OK – we’ve gone through diagnosis; we’ve gone through treatment and now we need to live with the consequences of cancer and its treatment. Not a day goes by when I don’t feel some twinge or some minor pain, and I think ‘what was that?‘. Fortunately, many things can just be day-to-day niggles or in my case, the perils of getting older!
The natural tendency is to think your cancer is causing these things…. easy to say, but very often not easy to prove. However, for Neuroendocrine Tumour (NET) patients who have had surgery, anything that seems like a bowel obstruction is quite a scary thought (I suspect this is also an issue for other cancer types). In fact, even before diagnosis, a bowel obstruction can be how the condition is diagnosed in the first place, i.e. pain leads to more pain, and that can sometimes result in a visit to the ER/A&E which can very often lead to a scan and an incidental diagnosis of NETs (and I suspect some other cancers).
I guess this isn’t just a threat for those who’ve had intestinal NETs but others in the vicinity of the intestines could also have this issue – the abdominal cavity is full of organs all very closely packed together! Both the small intestine and the large intestine can become blocked and if they can’t be unblocked by non-surgical means, it can become a bit of a drama for the patient. Blockages can be full or partial so it can often be a tough call for the medical team due to the effects of the patient’s existing surgery including but not limited to previous surgical scarring (adhesions), mesentery, or retroperitoneal fibrosis complications (yes retroperitoneal fibrosis is a thing – read about that by clicking here). Clearing the blockage by non-surgical means is the optimum solution. The presentational symptoms and scans can give immediate clues. Although there are slightly different symptoms for large and small intestine (bowel) obstructions, the key symptoms of a blockage would appear to be:
Feeling bloated and full
Severe abdominal pain
Feeling sick
Vomiting large amounts
Constipation and inability to pass gas
Looking at some authoritative sites, the logical (and fairly obvious) decision steps seem to be:
Is there an obstruction or is the problem something else?
If an obstruction, where exactly is it?
What is causing the obstruction?
Are there any complications such as adhesions, twisted loops or hernias
Optimum treatment
In the event of a trip to ER/A&E feeling like nothing is getting through, no home remedies are working, and the pain is becoming unbearable, then I would insist they check my latest CT scan on their system in order to at least see my adjusted plumbing. I suspect in many cases; a fresh CT might be ordered. I would also insist they call my NET team in order that they are made aware of my clinical background and risks. Several clinical trials have shown that nonoperative management resolves most uncomplicated small bowel obstructions. Personally, the very last thing I would want is another bowel surgery, which can come with considerable morbidity in someone with existing surgery in that area. I would hope that a non-operative solution could be found. But I would want my NET team involved in any non-oral solutions.
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