Digestive Problems after Childhood Cancer Treatment and Stem Cell Transplant

What are digestive problems after childhood cancer and stem cell transplant?

Some childhood cancer treatments and stem cell transplants can cause digestive problems later in life. These are called late effects.

Late effects are side effects of cancer or its treatment that patients have months or years after treatment is over. They may appear at diagnosis or during therapy and persist. Or they may happen months or years after cancer treatment has ended. Late effects can affect 1 or more areas in the body. Effects can be mild to severe.

The digestive system includes organs that digest food. Digestion is the process of breaking down food into smaller parts. The body uses this for energy, tissue growth, and repair.

Organs of the digestive system include the:

• Mouth
• Throat
• Esophagus
• Stomach
• Small and large intestine
• Rectum
• Anus

Treatments that may cause digestive problems include:

• Surgery involving the belly (abdomen) or pelvis
  
• Radiation that affects the neck, chest, belly, pelvis, or spine. This includes total body irradiation (TBI). TBI is sometimes used before a stem cell (bone marrow) transplant.

Other risk factors for digestive problems

• Tobacco use
• Personal or family history of:
  • Bowel scarring or blocked intestine
  • Chronic graft-versus-host disease (cGVHD) that involves digestive organs. GVHD can happen after a stem cell transplant.
  • Cancer of the colon (large intestine), rectum, or esophagus
  • Gallstones
  • Chronic hepatitis

Digestive problems that may occur 

Conditions may include:

• Blocked intestine (Something is blocking your intestine. It stops food and stool [poop] from moving freely.)
• Scarring and narrowing of the esophagus
• Gallstones
• Scar tissue in the liver
• Chronic swelling of the intestines (chronic enterocolitis)
• Colorectal cancer

Symptoms of digestive problems

Signs and symptoms may include:

• Heartburn (chronic acid reflux)
• Difficult or painful swallowing
• Chronic nausea or vomiting
• Belly pain
• Chronic diarrhea or constipation
• Black, sticky stools or blood in stool
• Weight loss
• Loss of appetite
• Feeling bloated
• Yellow eyes, yellow skin (jaundice)

Talk to your care team if you have these symptoms and are at risk for digestive problems.

Symptoms that come on quickly or are severe (such as sudden belly pain and vomiting) may signal an urgent problem. Seek medical help quickly.

What survivors can do

Take action to prevent digestive problems and detect problems early.

• Ask your doctor about your risks of developing digestive problems.
• Share a copy of your survivorship care plan. It includes details about your cancer treatment and potential health problems.
• Get a yearly physical exam. This should include a health history. Discuss any chronic symptoms with your health care provider.

If problems are suspected, the health care provider may also order tests such as:

• An ultrasound if the provider suspects gallstones or gallbladder problems
• Colonoscopy to look at the colon (large intestine)
• Endoscopy to look at the esophagus

Prevention

You can prevent some digestive problems with healthy habits:

• Eat a balanced diet.
• Get daily physical activity.
• Do not smoke or use tobacco products.
• Avoid secondhand smoke.
• Limit alcohol use. 

Questions to ask about digestive late effects

• Am I at risk for digestive late effects?
• What screenings do I need?
• What can I do to stay healthy?
• What are the signs and symptoms of digestive problems?
• What can I do to reduce my risk?