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Gastrointestinal Late Effects

Certain treatments for childhood cancer can cause problems of the gastrointestinal (GI) system, also called the digestive system, later in life.

The GI system includes organs that digest, or break down, food to absorb nutrients and keep the body working properly.

Graphic of a body with layover of organs visible. Organs of the gastrointestinal tract are highlighted, including the esophagus, liver, stomach, gallbladder, pancreas, large intestine, small intestine, appendix and rectum.

The GI system includes organs that digest, or break down, food to absorb nutrients and keep the body working properly.

Cancer Treatments That Cause GI Problems

  • Surgery involving the abdomen or pelvis
  • Radiation that affects the esophagus, stomach, and bowel

Other risk factors:

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

GI Problems That May Occur

  • Bowel obstruction (blockage of the intestines): 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
  • Hepatic fibrosis or cirrhosis (scarring to the liver)
  • Chronic diarrhea and abdominal pain
  • Colorectal cancer

Signs and symptoms

  • Chronic acid reflux (heartburn)
  • Difficulty or pain when 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
  • Jaundice/yellow eyes, yellow skin

Survivors with these symptoms should consult their health care provider. Symptoms that come on quickly or are severe (such as the sudden onset of abdominal pain and vomiting) may indicate an urgent problem (such as bowel obstruction) and require immediate medical evaluation.

What Survivors Can Do

Survivors should 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, which contains a treatment summary.
  • Get an annual physical examination, which should include a medical history. This exam may include tests such as X-rays, blood tests, and urine tests.

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


Survivors can prevent 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 GI cancer and problems.

Reviewed: June 2018