ABSTRACT
Gynecologic malignancies account for 77,000 new cancer cases annually in the United States, and 28,000 women will succumb to their disease. Principles that are applicable to end-of-life care for a patient with any type o f progressive malignancy can be applied to women with progressive gynecologic cancers, as many o f the issues and symptoms are similar. These include adequately addressing symptoms such as pain, depression, sleeplessness and anorexia. Unique features o f progressive gynecologic can cers include fistulas, functional bowel obstructions secondary to carcinomatosis, pelvic hemorrhage, groin and perineal recurrences, which require specific understanding o f appropriate interventions. Terminal physiology is usually referable to the specific disease. Progressive ovarian cancer often involves the peritoneal surfaces with miliary seeding o f tumor which inhibits intestinal motility, leading to an inability to absorb nutrients and move intestinal contents downstream. This phenomenon is known as a carcino matous ileus, or a functional malignant bowel obstruction, and leads to death through dehydration and malnutrition. Ovarian cancer that is progressive in the pulmonary or lymphatic system may lead to death through anorexia and cachexia. Endometrial cancer can recur in the abdominal or pelvic cavity, the retroperitoneal lymph nodes and/or
Gynecologic Oncology, edited by Paola Gehrig and Angeles Secord. ©2009 Landes Bioscience.
