ABSTRACT
The development of gastrointestinal obstruction can occur at any point during the course of cancer progression. The immediate impact of obstruction on the nutritional status of a patient may seem obvious; however, the effects may be more far reaching than immediately evident. A patient will often adapt to low-grade symptoms with dietary modification and changes in eating behaviors early in the course of disease progression, and clinical presentation may occur only after adaptive maneuvers fail. Others with a known history of malignancy may develop acute onset of symptoms which serve to signal the presence of heavy disease burden and disease progression. The distinction is important, as the course of symptom presentation plays a key role in the determination of treatment options available to the patient for both palliation and nutritional support.
Knowledge of the natural history of the specific cancers that lead to gastrointestinal obstruction and the associated nutritional deficiencies that occur as a result is crucial for the clinician treating patients with gastrointestinal obstruction caused by malignancy. This understanding permits a more accurate assessment of nutritional status and deficiencies, and allows the clinician to determine a diagnostic and treatment plan that will best serve an individual patient. This chapter specifically discusses the evaluation and treatment options for patients with upper gastrointestinal obstruction – specifically gastric outlet obstruction related to the cancer patient. The nutritional deficiencies that are common to patients with gastric outlet obstruction are discussed, in addition to the clinical presentation, diagnostic evaluation and palliative treatment options available for patients with gastric outlet obstruction.
