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Gastrointestinal QuickFact


Childhood cancer survivors can be at risk for developing the following gastrointestinal (GI) late effects:
  • Hepatic Dysfunction
    • Hepatic Toxicity
    • Veno-occlusive Disease
    • Hepatic Fibrosis/Cirrhosis
    • Hepatitis
    • Iron Overload
    • Focal Nodular Hypoplasia 
  • Cholelithiasis
  • Chronic Enterocolitis
  • Strictures/Fistulas
  • Bowel Obstruction /Adhesions
  • Neurogenic Bowel/Incontinence

For more information on risk factors for Hepatits B and Hepatitis C please see the Spleen/Immunology Quick Fact.

If your patient does not have a Survivor Health Plan (SHP), please refer him/her to the appropriate survivor clinic. 

 

Important factors in determining risk for gastrointestinal (GI) effects:

    • Total dose of radiation
    • Abdominal radiation
    • Abdominal surgery
    • Received blood products before 1972 or 1993
    • Multiple blood transfusions
    • Graft-vs-Host Disease (GVHD)
    • Total Parenteral Nutrition (TPN)
    • Viral hepatitis
    • History of VOD
    • Candida esophagitis
    • Illeal conduit
    • Gastroesophageal reflux
    • Siderosis
    • Alcohol use
    • Obesity
    • Pregnancy
    • Practices the predispose to sexual or blood transmission of Hepatits

 

For recommendations on how to screen for all potential late effects, please refer to The Children’s Oncology Group Long-Term Follow-Up Guidelines.

 

Chemotherapy

Table 1

 

Hepatic Dysfunction

Strictures/ Fistulas

Cholelithiasis

Bowel Obstruction/

Adhesions

Chronic Enterocolitis

Neurogenic Bowel/Incontinence

Alkylating Agents

Carmustine

   BCNU

Busulfan

Lomustine

   CCNU

Chlorambucil Cyclophosphamide

   Cytoxan

Ifosphamide

Mechlorethamine

Melphalan

Procarbazine

Thiotepa

 

Dacarbazine

    DTIC

Temozolomide

 

 

 

 

 

 

Heavy Metals

Carboplatin

Cisplatin

 

 

 

 

 

 

 

Antimetabolites

Cytarabine

   Ara-C

Mercaptopurine

   6MP

Thioguanine

   6TG

Methotrexate

Epipodophyllotoxins

 

X

Hepatic Dysfunction

Methotrexate, Mecaptopurine and Thioguanine Only

 

Veno-Occlusive

Disease

Mercaptopurine

Thioguanine Only

 

Include TBI in total dose calculation

 

 

 

 

Anthracycline antibiotics

Daunorubicin

Doxorubicin

   Adriamycin

Epirubicin

Idarubicin

Mitoxantrone

 

 

Esophageal Stricture

Include TBI in total dose calculation

Include TBI in total dose calculation

Include TBI in total dose calculation

 

Chemotherapy

Table 2

Hepatic Dysfunction

Strictures/ Fistulas

Cholelithiasis

Bowel Obstruction/

Adhesions

Chronic Enterocolitis

Neurogenic Bowel/Incontinence

Anti-tumor antibiotics

Bleomycin

Dactinomycin

 

 

 

 

 

 

Corticosteroids

Dexamethasone

   Decadron

Prednisone

 

 

Include TBI in total dose calculation

 

 

 

 

Enzymes

Asparaginase

 

 

 

 

 

 

 

Plant alkaloids

Vincristine

Vinblastine

 

 

 

 

 

 

 

Epipodophyllotoxins

Etoposide

   VP16

Teniposide

   VM26

 

Methotrexate, Mecaptopurine and Thioguinine Only

Veno-Occlusive

Mercaptopurine

Thioguanine Only

Esophageal Stricture

Include TBI in total dose calculation

Include TBI in total dose calculation

Include TBI in total dose calculation

 

Radiation

Hepatic Dysfunction

Strictures/ Fistulas

Cholelithiasis

Bowel Obstruction/

Adhesions

Chronic Enterocolitis

Neurogenic Bowel/Incontinence

All Radiation

 

 

 

 

 

 

TBI

 

 

 

 

 

 

Head/Brain

 

 

 

 

 

 

Neck

 

>    30 Gy

 

Include TBI in total dose calculation

 

 

 

 

Thorax

 

> 30 Gy

 

Include TBI in total dose calculation

 

 

 

 

Abdomen

> 30 Gy

 

Include TBI in total dose calculation

> 30 Gy

 

Include TBI in total dose calculation

> 30 Gy

 

Include TBI in total dose calculation

> 30 Gy

 

Include TBI in total dose calculation

> 30 Gy

 

Include TBI in total dose calculation

 

Pelvis

Epipodophyllotoxins

Veno-Occlusive

Mercaptopurinet

> 30 Gy

 

Include TBI in total dose calculation

 

> 30 Gy

 

Include TBI in total dose calculation

> 30 Gy

 

Include TBI in total dose calculation

 

Extremity

 

 

Esophageal Stricture

 

 

 

 

Hematopoeitic Stem Cell Transplant

Hepatic Dysfunction

Strictures/ Fistulas

Cholelithiasis

Bowel Obstruction/

Adhesions

Chronic Enterocolitis

Neurogenic Bowel/Incontinence

Hematopoeitic Stem Cell Transplant

X

Include TBI in total dose calculation

 

 

 

 

Hematopoeitic Stem Cell Transplant with any history of chronic GVHD

Epipodophyllotoxins

Veno-Occlusivelkkkk

Mercaptopurine

Esophageal Stricture

Include TBI in total dose calculation

Include TBI in total dose calculation

Include TBI in total dose calculation

 

Surgery

Hepatic Dysfunction

Strictures/ Fistulas

Cholelithiasis

Bowel Obstruction/

Adhesions

Chronic Enterocolitis

Neurogenic Bowel/Incontinence

Laparotomy

 

 

 

X

 

 

Neurosurgery-

Spinal Cord

Veno-Occlusivelkkkk

Mercaptopurine

Include TBI in total dose calculation

 

 

 

X

Pelvic Surgery

 

 

 

 

 

X

Cystectomy

Epipodophyllotoxins

 

Esophageal Stricture

Include TBI in total dose calculation

Include TBI in total dose calculation

Include TBI in total dose calculation

X

Other

 

Hepatic Dysfunction

Strictures/ Fistulas

Cholelithiasis

Bowel Obstruction/

Adhesions

Chronic Enterocolitis

Neurogenic Bowel/Incontinence

Diagnosed prior to 1972

 

X

Hepatitis B

 

Include TBI in total dose calculation

 

 

 

 

Diagnosed prior to 1993

Epipodophyllotoxins

X

Hepatitis C

Veno-Occlusivelkkkk

Mercaptopurine

Esophageal Stricture

Include TBI in total dose calculation

Include TBI in total dose calculation

Include TBI in total dose calculation

 

 

Health Links- Teaching Handouts from The Children's Oncology Group  

Visit www.survivorshipguidelines.org  to find many of the Health Links translated into other languages. 

 References:

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links  Version 4.0. October, 2013. www.survivorshipguidelines.org.

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 1/30/2015 4:08:54 PM
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