Digestive Late Effects after Childhood Cancer Treatment

Certain childhood cancer treatments can cause digestive problems later in life.

The digestive system includes organs that digest, or break down, food. This allows the body to absorb nutrients to build and nourish cells and provide energy.

Cancer Treatments That Can Cause Digestive Problems

• Surgery involving the abdomen or pelvis
• Radiation that affects the neck, chest, abdomen, pelvis, or spine

Other risk factors

• Tobacco use
• Personal or family history of:
  • Bowel scarring
  • Bowel obstruction
  • Chronic graft-versus-host disease (cGVHD) of the intestinal tract
  • Colorectal or esophageal cancer
  • Gallstones
  • Chronic hepatitis

Digestive Late Effects that May Occur in Cancer Survivors

Conditions may include:

• Bowel obstruction (blockage of the intestine) — The risk is higher for people who have had a combination of abdominal radiation and surgery.
• Esophageal stricture (scarring and narrowing of the esophagus) — This condition can cause problems with swallowing.
• Gallstones (solid deposits of cholesterol or calcium salts that form in the gallbladder or bile ducts) — The risk is higher in people who had abdominal radiation.
• Hepatic fibrosis or cirrhosis (scarring of the liver) — The risk is increased for people who received radiation to the abdomen or those with hepatitis (liver infection).
• Chronic enterocolitis (inflammation of the intestines resulting in chronic diarrhea and abdominal pain) — The risk is increased after abdominal or pelvic radiation.
• Colorectal cancer — The risk is increased for people who had abdominal or pelvic radiation.

Signs and Symptoms of Digestive Problems

• Heartburn (chronic acid reflux)
• Difficult or painful swallowing
• Chronic nausea or vomiting
• Abdominal pain
• Chronic diarrhea or constipation
• Black tarry stools or blood in stool
• Weight loss
• Changes in appetite
• Abdominal distension/ feeling bloated
• Yellow eyes, yellow skin (jaundice)

Survivors with these symptoms are encouraged to consult their health care provider. Symptoms that come on quickly or are severe (such as sudden abdominal pain and vomiting) may indicate an urgent problem that requires immediate medical attention.

What Survivors Can Do

Survivors are encouraged take action to prevent digestive problems and detect problems early.

Assess Your Risks and Monitor Your Health

• Ask your oncologist about your risks of developing late effects.
• Tell your primary health care provider about your risks. Share a copy of your survivorship care plan. It includes details about your cancer treatment and information about health problems that may occur because of your treatment.
• Get an annual physical examination, which should include a medical history. Discuss any chronic digestive symptoms with your health care provider.

If problems are suspected, the doctor may also order tests such as:

• An ultrasound if the provider suspects gallstones or gallbladder problems
• Colonoscopy to examine the colon
• Endoscopy to examine the esophagus

Prevention

Survivors can prevent some digestive problems with healthy habits:

• Eat a balanced diet.
• Don’t smoke or use tobacco products.
• Avoid second-hand smoke.
• Limit alcohol use. Heavy drinkers, especially who also use tobacco, have a higher risk of digestive cancer and problems.