Colon stopped working for ovarian cancer patient

[fernanda99]

Hi,

Mi mom's ovarian cancer was discovered 2 years ago, when she was 57. Since then, she had surgery and 2 rounds of chemo. She was doing fine until last month, when she started having serious constipation problems: no bowel movement for over 10 days.  Doctors performed a colostomy with no positive results: still no movement in the following 10 days. She went for another examination, but colonoscopy could not be performed because the colon was obstructed. The surgeon doesn't want to operate again because she is really week, has lost 13 pounds in 2 weeks and is dehydrated and anemic. The oncologist said that ovarian cancer often causes the colon to paralyze.
What else can we try? Is it worth it to operate again? as the first surgery didn't work.
Can something be done to "restart" the colon?  How can we help her?

Please, any help would be greatly appreciated, I am really desperate and can't believe there is nothing else to be done.
Thank you all,
Fernanda

[Annekathryn Goodman, M.D.]

Thank you Fernanda,

It sounds like the best thing you can do is to set up a meeting with your mother's doctor. If you have other family members who can come that would be ideal. You should make a list of questions to ask.
Consider using the questions that I asked you.

It is not possible to know what is going on with your mother without the information I suggested:
-does she have a blockage in an area before the colostomy?
-what xray tests have been done to determine if there is a blockage?.
-are her doctors sure that she does not have more than one area of bowel obstruction or blockage?
-How do they know that the cancer has not come back.?
-What kind of incision was made to make the colostomy? Was it a large midline incision where the whole abdomen can be explored or did her surgeon just make a small incision to pull up the colon to the abdominal wall?

if you are unable to visit your mother, see if another family member can help find out what is going on.

please let us know what happens
best wishes

[fernanda99]

Thank you for your answer. I'll try to answer all of your questions the best I can... I live away from home and sometimes I just get the summary of the situation.

Yes, in 2006 she had ovarian cancer surgery where the ovaries and a part of the epiploon were removed.  The uterus had been removed years before. The chemo was IV, but not sure what kind of medicine.
Late July 2008 she stopped having bowel movement. She had always have constipation problems, so she went about 11 days trying to fix it by herself (also because we were away in vacation). They performed a colostomy on Aug 7th and had the bag placed outside. A few days later she was discharged form the hospital, and at the begining she was having some secretions (mucus most of it). But then again , about a week ago she stop having any movement at all. She is hospitalized again, and they gave her laxatives last night, and I talk to her this morning and she said there were 3 bags of secretion. Im not sure if this is a good sign or it's just an effect of the laxatives.

When they operated, there was no sign of cancer or tumor. Looks like there were only adhesions.  She has nothing else.  
As I told you before, I have no easy access to the studies and scans. Her CA 125 levels are currently  39 (they went up from 33 from before the surgery).  I am not sure if she had a CT scan before the operation. I think just X-rays, but I know that it was impossible to put an enema because the colon was so blocked that not even liquid could go through . Same with the  colonoscopy .

I hope this information can be useful for you to help us.
Thank you,
fernanda

[Annekathryn Goodman, M.D.]

Dear Fernanda,

I am so sorry to hear about all the trouble the your mother is having.
Just to summarize my understanding of her condition:

2006 ovarian cancer surgery (?hysterectomy) and 2 cycles of chemo (?carbo/taxol; IV or IP?)
2008 sudden onset of bowel dysfunction
-colostomy (this is a surgery where the large intestine is brought to the abdominal wall; then bowel movements go into a bag that is on the abdominal wall)
-she is now 10 days after the surgery and still no bowel movements

did I understand you correctly?

so the information I do not have that may be helpful is: what is the status of her cancer?
did she have a blockage in her large intestine from cancer?
does she have a completely different problem such as diverticulitis?
does she have adhesions?

What you can do, Fernanda , to answer these questions is to ask for a copy of the operative note from her surgery 10 days ago. It would also be helpful to get a copy of recent scans. I imagine she must have had a CT scan or a barium enema before surgery to understand what is going on.Also what is her current CA 125 test?

If you can get these reports and type them in here, I can better explain my understanding of what might be going on?
I look forward to hearing from you.