Excluding Other Causes Of Gi Symptoms After Cancer Treatment
Different pathological processes can produce identical symptoms, for example diarrhoea has at least 13 different mechanisms.13 As demonstrated in the above case studies, GI symptoms after cancer treatment are complex and within a specialist setting, less frequently occurring diagnoses are made more commonly. However, other causes of GI symptoms and factors unrelated to cancer treatment, such as the psychological effect of a cancer diagnosis and its treatment, changes in diet, new GI disease or pre-existing underlying conditions, may also result in GI symptoms.79
Why Does Faecal Incontinence Occur After Radiation
Faecal incontinence is a broad term that basically means that you experience a loss of control with gas, have small seepages of poo on your underwear, or may lose control of your bowel without any urgency or sensation for needing to go. Radiation exposure to the internal aspect of the anus and rectum is thought to contribute to a complex set of common experiences after therapy such as changes in bowel frequency, stool consistency, urgency, bleeding, pain and infection. Although the exact mechanisms of why radiotherapy causes faecal incontinence is currently not well understood. The research suggests that men who have radiation for their prostate cancer could experience damage to their gastrointestinal nerves and therefore have a reduced ability to sufficiently close their anal sphincter.
Talk To Your Doctor Nurseor Care Team
If your bowel issues are bothering you and preventing you from doing your usual daily activities, speak to your doctor. This could be your family doctor, or doctor thatâs been treating the cancer . Your doctor may prescribe medications to help with either constipation or diarrhea. You can also speak with a nurse about getting help.
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Management Of Bowel Dysfunction
Short of treating individual symptoms as needed, there are few, if any, treatment options for bowel dysfunction following radiation therapy. Laser therapy can stop rectal bleeding caused by radiation. Anti-diarrheal agents can help with loose bowel movements. Increasing fiber intake through whole grains, fruits and vegetables, or fiber supplements can also help.Avoiding foods that might irritate the gastrointestinal tract is important, but complete elimination of fibrous, bulky foods can lead to constipation and straining, which in turn can exacerbate rectal bleeding.
Dry Orgasm And Infertility
Both the prostate and the glands responsible for semen production are removed during surgery, which is a common prostate cancer treatment. If you received this treatment, youd still be able to have an orgasm but youd no longer ejaculate.
This means that youll no longer be fertile. If you plan to have children in the future, you may consider banking your sperm before your surgery.
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Inflammation Of The Back Passage
Inflammation of the back passage is a long term side effect. Proctitis can cause a feeling of wanting to strain whether or not you actually need to pass a bowel movement. You might also have bleeding from your back passage or a slimy mucous discharge.
Bleeding is usually slight but can be more severe for some people. Talk to your radiographer or nurse if you have proctitis. They might suggest you use treatments such as steroid suppositories for a short time. This might reduce the inflammation.
Recommendations On How To Optimize The Anal Canal Radio
Table 5 summarizes all the recommendations derived from this literature review regarding irradiation of the anal canal during prostate RT.
Table 5 Optimization of late gastrointestinal tolerance after radiotherapy for localized prostate cancer.
Taking Into Account the Patients Medical History and Their Individual Factors in Predicting Late GIT
It is primordial to consider the patients clinical factors, in addition to the dosimetric analysis, in order to limit RT related LGIT . An adaptation of the dose levels could then be done based on these clinical risk factors. Patients should be informed of a potential increased risk of GIT if they have any of the described risk factors, namely any prior abdominal surgery, cardiovascular or smoking history or history of GI symptoms prior to RT. We also believe that the concept of rectal capacitance, which is well described in the context of RT for rectal cancer , should be further studied in prostate RT in order to better predict the risk of LGIT. This specific point could be extrapolated to the AC in future studies. An exciting area of innovation is the emergence of biomarkers that can predict radiation induced toxicities. These could allow clinicians to adapt the management of patients that have individual susceptibility to ionizing radiation . Indeed, there are reports already of the existence of genetic factors that could predispose to anorectal bleeding .
