Skip to main content

Diarrhea, Constipation, and Obstruction in Cancer Management

  • Chapter
  • First Online:
The MASCC Textbook of Cancer Supportive Care and Survivorship

Abstract

Gastrointestinal symptoms encountered by cancer patients include those not only induced by the primary malignancy but also by its treatment. These symptoms range from being nonspecific and annoying to life-threatening and a harbinger for imminent death. Symptoms from the primary tumor may be resolved with surgery, but subsequent adhesions may produce intermittent discomfort. Opiates may relieve somatic pain but induce severe pain and distress from constipation and bowel obstruction. When symptoms impact one’s quality of life, major efforts, and support may be required to prevent a decreased quantity of life. The clinical judgment and experience of the practitioner impacts not only which intervention is chosen but also the timing of the specific therapeutic modality. For patients with gastrointestinal symptoms, the management of iatrogenic diarrhea, constipation, and obstructive symptoms is central to the patient’s well-being. As the toxicities from conventional cytotoxic chemotherapeutic agents are predictable and manageable, combining “targeted agents” presents new challenges and opportunities in cancer care. The era of “molecular medicines” is here, and going forward with dose escalations and combinations is the immediate future in treating cancer. Success will depend upon not only identifying adverse effects from these anticancer agents but also in the development of supportive care pathways that controls or improves symptom burden.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Engelking C, Rutledge DN, Ippoliti C et al. Cancer-related diarrhea: a neglected cause of cancer-related symptom distress. Oncology Nursing Forum 1998;25(5):859–860.

    PubMed  CAS  Google Scholar 

  2. Hecht JR, Mitchell E, Chidiac T et al. A randomized phase IIIB trial of chemotherapy, bevacizumab, and panitumumab compared with chemotherapy and bevacizumab alone for metastatic colorectal cancer. Journal of Clinical Oncology 2009;27(5):672–680.

    Article  PubMed  CAS  Google Scholar 

  3. National Cancer Institute Common Toxicity Criteria. Available online at http:ctep.cancer.gov/protocolDevelopment/electronic_aaplications/docs/ctcaev3.pdf. Accessed February 5, 2010.

    Google Scholar 

  4. Ikuno N, Soda H, Watanabe M et al. Irinotecan (CPT-11) and characteristic mucosal changes in the mouse ileum and cecum. Journal of the National Cancer Institute 1995;87(24):1876–1883.

    Article  PubMed  CAS  Google Scholar 

  5. Milles S, Muggia A, Spiro H. Colonic histological changes induced by 5-fluorouracil. Gastroenterology 2010;43:390–391.

    Google Scholar 

  6. Meyerhardt JA, Mayer RJ. Systemic therapy for colorectal cancer [Review] [107 refs]. New England Journal of Medicine 2005;352(5):476–487.

    Article  PubMed  CAS  Google Scholar 

  7. Petrelli N, Douglass HO, Jr., Herrera L et al. The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Gastrointestinal Tumor Study Group [Erratum appears in J Clin Oncol 1990 Jan;8(1):185]. Journal of Clinical Oncology 1989;7(10):1419–1426.

    PubMed  CAS  Google Scholar 

  8. Cascinu S, Barni S, Labianca R et al. Evaluation of factors influencing 5-fluorouracil-induced diarrhea in colorectal cancer patients. An Italian Group for the Study of Digestive Tract Cancer (GISCAD) study. Supportive Care in Cancer 1997;5(4):314–317.

    Article  PubMed  CAS  Google Scholar 

  9. Kuebler JP, Colangelo L, O’Connell MJ et al. Severe enteropathy among patients with stage II/III colon cancer treated on a randomized trial of bolus 5-fluorouracil/leucovorin plus or minus oxaliplatin: a prospective analysis. Cancer 2007;110(9):1945–1950.

    Article  PubMed  CAS  Google Scholar 

  10. Sloan JA, Goldberg RM, Sargent DJ et al. Women experience greater toxicity with fluorouracil-based chemotherapy for colorectal cancer. Journal of Clinical Oncology 2002;20(6):1491–1498.

