Doctor, Does This Mean I'm Going to Starve to Death?

Abstract

Here’s the Case “Shirley” is a 60-year-old woman who presented with abdominal pain and distension 10 years ago. Following a total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy she had been diagnosed with an International Federation of Gynecology and Obstetrics stage IC poorly differentiated endometrioid cancer of the ovary and had subsequently received six cycles of carboplatin, cyclophosphamide, doxorubicin, and ifosfamide. She was well until 3 years ago, when a computed tomography scan showed extensive disease in the omentum and pelvis. A laparotomy revealed inoperable intra-abdominal disease that was histologically consistent with recurrent ovarian cancer. She received six cycles of carboplatin and paclitaxel. A computed tomography scan confirmed a partial response, and Shirley remained well until 2 years ago. At that time, she developed abdominal distension, colic, and flatulence, due to progressive disease. She was treated with single agent carboplatin, but after two cycles, Shirley presented with the symptoms and signs of bowel obstruction. Surgical management was not an option, given the extent of the intra-abdominal disease. Nausea and abdominal discomfort were well controlled medically, and she reported a good quality of life, although she vomited after eating. Following a series of long discussions with Shirley, her relatives, nursing staff, and a number of physicians, a percutaneous venting jejunostomy was fashioned to permit her to eat and drink. This drained 2 L of fluid per day on average. At this point, Shirley and her medical team began to consider whether intravenous nutritional support should be initiated. Ovarian cancer is a common malignancy in the Western world, causing ap