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
|
|
|