    Article  PubMed  CAS  Google Scholar 

  11. Lee A, Ezzeldin H, Fourie J et al. Dihydropyrimidine dehydrogenase deficiency: impact of pharmacogenetics on 5-fluorouracil therapy [Review] [51 refs]. Clinical Advances in Hematology & Oncology 2004;2(8):527–532.

    Google Scholar 

  12. Ezzeldin H, Diasio R. Dihydropyrimidine dehydrogenase deficiency, a pharmacogenetic syndrome associated with potentially life-threatening toxicity following 5-fluorouracil administration [Review] [70 refs]. Clinical Colorectal Cancer 2004;4(3):181–189.

    Article  PubMed  CAS  Google Scholar 

  13. Mattison LK, Fourie J, Desmond RA et al. Increased prevalence of dihydropyrimidine dehydrogenase deficiency in African-Americans compared with Caucasians. Clinical Cancer Research 2006;12(18):5491–5495.

    Article  PubMed  CAS  Google Scholar 

  14. van Kuilenburg AB, Meijer J, Mul AN et al. Analysis of severely affected patients with dihydropyrimidine dehydrogenase deficiency reveals large intragenic rearrangements of DPYD and a de novo interstitial deletion del(1)(p13.3p21.3). Human Genetics 2009;125(5–6):581–590.

    Article  PubMed  Google Scholar 

  15. van Kuilenburg AB, Meinsma R, Zonnenberg BA et al. Dihydropyrimidinase deficiency and severe 5-fluorouracil toxicity. Clinical Cancer Research 2003;9(12):4363–4367.

    PubMed  Google Scholar 

  16. Morel A, Boisdron-Celle M, Fey L et al. Identification of a novel mutation in the dihydropyrimidine dehydrogenase gene in a patient with a lethal outcome following 5-fluorouracil administration and the determination of its frequency in a population of 500 patients with colorectal carcinoma. Clinical Biochemistry 2007;40(1–2):11–17.

    Article  PubMed  CAS  Google Scholar 

  17. Gamelin E, Delva R, Jacob J et al. Individual fluorouracil dose adjustment based on pharmacokinetic follow-up compared with conventional dosage: results of a multicenter randomized trial of patients with metastatic colorectal cancer. Journal of Clinical Oncology 2008;26(13):2099–2105.

    Article  PubMed  CAS  Google Scholar 

  18. Andre T, Boni C, Navarro M et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. Journal of Clinical Oncology 2009;27(19):3109–3116.

    Article  PubMed  CAS  Google Scholar 

  19. de Gramont A, Figer A, Seymour M et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. Journal of Clinical Oncology 2000;18(16):2938–2947.

    PubMed  CAS  Google Scholar 

  20. Haller DG, Cassidy J, Clarke SJ et al. Potential regional differences for the tolerability profiles of fluoropyrimidines. Journal of Clinical Oncology 2008;26(13):2118–2123.

    Article  PubMed  CAS  Google Scholar 

  21. Cunningham D, Starling N, Rao S et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. New England Journal of Medicine 2008;358(1):36–46.

    Article  PubMed  CAS  Google Scholar 

  22. Abigerges D, Chabot GG, Armand JP et al. Phase I and pharmacologic studies of the camptothecin analog irinotecan administered every 3 weeks in cancer patients. Journal of Clinical Oncology 1995;13(1):210–221.

    PubMed  CAS  Google Scholar 

  23. Rouits E, Boisdron-Celle M, Dumont A et al. Relevance of different UGT1A1 polymorphisms in irinotecan-induced toxicity: a molecular and clinical study of 75 patients. Clinical Cancer Research 2004;10(15):5151–5159.

    Article  PubMed  CAS  Google Scholar 

  24. Gupta E, Lestingi TM, Mick R et al. Metabolic fate of irinotecan in humans: correlation of glucuronidation with diarrhea. Cancer Research 1994;54(14):3723–3725.

    PubMed  CAS  Google Scholar 

  25. Takasuna K, Hagiwara T, Hirohashi M et al. Involvement of beta-glucuronidase in intestinal microflora in the intestinal toxicity of the antitumor camptothecin derivative irinotecan hydrochloride (CPT-11) in rats. Cancer Research 1996;56(16):3752–3757.

