Health Link

Healthy living after treatment of childhood, adolescent, and young adult cancer

Gastrointestinal Health after Cancer Treatment
Treatment for childhood cancer can sometimes cause scarring and chronic problems of the intestines (bowel) or
other parts of the gastrointestinal (GI) system. It is important to know about the GI system so that you can recognize
symptoms and keep your GI system healthy.
How does the gastrointestinal system work?

The GI system (also known as “the digestive system”) is a group of organs that break down (digest) the food that weeat. This allows the body to use food to build and nourish cells and provide energy.
What types of GI problems can arise aftertreatment?

The types of problems can vary depending on the treatmentthat was given. Generally, GI problems occurring after
treatment for childhood cancer are related to surgery orradiation. The effects depend on the location of the surgery,the radiation treatment field, and the dose of radiation
received.

Eshopagus
Liver
Gallbladder
Large intestine (colon)
Intestines

Small intestine

Problems that can develop include:Rectum• Bowel obstruction (blockage of the intestines)—therisk is higher for people who have had a combinationof abdominal radiation and surgery.
• Esophageal stricture (scarring and narrowing of the tube that delivers food from the mouth to the stomach)—this is usually a result of radiation and can cause problems with swallowing.
• Gallstones (solid deposits of cholesterol or calcium salts that form in the gallbladder or bile ducts)—the risk isincreased in people who had abdominal radiation.
• Hepatic fibrosis or cirrhosis (scarring of the liver)—the risk is increased for people who received radiation to theabdomen, or for those with a chronic liver infection (hepatitis).
• Chronic enterocolitis (inflammation of the intestines resulting in chronic diarrhea and abdominal pain)—the risk
is increased after abdominal or pelvic radiation.
• Colorectal cancer (cancer of the large intestine)—the risk is increased for people who had abdominal or pelvic
radiation (see related Health Link: Colorectal Cancer).
What treatments increase the risk for developing a gastrointestinal problem?

•••

Surgery involving the abdomen or pelvis
Radiation:– Neck– Chest– Abdomen– Pelvis– Spine (cervical, thoracic, lumbar, sacral)
Other risk factors include:– History of bowel adhesions (scarring)

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Healthy living after treatment of childhood, adolescent, and young adult cancer–––––

History of bowel obstruction (blockage)
History of chronic graft-versus-host disease (cGVHD) of the intestinal tract
Family history of colorectal or esophageal cancer
Family history of gallstones
Tobacco use

What are the possible symptoms of a gastrointestinal problem?

••••
•
•••
•
••

Chronic acid reflux (heartburn)
Difficult or painful swallowing
Chronic nausea or vomiting
Abdominal pain
Chronic diarrhea
Chronic constipation
Black tarry stools or blood in stool
Weight loss
Changes in appetite
Abdominal distension/Feeling bloatedJaundice/Yellow eyes, yellow skin (see related Health Link: Liver Health)If you develop any of these symptoms, see your healthcare provider. Symptoms that come on quickly or are severe(such as the sudden onset of abdominal pain and vomiting) may indicate a more urgent problem (such as a bowelobstruction) requiring immediate medical evaluation.
What medical tests are used to screen for a gastrointestinal problem?

Screening for problems affecting the GI system involves an annual physical examination by a qualified health care
professional. X-rays, blood tests, and testing for small amounts of blood in the stool (called the guaiac test) aresometimes needed. An ultrasound may be needed if gallstones or gallbladder problems are suspected. Additionally,certain tests that examine the inside of the colon (colonoscopy) or esophagus (endoscopy) with special instruments
are sometimes needed.
What can be done to prevent gastrointestinal problems?

•Develop a healthy nutrition plan. Suggestions for a healthy diet include:– Choose a variety of foods from all the food groups. Visit www.choosemyplate.gov for help developing a wellbalanced meal plan.
– Eat 5 or more servings a day of fruits and vegetables, including citrus fruits and dark-green and deep-yellowvegetables.
– When drinking juice, choose 100% fruit or vegetable juice, and limit to about 4 ounces a day.
– Eat plenty of high fiber foods, such as whole grain breads, rice, pasta and cereals. Avoid foods high in sugars(such as candy, sweetened cereals, and sodas).
– Buy a new fruit, vegetable, low-fat food, or whole grain product each time you shop for groceries.
– Decrease the amount of fat in your meals by baking, broiling or boiling foods and not eating fried foods.
– Limit intake of red meat by substituting fish, chicken, turkey or beans. When you eat meat, select leaner cuts

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Healthy living after treatment of childhood, adolescent, and young adult cancer

and smaller portions.
– Limit fried and high-fat foods, such as fries, snack chips, cheeseburgers, and pizza.
– Choose low-fat milk and dairy products.
– Avoid salt cured, smoked, charbroiled and pickled foods.
– Be sure that you eat foods rich in calcium, such as milk, yogurt and dark green vegetables.
• Avoid cancer-promoting habits.
– Do not smoke or use tobacco products.
– Avoid second-hand smoke when at all possible.
• If you drink alcohol, use moderation.
– Heavy drinkers (people who drink two or more hard drinks per day), especially those who use tobacco, have ahigher risk of GI cancer and other gastrointestinal problems.
–Limiting the use of alcohol can reduce these risks.

Written by: Sharon M. Castellino, MD, MSc, Children’s Healthcare of Atlanta - Egleston, Atlanta, GA; and Sheila Shope, RN, FNP, St.
Jude Children’s Research Hospital, Memphis, TN.
Reviewed by Daniel Smith, DNP, FNP; Kayla L. Foster, MD, MPH; and Melissa Acquazzino, MD, MS.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or young
adulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health Links
were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s Oncology
Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding a
medical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.
To physicians and other healthcare providers: The Informational Content is not intended to replace your independent clinical judgment, medical advice, or to exclude other legitimate criteria
for screening, health counseling, or intervention for specific complications of childhood cancer treatment. Neither is the Informational Content intended to exclude other reasonable alternative
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