Considering the Dose-Effect Relationship
An Approach To Nausea And Vomiting
Chronic nausea and vomiting are not uncommon in the general population and a careful history and examination are required to eliminate common medical causes. In the cancer patient, disease recurrence must be considered. Small bowel bacterial overgrowth, gastric bile reflux or acid reflux are frequent benign causes of nausea, vomiting and retching after cancer treatment.13 Metabolic causes such as hyperglycaemia, hypercalcaemia, renal impairment, and Addison’s disease need to be excluded. Gastroparesis and slow upper GI transit can exacerbate symptoms. Oesophageal motility disorders such as diffuse oesophageal spasm or ineffective motility can develop. Oesophageal strictures are another important cause.12
After oesophagectomy with gastric tube reconstruction, symptoms of reflux and nausea are often accompanied by early satiety, absence of hunger, inhibited passage of food due to high viscosity and impaired gastric emptying and postprandial dumping.4748 The surgical procedure itself can still influence nutritional aspects and lead to altered stool frequency for prolonged periods after surgery, so patients frequently struggle to maintain their body weight.48
What Are The Different Types Of Internal Radiation Therapy
Brachytherapy and radiopharmaceuticals are both considered internal radiation therapies because they both work after being inserted inside the body, rather than being directed from outside. However, the similarities mostly end there. Brachytherapy works by implanting radioactive material into the prostate and is used for localized prostate cancer. Radiopharmaceuticals are injected into the bloodstream and are used for advanced, metastatic prostate cancer. Read on to find the details of each.
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Your Role On Your Radiation Therapy Team
Youll have a team of healthcare providers working together to care for you. Youre part of that team, and your role includes:
- Getting to your appointments on time.
- Asking questions and talking about your concerns.
- Telling someone on your radiation therapy team when you have side effects.
- Telling someone on your radiation therapy team if youre in pain.
- Caring for yourself at home by:
- Quitting smoking, if you smoke. If you want to quit, call our Tobacco Treatment Program at .
- Caring for your skin as instructed.
- Drinking liquids as instructed.
Radiation therapy for prostate cancer can irritate the bowel, the bladder, or both.
A person can develop:
Radiation proctitis: Symptoms include diarrhea and blood in the stool.
Radiation cystitis: Symptoms include a need to urinate more often, a burning sensation when urinating, and blood in the urine.
Bladder problems may improve after treatment, but they may not go away completely.
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Side Effects Of Surgery For Prostate Cancer
The most commonly experienced side effects of surgery for prostate cancer are urinary incontinence and erectile dysfunction.
According to the patient-reported outcomes from men who participated in the ProtecT trial, men who undergo a radical prostatectomy experience more sexual dysfunction and urinary problems than those treated with radiation therapy.
While many reported an improvement in the severity of their symptoms six months after surgery, these men continued to report poorer sexual quality of life six years after surgery compared to those who had radiation therapy.
While men treated with radiation reported experiencing bowel function problems after treatment, the men who had a prostatectomy were generally able to undergo the procedure without experiencing any changes in bowel function after surgery.
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Radiotherapy To The Prostate
Side effects during/soon after treatment
General Fatigue is quite common in the second half of treatment and is very variable between patients. It may be worse for men on both hormone therapy and radiation therapy. Fatigue can persist for a few weeks after treatment, but as for other early side effects, this has usually settled within 4-6 weeks after radiation therapy is completed.
Local All other side effects of radiation therapy come from the structures/organs in and just next to where the radiation is being targeted. For the prostate this means the bottom of the bladder, the urethra and the front part of the rectum . These can commonly cause the following side effects, which usually have fully settled by 4- 6 weeks after treatment is finished.
Bladder/urethra in weeks 3-4 of treatment it is common to start to get some or all of the following: increased frequency of urine, especially at night stinging or burning while passing urine a sense of not fully emptying the bladder a poorer stream than before. These symptoms are usually mild to moderate but can be worse if there were significant urinary problems before treatment.
Rectum Bowel motions may become more frequent in the second half of treatment or there may be a need to go more frequently or urgently to open the bowels. There may be some more mucous discharge, excess wind and/or discomfort on opening bowels. Diarrhoea is very uncommon.
What can help reduce side effects?
Side effects well after treatment
Outcome After Five Visits To The Clinic
- Nausea resolved with promotility regimen and the use of intermittent sucralfate suspension.
- Vomiting now infrequent
- No retrosternal pain when eating
- Early satiety managed with smaller, more frequent meals
- Bowel frequency: 12×/day
- Symptoms of early dumping only occurring when eating larger meal portions
- Weight increasing
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Side Effects Of External Radiotherapy
Radiotherapy to the prostate can cause some side effects, such as loose or watery poo and passing wee more often.
Side effects tend to start a week or 2 after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends. But they usually begin to improve after around 2 weeks or so.
These side effects vary from person to person. You may not have all of the effects mentioned.
Side effects can include:
You might feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.
Tiredness can carry on for some weeks after the treatment has ended but it usually improves gradually.
Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. Its important to balance exercise with resting.
Your skin in the treatment area might get sore, or redden or darken. Following these tips can help with this:
Possible Side Effects Of Radiation Treatment
There are possible side effects associated with radiation therapy. Some people may not experience any side effects. Others may experience mild or bothersome side effects.
Some side effects may only last a short period of time, and others may last longer or forever. Side effects may occur at the time of treatment or could develop months after treatment.