    PubMed  CAS  Google Scholar 

  26. Wasserman E, Myara A, Lokiec F et al. Severe CPT-11 toxicity in patients with Gilbert’s syndrome: two case reports. Annals of Oncology 1997;8(10):1049–1051.

    Article  PubMed  CAS  Google Scholar 

  27. Maitland ML, Vasisht K, Ratain MJ. TPMT, UGT1A1 and DPYD: genotyping to ensure safer cancer therapy? [Review] [67 refs]. Trends in Pharmacological Sciences 2006;27(8):432–437.

    Article  PubMed  CAS  Google Scholar 

  28. Abigerges D, Armand JP, Chabot GG et al. Irinotecan (CPT-11) high-dose escalation using intensive high-dose loperamide to control diarrhea. Journal of the National Cancer Institute 1994;86(6):446–449.

    Article  PubMed  CAS  Google Scholar 

  29. Hecht JR. Gastrointestinal toxicity or irinotecan [Review] [77 refs]. Oncology (Williston Park) 1998;12(8 Suppl 6):72–78.

    CAS  Google Scholar 

  30. Fuchs CS, Moore MR, Harker G et al. Phase III comparison of two irinotecan dosing regimens in second-line therapy of metastatic colorectal cancer. Journal of Clinical Oncology 2003;21(5):807–814.

    Article  PubMed  CAS  Google Scholar 

  31. Fuchs CS, Marshall J, Barrueco J. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: updated results from the BICC-C study. Journal of Clinical Oncology 2008;26(4):689–690.

    Article  PubMed  Google Scholar 

  32. Lenz HJ, Van CE, Khambata-Ford S et al. Multicenter phase II and translational study of cetuximab in metastatic colorectal carcinoma refractory to irinotecan, oxaliplatin, and fluoropyrimidines. Journal of Clinical Oncology 2006;24(30):4914–4921.

    Article  PubMed  CAS  Google Scholar 

  33. Hanna N, Lilenbaum R, Ansari R et al. Phase II trial of cetuximab in patients with previously treated non-small-cell lung cancer. Journal of Clinical Oncology 2006;24(33):5253–5258.

    Article  PubMed  CAS  Google Scholar 

  34. Van CE, Peeters M, Siena S et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic ­colorectal cancer. Journal of Clinical Oncology 2007;25(13):1658–1664.

    Article  Google Scholar 

  35. Hecht JR, Patnaik A, Berlin J et al. Panitumumab monotherapy in patients with previously treated metastatic colorectal cancer. Cancer 2007;110(5):980–988.

    Article  PubMed  CAS  Google Scholar 

  36. Moy B, Goss PE. Lapatinib-associated toxicity and practical management recommendations [Review] [58 refs]. Oncologist 2007;12(7):756–765.

    Article  PubMed  CAS  Google Scholar 

  37. Carter CA, Kelly RJ, Giaccone G. Small-molecule inhibitors of the human epidermal receptor family [Review] [105 refs]. Expert Opinion on Investigational Drugs 2009;18(12):1829–1842.

    Article  PubMed  CAS  Google Scholar 

  38. Shepherd FA, Rodrigues PJ, Ciuleanu T et al. Erlotinib in previously treated non-small-cell lung cancer. New England Journal of Medicine 2005;353(2):123–132.

    Article  PubMed  CAS  Google Scholar 

  39. Thatcher N, Chang A, Parikh P et al. Gefitinib plus best supportive care in previously treated patients with refractory advanced non-small-cell lung cancer: results from a randomised, placebo-controlled, multicentre study (Iressa Survival Evaluation in Lung Cancer). Lancet 2005;366(9496):1527–1537.

    Article  PubMed  CAS  Google Scholar 

  40. Messersmith WA, Laheru DA, Senzer NN et al. Phase I trial of irinotecan, infusional 5-fluorouracil, and leucovorin (FOLFIRI) with erlotinib (OSI-774): early termination due to increased toxicities. Clinical Cancer Research 2004;10(19):6522–6527.

