Quick Hits
Summary
- Often multifactorial in advanced malignancy
- Medical management frequently preferred over surgery
- Octreotide reduces secretions and vomiting
- Steroids may help partial obstruction
- Prognosis often limited in multifocal disease
Common Regimens
| Drug | Dose | Notes |
|---|---|---|
| Dexamethasone | 8 mg daily | Trial x5 days |
| Octreotide | 100–300 mcg TID | Reduces secretions |
| Haloperidol | 0.5–1 mg q6h | Nausea |
Clinical Pearls
- Avoid prokinetics in complete obstruction
- Colicky pain often responds to anticholinergics
- Venting G-tube may significantly improve quality of life
Deep Dive
Pathophysiology
Mechanical and functional obstruction may coexist.
Surgical Considerations
Surgical benefit is limited in multifocal advanced disease.
Prognosis
Poor prognostic markers include:
- multifocal obstruction
- ascites
- declining PPS
- hypoalbuminemia
Related
References
- MASCC guideline
- NCCN Palliative Care