Treatment for childhood cancer can cause severe early side effects which involve the gut and these may translate into chronic health problems many years later.
These long term side effects are uncommon but can be very serious.
Mucosal inflammation may result in chronic fibrosis and scarring. The small intestine is especially sensitive to damage because of the rapid cell turn over.
Childhood cancer survivors (CCS) who are especially at risk for chronic GI problems are those that were previously treated with abdominal or pelvic radiation therapy (RT) for tumors such as rhabdomyosarcoma because:
- The dose of RT required is moderately high
- It is likely that they had surgery (risk of adhesions)
- Concurrent chemotherapy given (especially alkylating agents) with RT has a sensitizing effect
The Childhood Cancer Survivor Study (US study of 14,358 CCS diagnosed between 1970 and 1986) assessed rates of self-reported late GI complications (occurring 5 or more years after cancer diagnosis).
Compared with their siblings, survivors had increased relative risk of late-onset complications of:
- Upper GI tract (RR, 1.8)
- Lower GI tract (RR, 1.9)
- Requiring colostomy/ileostomy (RR, 5.6)
They found that older age at diagnosis, intensified therapy, abdominal RT and abdominal surgery increased the risk of some GI complications.
Normal anatomy and function:
This section relates to the:
- Upper GI tract:
- Lower GI tract: