|
|
Table 7. Gastrointestinal (GI) Late Effectsa
Late Effects
|
Causative Treatment
|
Signs and Symptoms
|
Screening and Diagnostic Tests
|
Management and Intervention
|
aAdapted from Schwartz et al.[37]
|
Enteritis |
Chemotherapy: Actinomycin D and doxorubicin (enhance radiation therapy effect) |
Abdominal pain, diarrhea, decreased stool bulk, emesis, weight loss, poor linear growth |
Height and weight every year, stool guaiac every year, CBC with mean corpuscle volume (MCV) every year, total protein & albumin every 3–5 years (absorption tests, vitamin B12 level, and contrast studies) |
Dietary management, refer to gastroenterologist |
Radiation: >40 Gy |
Surgery: Abdominal surgery enhances radiation effect |
Adhesions |
Radiation: Radiation enhances effect |
Abdominal pain, bilious vomiting, hyperactive bowel sounds |
Abdominal radiograph |
Nothing by mouth, gastric suction, adhesion lysis |
Surgery: Laparotomy |
Fibrosis: esophagus (stricture) |
Chemotherapy: Actinomycin D and doxorubicin (radiation therapy enhancers) |
Weight loss, dysphagia, poor linear growth |
Height and weight every year, CBC every year, (barium swallow/endoscopy as needed) |
Esophageal dilation, antireflux surgery |
Radiation: >40–50 Gy |
Surgery: Abdominal surgery |
Fibrosis: small intestines |
Radiation: >40 Gy |
Diarrhea, weight loss, obstruction, abdominal pain, constipation |
Height and weight every year, CBC with MCV every year, serum protein & albumin every 3–5 years (upper GI, small bowel biopsy) |
High-fiber diet, decompression, resection, balloon dilation |
Surgery: Abdominal surgery |
Fibrosis: large intestine, colon |
Radiation: >40 Gy |
Abdominal colic, rectal pain, constipation, melena, weight loss, obstruction |
Height and weight every year, rectal exam, stool guaiac every year, lower GI, colonoscopy, sigmoidoscopy |
Stool softeners, high-fiber diet |
Surgery: Abdominal surgery |
References
-
Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.
|
|
|