Small bowel obstruction after folfox + avastin

Please feel free to read, share your thoughts, your stories and connect with others!
bluebae
Posts: 4
Joined: Fri Jul 09, 2021 9:06 am

Small bowel obstruction after folfox + avastin

Postby bluebae » Mon Jul 12, 2021 11:20 am

Hello everyone.. i'm new here but I've been a silent reader for quite some time and i really appreciate the support and strength that this forum gave to those who need it most.

I need some advice. My boyfriend (35 yo) was diagnosed with rectal cancer (signet ring cell carcinoma) 2 years ago. He underwent surgery and has permanent colostomy, and already got 6 cycles of FOLFOX. unfortunately now the tumor has grown back and spread very fast to his urinary tract and even to distant lymph nodes. He is now programmed for 12 cycles of Folfox + Avastin, but a few days after the first cycle he started to feel bloated which progressed to intense abdominal pain that comes and goes with bowel peristaltic. Today (9 days after avastin) his xray showed small bowel obstruction. Im so worried that he might need surgery, because he just got Avastin which to my knowledge can interfere with wound healing. So I wondered if anyone here have any experience with small bowel obstruction during chemotherapy (especially with avastin), and how was it managed. Is there any other way other than surgery?
Caring for BF
Dx 7/7/19, 33 yo
Rectal cancer, signet ring cell. T4N2Mx
APR surgery + permanent colostomy
Refused adjuvant chemo
8/8/20 nodule on gluteal area. biopsy: metastasis
CT: residive mass, infiltration to bladder, prostate
10/28/20 - 3/28/21 FOLFOX
4/7/21 CEA 18,1
5/9/21 CT: mass on pelvic cavity, infiltrating the lymph nodes, bladder, prostate, ureter
6/10/21 URS surgery, stenting failed
6/29/21 FOLFOX + avastin
7/15/21 bowel obstruction caused by residive mass. surgery + ileostomy

catstaff
Posts: 138
Joined: Wed Mar 03, 2021 11:37 am

Re: Small bowel obstruction after folfox + avastin

Postby catstaff » Tue Jul 13, 2021 9:19 am

Whether they need to do surgery immediately may depend on what is causing the obstruction. If it's a tumor they may have little choice. If it's not they will probably try to manage it with a nasogastric tube for several days in the hope it will resolve on its own, which it often does. Of course they will have to suspend chemo and he would be hospitalized for this.

My husband had a small-bowel obstruction at the beginning of June and spent nearly two weeks in emergency rooms and the hospital as a result. It was not due to cancer, almost certainly it was from surgical adhesions. They waited nearly a week for it to resolve, then he had to be first on clear liquids and then a low-residue diet for 3-4 days to satisfy them that it was resolved before he was discharged.

If they decide they have to do surgery they will probably do it. He was a similar time past Avastin (he is on folfiri+bev) when they were considering surgery. They'd prefer a four-week interval after any chemo, but two weeks or so after Avastin is usually OK.

One problem we encountered is that at least in the US, the hospital protocol is to give a daily injection of a blood thinner, which did seem to possibly interact with the lingering effects of bevacizumab to increase some bleeding. We don't know that for sure, he just seemed to have a lot more bleeding from his ileal conduit than usual, and it may have caused them to suspend the Avastin when he did get back on chemo.
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-

bluebae
Posts: 4
Joined: Fri Jul 09, 2021 9:06 am

Re: Small bowel obstruction after folfox + avastin

Postby bluebae » Fri Jul 16, 2021 11:55 am

Thankyou for the reply catstaff! I'm sorry that your husband also experienced small bowel obstruction. Hope he is better now.

Im just going to give a little update. My BF had nasogastric tube for 3 days but there was no improvement, the pain got worse, and on the third day there was no feces or gas coming out from the colostomy at all. The doctor decided to do surgery yesterday. Turned out my BF's obstruction is caused by tumor and not adhesion. They made an ileostomy because the colostomy doesnt work anymore. So my BF have two bags right now. I hope the wound heals well, cant really tell because it's only been one day after the surgery.
Caring for BF
Dx 7/7/19, 33 yo
Rectal cancer, signet ring cell. T4N2Mx
APR surgery + permanent colostomy
Refused adjuvant chemo
8/8/20 nodule on gluteal area. biopsy: metastasis
CT: residive mass, infiltration to bladder, prostate
10/28/20 - 3/28/21 FOLFOX
4/7/21 CEA 18,1
5/9/21 CT: mass on pelvic cavity, infiltrating the lymph nodes, bladder, prostate, ureter
6/10/21 URS surgery, stenting failed
6/29/21 FOLFOX + avastin
7/15/21 bowel obstruction caused by residive mass. surgery + ileostomy

JMRWife
Posts: 71
Joined: Mon Oct 05, 2015 9:41 pm

Re: Small bowel obstruction after folfox + avastin

Postby JMRWife » Sun Jul 18, 2021 6:37 pm

Praying for you and your bf.
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Started neoadjuvant Folfox 5/18; CEA 107.
Aug 11: 7 rounds Folfox completed. CEA 3.2.
Pathology: COLON, SIGMOID (COLONOSCOPY): -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED

Clinical stage stage IIA. (negative lymph nodes). By imaging at least clinical stage 3 (abnormal lymph nodes on CT), but given negative mesenteric lymph nodes biopsy - considered at least stage 2.

bluebae
Posts: 4
Joined: Fri Jul 09, 2021 9:06 am

Re: Small bowel obstruction after folfox + avastin

Postby bluebae » Mon Jul 26, 2021 1:20 pm

JMRWife wrote:Praying for you and your bf.


Thank you so much JMRWife. Your prayer means a lot. the wound is healing well, despite the relatively short period since avastin is given to the surgery (only 10 days). the new ileostomy which we named "Tomo" is working great too, maybe a little too well because my BF got severe hypokalemia due to the very watery excretion. not complaining tho, as it is still manageable, and the most important thing is he's not in pain anymore.
Caring for BF
Dx 7/7/19, 33 yo
Rectal cancer, signet ring cell. T4N2Mx
APR surgery + permanent colostomy
Refused adjuvant chemo
8/8/20 nodule on gluteal area. biopsy: metastasis
CT: residive mass, infiltration to bladder, prostate
10/28/20 - 3/28/21 FOLFOX
4/7/21 CEA 18,1
5/9/21 CT: mass on pelvic cavity, infiltrating the lymph nodes, bladder, prostate, ureter
6/10/21 URS surgery, stenting failed
6/29/21 FOLFOX + avastin
7/15/21 bowel obstruction caused by residive mass. surgery + ileostomy

JMRWife
Posts: 71
Joined: Mon Oct 05, 2015 9:41 pm

Re: Small bowel obstruction after folfox + avastin

Postby JMRWife » Tue Jul 27, 2021 4:50 pm

the most important thing is he's not in pain anymore

Amen to that! Glad Tomo is working well!
Age 58.
4/27/2021 - Dx obstructing "apple core" sigmoid tumor at 30cm. MMR proficient. 4/28: Diverting colostomy.
Started neoadjuvant Folfox 5/18; CEA 107.
Aug 11: 7 rounds Folfox completed. CEA 3.2.
Pathology: COLON, SIGMOID (COLONOSCOPY): -- INVASIVE ADENOCARCINOMA, MOD DIFFERENTIATED

Clinical stage stage IIA. (negative lymph nodes). By imaging at least clinical stage 3 (abnormal lymph nodes on CT), but given negative mesenteric lymph nodes biopsy - considered at least stage 2.


Return to “Colon Talk - Colon cancer (colorectal cancer) support forum”



Who is online

Users browsing this forum: No registered users and 38 guests