    Article  PubMed  CAS  Google Scholar 

  41. Czito BG, Willett CG, Bendell JC et al. Increased toxicity with gefitinib, capecitabine, and radiation therapy in pancreatic and rectal cancer: phase I trial results. Journal of Clinical Oncology 2006;24(4):656–662.

    Article  PubMed  CAS  Google Scholar 

  42. Clark JW, Eder JP, Ryan D et al. Safety and pharmacokinetics of the dual action Raf kinase and vascular endothelial growth factor receptor inhibitor, BAY 43-9006, in patients with advanced, refractory solid tumors. Clinical Cancer Research 2005;11(15):5472–5480.

    Article  PubMed  CAS  Google Scholar 

  43. Escudier B, Eisen T, Stadler WM et al. Sorafenib in advanced clear-cell renal-cell carcinoma [Erratum appears in N Engl J Med 2007 Jul 12;357(2):203]. New England Journal of Medicine 2007;356(2):125–134.

    Article  PubMed  CAS  Google Scholar 

  44. Worns MA, Weinmann A, Pfingst K et al. Safety and efficacy of sorafenib in patients with advanced hepatocellular carcinoma in consideration of concomitant stage of liver cirrhosis. Journal of Clinical Gastroenterology 2009;43(5):489–495.

    Article  PubMed  Google Scholar 

  45. Motzer RJ, Hutson TE, Tomczak P et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. New England Journal of Medicine 2007;356(2):115–124.

    Article  PubMed  CAS  Google Scholar 

  46. Demetri GD, van Oosterom AT, Garrett CR et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomised controlled trial. Lancet 2006;368(9544):1329–1338.

    Article  PubMed  CAS  Google Scholar 

  47. Socinski MA, Novello S, Brahmer JR et al. Multicenter, phase II trial of sunitinib in previously treated, advanced non-small-cell lung cancer. Journal of Clinical Oncology 2008;26(4):650–656.

    Article  PubMed  CAS  Google Scholar 

  48. Deininger MW, O’Brien SG, Ford JM et al. Practical management of patients with chronic myeloid leukemia receiving imatinib [Review] [35 refs]. Journal of Clinical Oncology 2003;21(8):1637–1647.

    Article  PubMed  CAS  Google Scholar 

  49. Motzer RJ, Escudier B, Oudard S et al. Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet 2008;372(9637):449–456.

    Article  PubMed  CAS  Google Scholar 

  50. Yao JC, Lombard-Bohas C, Baudin E et al. Daily oral everolimus activity in patients with metastatic pancreatic neuroendocrine tumors after failure of cytotoxic chemotherapy: a phase II trial. Journal of Clinical Oncology 2010;28(1):69–76.

    Article  PubMed  CAS  Google Scholar 

  51. Kane RC, Farrell AT, Sridhara R et al. United States Food and Drug Administration approval summary: bortezomib for the treatment of progressive multiple myeloma after one prior therapy. Clinical Cancer Research 2006;12(10):2955–2960.

    Article  PubMed  CAS  Google Scholar 

  52. Mann BS, Johnson JR, He K et al. Vorinostat for treatment of cutaneous manifestations of advanced primary cutaneous T-cell lymphoma. Clinical Cancer Research 2007;13(8):2318–2322.

    Article  PubMed  CAS  Google Scholar 

  53. Rosenoff SH, Gabrail NY, Conklin R et al. A multicenter, randomized trial of long-acting octreotide for the optimum prevention of chemotherapy-induced diarrhea: results of the STOP trial. The Journal of Supportive Oncology 2006;4(6):289–294.

    PubMed  CAS  Google Scholar 

  54. Benson AB, III, Ajani JA, Catalano RB et al. Recommended guidelines for the treatment of cancer treatment-induced diarrhea. Journal of Clinical Oncology 2004;22(14):2918–2926.

    Article  PubMed  CAS  Google Scholar 

  55. Maroun J, Anthony L, Blais N et al. Prevention and management of chemotherapy-induced diarrhea in patients with colorectal cancer: a consensus statement by the Canadian Working Group on Chemotherapy-Induced Diarrhea. Current Oncology 2007;14:13–20.

