Screening for GI Injury
It is recommended that survivors of childhood cancer have yearly re-evaluations with their HCP for chronic health problems. Screening for GI problems should include a history to ascertain if there are any symptoms of:
- Nausea or anorexia
- Weight loss
- A dry mouth
- Difficulty swallowing
- Abdominal pain
- Diarrhoea/Constipation/Change in bowel habit
- Rectal bleeding or pain
Physical examination should look for signs of:
- Cutaneous signs of GvHD
- Abdominal distention and pain
- Rectal examination
Investigations should include:
- Routine blood work
- CBC to rule out microcytic anemia
- Lytes, creatinine and BUN
- LFTs with serum albumin level
- If malabsorption suspected: Levels of folate and vitamin B12
Persistent GI symptoms should prompt referral to a gastroenterologist for a detailed evaluation.
Investigations may include:
- Endoscopy and small bowel biopsy to establish site of problem
- D-xylose absorption test
- Lactose breath hydrogen test
- 72 hour fecal fat determination
- Quantitate bacterial culture of small bowel to exclude stasis syndrome
These patients are also at increased risk for second cancers involving the GI tract. RT to the abdomen, pelvis or spine is likely to be associated with an increased risk of colo-rectal cancer (CRC).
Factors which significantly increase the risk of CRC include a previous history of:
- RT doses of 30 Gy or higher to the abdomen, pelvis, or spine
- Large volume RT
- Chemotherapy that included alkylating agents (e.g. cyclophosphamide)
Screening guidelines for CRC:
CRC may occur at a younger age in childhood cancer survivors than in the general population.
The National Comprehensive Cancer Network (NCCN) guidelines recommend
surveillance in high-risk populations beginning as early as 10 years of
age, depending on the speciﬁc predisposition syndrome.
The Children’s Oncology Group long-term follow-up guidelines recommend
colonoscopy in survivors exposed to 30 Gy of abdominal RT beginning at age 35 or 10 years post radiation, whichever occurs last.
Secondary Colorectal Carcinoma After Childhood Cancer
Kerri Nottage, Joshua McFarlane, Matthew J. Krasin, Chenghong Li, Deokumar Srivastava, Leslie L. Robison and Melissa M. Hudson