Most side effects are manageable by your radiation team and last only a short time. Before starting treatment, your doctor will discuss possible side effects and their duration.
Because we use advanced targeting technology, the probability of side effects is lower.
Possible side effects include:
Bowel Issues Because radiation treatment is so close to the rectum, it could cause irritation. This irritation could cause soreness, blood in your stool, or rectal leakage. Most of the time these issues are temporary, but in rare cases, normal bowel function does not return. Because patients use a rectal balloon during each treatment, the likelihood of rectal issues is lower.
Urinary Issues Radiation can cause irritation to the bladder. This can cause urinary frequency, urgency and a burning sensation. If these problems occur, they generally go away after time.
Keeping your activity level up will result in less fatigue and feeling better.
Keeping your activity level up will result in less fatigue and you will feel better overall.
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An Inclusive Clinical Trial
The team designed the phase 3 trial to be as inclusive as possible to capture a population that looks like people commonly treated in the community, Dr. Buyyounouski explained. The participants included both people getting radiation immediately after surgery and those who waited until they had rising PSA levels.
Participants who had some invasion of their cancer into nearby tissue were eligible, although those whose cancer had spread to their lymph nodes were excluded. They could also receive up to 6 months of androgen deprivation therapy, a type of hormone therapy, if recommended by their doctor.
Participants were randomly assigned to treatment with HYPORT, consisting of a higher dose of radiation every weekday for 5 weeks or the commonly used, lower dose every weekday for 7 weeks. They were asked about urinary and bowel symptoms before radiation and 6, 12, and 24 months after treatment, using the Expanded Prostate Cancer Index Composite questionnaire.
After prostate cancer treatments, common urinary symptoms can include urine leakage or pain or burning when urinating. Common bowel symptoms can include bowel leakage or urgency. The trial did not measure sexual side effects, such as erectile dysfunction, since these can also be affected by hormone therapy.
About three-quarters of the participants completed all questionnaires. At the end of treatment, people who received HYPORT reported more bowel side effects, although urinary side effects were equivalent between groups.
Speaking With Your Healthcare Professional
It is important that your healthcare professional tries to diagnose the underlying cause of the bowel symptoms, rather than simply treating the symptom itself.
You can speak with:
- your clinical nurse specialist
- your cancer doctor .
It can help to speak to a healthcare professional you already know, trust and who has an understanding of your medical history.
You might be having this conversation years after you have finished your treatment, so it is a good idea to be clear about what is happening. You could:
- tell them that these bowel changes started after pelvic radiotherapy treatment
- tell them when the symptoms started
- tell them how long the symptoms have lasted for
- explain the impact the symptoms are having on your life be prepared to give all the details.
It may be helpful to write down what you experience day-to-day or keep a diary of when the bowel changes flare up.
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Symptoms Of Bowel Changes
The most common bowel symptoms caused by pelvic radiotherapy include:
- needing to poo more often
- needing to poo urgently or in a rush
- loose or runny poo
- finding it hard to poo
- bowel or stomach cramps, bloating or pain
- leaking from your bottom or having accidents where you cannot control your bowels
- bleeding from your bottom
- feeling that your bowels havent been completely emptied
- feeling gassy or passing a lot of wind.
This list doesnt cover every possible bowel symptom. If you have a symptom that isnt on this list, it is still important to speak with your healthcare professional about it.
Constipation Is Quite Normal After Prostate Cancer Treatment
Some bowel issues, like constipation are normal after treatment. They are especially common after surgery. Long-term bowel issues after treatment, however, are rare. If youâre experiencing some unusual or painful changes to your bowel habits, itâs important to speak to your care team.
Constipation can also put pressure on your bladder, making it more difficult to urinate . Let your team know if youâre struggling to empty your bowels .
Radiation therapy can cause issues besides constipation
After radiation therapy, you might experience changes to your bowel habits. These changes are usually temporary and include constipation, diarrhea and strong urges to relieve yourself. For more specific information, read about bowel issues after radiation therapy.â â
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Drugs That Can Increase Bowel Symptoms
You may be taking medicines that can make bowel symptoms worse. For example:
- magnesium in antacids this treatment for heartburn may cause diarrhoea
- proton pump inhibitors such as omeprazole may cause wind and diarrhoea
- laxatives such as Lactulose® and Fybogel® may cause wind and diarrhoea
- metoclopramide this anti-sickness drug may cause diarrhoea
- metformin this tablet to treat diabetes may cause diarrhoea, particularly when you have just started taking it
- beta-blockers these tablets to treat high blood pressure and some heart problems may cause diarrhoea.
If you think a drug you are taking might be making your symptoms worse, tell your doctor. They may be able to prescribe a different drug that may affect you less.
Possible Side Effects Of Radiation Treatment For Prostate Cancer
The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.
You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.
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