Gastrointestinal dysmotility in a patient with advanced lung cancer: paraneoplastic or drug-induced?

Abstract

A 75-year-old man was hospitalised for bronchoscopy with biopsy due to a suspicious pulmonary mass at chest tomography. He had significant dyspnoea, constipation, nausea, vomiting, anorexia and a 33% loss of weight in the past 3 months. Biopsy revealed a pulmonary squamous cell carcinoma, which was inoperable. Tramadol used at home for 3 months was replaced by morphine on admission. The patient remained constipated despite prokinetics and laxatives, leading to the diagnostic hypothesis of paraneoplastic motility disorder and opioid-induced constipation. Abdominal tomography ruled out the possibility of mechanical obstruction. As complications, the patient presented superior vena cava syndrome and opioid (morphine) intoxication. The patient died a few days later. The management of this case highlights the importance of multidisciplinary care and the challenges of palliative oncology care. Paraneoplastic motility disorder must always be considered among the mechanisms of intestinal dysfunction in patients with advanced oncological disease.

A Rapid Review on the Management of Constipation for Hospice and Palliative Care Patients

“…One study focused specifically on the management of constipation in children in concurrent care management versus standard hospice care 19 . Eight of the 11 studies focused on cancer, or advanced cancer, and constipation 2,8,12-15,18,21 …”

“…19 Eight of the 11 studies focused on cancer, or advanced cancer, and constipation. 2,8,[12][13][14][15]18,21 Three studies, a case report, 12 a systematic review of international randomized controlled trials, 8 and a systematic review and meta-analysis 16 examined peripherally acting μ-opioid receptor antagonists (PAMORAs). Dias et al 15 (2021) considered the impact of advanced lung cancer versus drug-induced gastrointestinal dysmotility using a case report.…”

“…This case study is one of the first to identify that 2 PAMORAs may be needed for relief of constipation at EOL. 12 In the case of a patient with small cell lung cancer accompanied by nausea, vomiting, and constipation, Dias et al 15 (2021) described opioid-induced bowel dysfunction as a clinical presentation similar to paraneoplastic gastrointestinal dysmotility. A 75-year-old man found to have inoperable pulmonary squamous cell carcinoma progressed to EOL with ongoing constipation unrelieved by a combination of prokinetics (metoclopramide, domperidone), laxatives (polyethylene glycol, lactulose, bisacodyl), and daily enemas.…”

“…The most common neoplasm associated with paraneoplastic gastrointestinal dysmotility is small cell lung carcinoma, and combined OIC poses significant challenges for the IDT. The authors urge the prevention of opioid-induced dysmotility, and management may include opioid discontinuation 15 …”

“…2,8,[12][13][14][15]18,21 Three studies, a case report, 12 a systematic review of international randomized controlled trials, 8 and a systematic review and meta-analysis 16 examined peripherally acting μ-opioid receptor antagonists (PAMORAs). Dias et al 15 (2021) considered the impact of advanced lung cancer versus drug-induced gastrointestinal dysmotility using a case report. Only 1 study conducted in Taiwan examined the effect of acupressure on alleviation of constipation.…”