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

37. Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.