    Article  PubMed  CAS  Google Scholar 

  56. Lamberts SW, van der Lely AJ, de Herder WW et al. Octreotide [Review] [76 refs]. New England Journal of Medicine 1996;334(4):246–254.

    Article  PubMed  CAS  Google Scholar 

  57. Cascinu S, Fedeli A, Fedeli SL et al. Octreotide versus loperamide in the treatment of fluorouracil-induced diarrhea: a randomized trial. Journal of Clinical Oncology 1993;11(1):148–151.

    PubMed  CAS  Google Scholar 

  58. Kornblau S, Benson AB, Catalano R et al. Management of cancer trea­tment-related diarrhea. Issues and therapeutic strategies [Review] [63 refs]. Journal of Pain and Symptom Management 2000;19(2):118–129.

    Article  PubMed  CAS  Google Scholar 

  59. Harris AG, O’Dorisio TM, Woltering EA et al. Consensus statement: octreotide dose titration in secretory diarrhea. Diarrhea Management Consensus Development Panel [Review] [39 refs]. Digestive Diseases and Sciences 1995;40(7):1464–1473.

    Article  PubMed  CAS  Google Scholar 

  60. Goumas P, Naxakis S, Christopoulau A et al. Octreotide acetate in the treatment of fluorouracil-induced diarrhea. The Oncologist 1998;3:50–53.

    PubMed  CAS  Google Scholar 

  61. Abernethy AP, Wheeler JL, Zafar SY. Detailing of gastrointestinal symptoms in cancer patients with advanced disease: new methodologies, new insights, and a proposed approach [Review] [39 refs]. Current Opinion in Supportive and Palliative Care 2009;3(1):41–49.

    Article  PubMed  Google Scholar 

  62. Yamagishi A, Morita T, Miyashita M et al. Symptom prevalence and longitudinal follow-up in cancer outpatients receiving chemotherapy. Journal of Pain and Symptom Management 2009;37(5):823–830.

    Article  PubMed  Google Scholar 

  63. Legha SS. Vincristine neurotoxicity. Pathophysiology and management [Review] [45 refs]. Medical Toxicology 1986;1(6):421–427.

    PubMed  CAS  Google Scholar 

  64. Holland JF, Scharlau C, Gailani S et al. Vincristine treatment of advanced cancer: a cooperative study of 392 cases. Cancer Research 1973;33(6):1258–1264.

    PubMed  CAS  Google Scholar 

  65. Hohneker JA. A summary of vinorelbine (Navelbine) safety data from North American clinical trials. Seminars in Oncology 1994;21(5 Suppl 10):42–46.

    PubMed  CAS  Google Scholar 

  66. Haim N, Epelbaum R, Ben-Shahar M et al. Full dose vincristine (without 2-mg dose limit) in the treatment of lymphomas. Cancer 1994;73(10):2515–2519.

    Article  PubMed  CAS  Google Scholar 

  67. Singhal S, Mehta J, Desikan R et al. Antitumor activity of thalidomide in refractory multiple myeloma [Erratum appears in N Engl J Med 2000 Feb 3;342(5):364]. New England Journal of Medicine 1999;341(21):1565–1571.

    Article  PubMed  CAS  Google Scholar 

  68. Fine HA, Figg WD, Jaeckle K et al. Phase II trial of the antiangiogenic agent thalidomide in patients with recurrent high-grade gliomas. Journal of Clinical Oncology 2000;18(4):708–715.

    PubMed  CAS  Google Scholar 

  69. Dimopoulos MA, Eleutherakis-Papaiakovou V. Adverse effects of thalidomide administration in patients with neoplastic diseases [Review] [91 refs]. American Journal of Medicine 2004;117(7):508–515.

    Article  PubMed  CAS  Google Scholar 

  70. National Comprehensive Cancer Network. NCCN: Palliative Care. In NCCN Clinical Practice Guidelines Version 1.2010. 1–52. 2010.

    Google Scholar 

  71. Weed HG. Lactulose vs sorbitol for treatment of obstipation in hospice programs. Mayo Clinic Proceedings 2000;75(5):541.

    PubMed  CAS  Google Scholar 

  72. Reville B, Axelrod D, Maury R. Palliative care for the cancer patient [Review] [146 refs]. Primary Care 2009;36(4):781–810.

