the obstruction, often without intestinal drainage. Algorithms are available to assist in the management of ovarian cancer patients with obstruction, but ultimately the treatment decision rests with the patient. The oncologist must use his or her knowledge and clinical judgment to help the patient develop an appropriate, individualized plan.