Types of patients affected
Many more patients are either being cured from cancer or surviving longer with cancer than in previous years, as treatments have improved. Unfortunately however, up to half of patients suffer long term side effects of cancer treatments, with bowel symptoms being the most common and most troublesome. This is a great shame, as patients are often unable to fully enjoy their lives just at a time when they have overcome huge personal difficulties.
Long term bowel symptoms after treatment most commonly occur in patients with pelvic cancers, such as prostate, uterine (womb), ovarian, bladder, bowel and vaginal. However, gut symptoms have been described after the treatment of almost any cancer type, such as those higher up in the abdomen and chest. Most bowel symptoms result from radiotherapy treatment, but can also occur in patients who have undergone chemotherapy, surgery or a combination of these.
Historically, there has been a general lack of awareness of this important problem amongst doctors and other healthcare professionals, and patients are often unaware that their symptoms can be improved by clinicians with an interest in this field.
Types of side effects
Practically any gut symptom can occur after cancer treatment. These include:
- Rectal bleeding
- Excessive wind
- Faecal urgency
Although the effects of radiotherapy on the bowel wall are irreversible, there are a number of changes to normal gut functioning that both cause symptoms and can be effectively treated. These include:
- Small intestinal bacterial overgrowth (SIBO)
- Bile salt diarrhea (BSD)
- Pancreatic exocrine insufficiency (PEI)
- Radiation proctopathy (RP; sometimes called ‘radiation proctitis’)
- Malnutrition is an often overlooked aspect of this problem, and can occur commonly. This is because the small bowel, which is responsible for the absorption of nutrients, vitamins and calories, is commonly damaged form radiation treatment.
A detailed initial assessment is important in order to consider which of the conditions listed above should be considered in any particular patient with bowel symptoms. A number of treatments have been shown to be effective, such as:
- SIBO: tailored antibiotic treatment
- BSD: bile salt sequestrants (medications to reduce the effect of bile salts on the bowel lining)
- PEI: pancreatic enzyme supplementation
- RP: endoscopy and argon plasma coagulation; specific antibiotic therapy; sucralfate enemas; hyperbaric oxygen therapyOther common gut conditions should also be considered and treated, such as irritable bowel syndrome (IBS), gallstones, peptic ulcers and gastro-oesophageal reflux disease.
Malnutrition can be managed with appropriate nutritional assessments (including a dietician review) followed by dietary advice or even artificial nutritional support.
Whilst in the vast majority of cases, long term bowel symptoms after cancer treatment are not caused by serious conditions, they can often be debilitating. The focus therefore, should be on treating these symptoms as effectively as possible to improve patients’ quality of life.
Many patients can expect to experience an improvement of symptoms, greater empowerment over their symptoms or an overall improved quality of life with the right management and advice.