Patients with cancer of the abdomen and pelvis are often treated with radiotherapy. This treatment, either alone or in combination with surgery or chemotherapy, is becoming more successful meaning that patients are living for longer than ever before. However, unfortunately up to half of patients will suffer with long term gut symptoms affecting their quality of life, as a direct result of their cancer treatment. This is a hugely under-recognised problem, sometimes because patients don’t report these symptoms to their cancer teams as they’re not aware that anything can be done about them. These long-term gut complaints come about as a direct result of damage to the bowel from previous radiotherapy and can occur some years after the treatment has ended.
Symptoms of pelvic radiation disease include:
- Nausea and vomiting
- Stomach cramps
- Bleeding from your bottom and rectal pain
- Weight loss
- Discharge of mucus from your anus
- Anaemia and partial bowel obstruction in some cases
Your risk of developing pelvic radiation disease increases depending on:
- The radiation dosage and duration of treatment.
- The size of the tumour being treated.
- Whether you also have chemotherapy.
- The presence of other medical conditions such as high blood pressure, diabetes, pelvic inflammatory disease or endometriosis. Previous stomach surgery may also increase your risk.
- Endoscopy, which involves looking at your stomach and upper GI tract using a long, thin flexible tube with a camera at one end which is placed inside your throat.
- Capsule endoscopy, which allows the doctor to see sections of the small intestine that other methods cannot get to. It entails swallowing a small pill that contains a camera which transmits images to a computer monitor.
- Colonoscopy, which uses a long, thin flexible tube with a camera at one end to look inside your bowel and small intestine. The colonoscope is inserted via your anus.
- An abdominal CT scan or MRI scan might also be used.
You may be offered:
- Antidiarrheal medication
- Antibiotics to treat the overgrowth of bacteria
- A lactose-free and low-fat diet to reduce strain on the digestive system. Your doctor may suggest foods to eat that can support your digestive system, including fish, chicken, bananas and eggs.
- Digestive enzymes where necessary
- Endoscopic treatment of rectal bleeding
If the condition becomes severe, you may need a feeding tube temporarily. In chronic cases you may need intestinal bypass surgery which involves removing the inflamed sections of intestine and connecting them to the healthy parts. This is a relatively uncommon procedure as the condition normally resolves with less invasive treatment.
Often the effects of cancer treatments such as radiotherapy on the bowel are irreversible. However, several gut conditions can occur as a result of these treatments which themselves lead to unpleasant symptoms. These conditions are entirely benign and not worrying, but need to be given specific consideration if they are to be tested for and treated appropriately. These include, but are not limited to, conditions termed bile salt diarrhoea, small intestinal bacterial overgrowth, pancreatic insufficiency and radiation proctopathy. The specific treatments for these are usually very effective at improving symptoms and patients’ overall quality of life.