    Article  PubMed  Google Scholar 

  73. Verne GN, Davis RH, Robinson ME et al. Treatment of chronic constipation with colchicine: randomized, double-blind, placebo-controlled, crossover trial. American Journal of Gastroenterology 2003;98(5):1112–1116.

    PubMed  CAS  Google Scholar 

  74. Thomas J, Karver S, Cooney GA et al. Methylnaltrexone for opioid-induced constipation in advanced illness. New England Journal of Medicine 2008;358(22):2332–2343.

    Article  PubMed  CAS  Google Scholar 

  75. Nyam DC, Pemberton JH, Ilstrup DM et al. Long-term results of surgery for chronic constipation [Erratum appears in Dis Colon Rectum 1997 May;40(5):529]. Diseases of the Colon and Rectum 1997;40(3):273–279.

    Article  PubMed  CAS  Google Scholar 

  76. Mercadante S, Casuccio A, Mangione S. Medical treatment for inoperable malignant bowel obstruction: a qualitative systematic review [Review] [14 refs]. Journal of Pain and Symptom Management 2007;33(2):217–223.

    Article  PubMed  CAS  Google Scholar 

  77. Weber C, Zulian GB. Malignant irreversible intestinal obstruction: the powerful association of octreotide to corticosteroids, antiemetics, and analgesics. American Journal of Hospice & Palliative Medicine 2009;26(2):84–88.

    Article  Google Scholar 

  78. Mangili G, Aletti G, Frigerio L et al. Palliative care for intestinal obstruction in recurrent ovarian cancer: a multivariate analysis. International Journal of Gynecological Cancer 2005;15(5):830–835.

    Article  PubMed  CAS  Google Scholar 

  79. Feuer DJ, Broadley KE. Systematic review and meta-analysis of corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancers. Systematic Review Steering Committee. Annals of Oncology 1999;10(9):1035–1041.

    CAS  Google Scholar 

  80. Baines M, Oliver DJ, Carter RL. Medical management of intestinal obstruction in patients with advanced malignant disease. A clinical and pathological study. Lancet 1985;2(8462):990–993.

    CAS  Google Scholar 

  81. Mercadante S, Ripamonti C, Casuccio A et al. Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Supportive Care in Cancer 2000;8(3):188–191.

    Article  PubMed  CAS  Google Scholar 

  82. Ripamonti C, Mercadante S, Groff L et al. Role of octreotide, scopolamine butylbromide, and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: a prospective randomized trial. Journal of Pain and Symptom Management 2000;19(1):23–34.

    Article  PubMed  CAS  Google Scholar 

  83. Mystakidou K, Tsilika E, Kalaidopoulou O et al. Comparison of octreotide administration vs conservative treatment in the management of inoperable bowel obstruction in patients with far advanced cancer: a randomized, double-blind, controlled clinical trial. Anticancer Research 2002;22(2B):1187–1192.

    PubMed  CAS  Google Scholar 

  84. Mercadante S, Ferrera P, Villari P et al. Aggressive pharmacological treatment for reversing malignant bowel obstruction. Journal of Pain and Symptom Management 2004;28(4):412–416.

    Article  PubMed  Google Scholar 

  85. Massacesi C, Galeazzi G. Sustained release octreotide may have a role in the treatment of malignant bowel obstruction. Palliative Medicine 2006;20(7):715–716.

    PubMed  Google Scholar 

  86. Matulonis UA, Seiden MV, Roche M et al. Long-acting octreotide for the treatment and symptomatic relief of bowel obstruction in advanced ovarian cancer. Journal of Pain and Symptom Management 2005;30(6):563–569.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lowell B. Anthony .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Society for Imaging Informatics in Medicine

About this chapter

Cite this chapter

Anthony, L.B. (2010). Diarrhea, Constipation, and Obstruction in Cancer Management. In: Olver, I. (eds) The MASCC Textbook of Cancer Supportive Care and Survivorship. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-1225-1_26

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1225-1_26

  • Published:

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4419-1224-4

  • Online ISBN: 978-1-4419-1225-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics