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MBO Surgical Selection — SCE Medical Oncology MCQ

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ModerateGynaecological CancersMBO Surgical SelectionSCE Medical Oncology

A 60-year-old woman with ovarian cancer develops a bowel obstruction during chemotherapy. CT shows a single transition point without carcinomatosis. She is responding to chemotherapy. What approach should be discussed?

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Correct answer: C — Surgical evaluation — a single mechanical obstruction point in a patient responding to chemotherapy with good PS may be amenable to surgical relief, allowing chemotherapy continuation

The decision between surgical and medical management of malignant bowel obstruction depends on: (1) number of obstruction points (single vs multifocal), (2) performance status, (3) disease trajectory (responding vs refractory), (4) extent of carcinomatosis, and (5) estimated prognosis. A single transition point in a chemotherapy-responsive patient with good PS is a surgical indication — successful surgery allows chemotherapy continuation and may significantly improve outcomes. Multifocal obstruction with extensive carcinomatosis favours medical management.

Reference: ESMO 2024 Supportive Care; NICE palliative care pathway; Bais et al Cochrane