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Other PLAIN summaries
- Asymptomatic coronary artery disease
- Bone problems
- Cancer-related fatigue
- Central precocious puberty – CPP
- Chronic pain
- Craniofacial growth problems
- Dental and oral problems
- Dyslipidemia
- Eye problems
- Gastro-intestinal problems
- Hair loss
- Health promotion
- Hearing problems
- Heart problems
- Higher risk groups
- HP axis problems
- Hypertension
- Impaired glucose metabolism and diabetes
- Kidney problems
- Liver problems
- Lower urinary tract problems
- Lung problems
- Male fertility problems, testosterone deficiency and sexual dysfunction
- Mental health problems
- Neurocognitive problems
- Obstetric problems
- Overweight and obesity
- Peripheral neuropathy
- Premature ovarian insufficiency
- Psychosocial problems
- Spine scoliosis and kyphosis
- Spleen problems
- Stroke
- Subsequent neoplasms:
- Thyroid problems
GASTRO-INTESTINAL PROBLEMS
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
This PLAIN summary is based on the PanCareFollowUp guideline about “Gastro-intestinal problems” [1], which is based on the consensus of different national guidelines.
PLAIN version 2.1: 27/05/2024
Gastro-intestinal problems
When we swallow our food, it passes through the food pipe (oesophagus) and into the stomach. Here the food is broken down into smaller bits. The food then moves to the bowels (intestines), where the water and nutrients from the food are absorbed. What is left is stool, which is stored in the rectum until you poo. All the organs that food travels through make up the gastro-intestinal tract.
Sometimes problems can occur with the gastro-intestinal tract. Gastro-intestinal problems include:
- Obstruction, where a part of the gastro-intestinal tract narrows. This makes it more difficult for food to pass through.
- Gallstones, which are small stones that form in the gallbladder. If the stones become too big, they can obstruct the opening of the gallbladder.
- Chronic inflammation, which is caused by an infection of the gastro-intestinal tract or an underlying disease.
- A gastro-intestinal fistula. This is an abnormal opening or hole which allows fluids to seep through from the bowels to another part of the body.
- Malabsorption, where not enough nutrients are absorbed from the food.
- Nerve damage, which can cause stool to leak from the anus.
Nutrients
The gastro-intestinal tract and the digestion of foods
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Hover over the letters/numbers in the figure for more information.
Gastro
A. food enters the body
B. food passes through the food pipe
C. food is broken down into smaller bits
D. water and nutrients are absorbed
E. stool is stored in rectum until you poo
1. mouth
2. food pipe (oesophagus)
3. stomach
4. gallbladder
5. small intestine
6. large intestine
7. rectum
Am I at higher risk of gastro-intestinal problems?
Anyone, including people who have never had cancer treatment, may develop gastro-intestinal problems. However, there are some cancer treatments that may increase the risk of having gastro-intestinal problems later in life. The problems that can occur depend on the type of cancer treatment received.
The following treatments can increase the risk of gastro-intestinal problems:
- Radiotherapy to the gastro-intestinal tract or an area that includes the gastro-intestinal tract can cause problems in the area that was treated.
- Surgery to the oesophagus or abdomen can cause problems in the area that was operated on.
- Stem cell transplantation can cause problems when graft-versus-host disease (GvHD) occurs in the gastro-intestinal tract.
You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.
If you experience gastro-intestinal problems, it does not always mean that it was caused by your cancer treatment. Gastro-intestinal problems may have other causes.
Graft versus host disease
Stem cell transplantation is a type of cancer treatment that involves taking stem cells from the blood of a donor (‘graft’) and putting them in your body (‘host’). Sometimes these stem cells can attack your own cells because they falsely recognize them as foreign and attack them. This is called GvHD.
GvHD can have serious health implications when you are experiencing it but it can also put you at higher risk of some late effects.
Stem cell transplantation
Stem cell transplantation means that blood stem cells are taken out of the body of a person and transplanted back into the same person (autologous) or to another person (allogeneic).
This procedure is often used to treat diseases such as leukaemia and lymphoma, and some solid tumours (such as neuroblastoma) as well as certain immune system and genetic disorders.
There are different types of stem cell transplants, including:
- Autologous Transplant: Uses the patient’s own stem cells, which are harvested before treatments like chemotherapy or radiation and then returned to the body to help recover.
- Allogeneic Transplant: Uses stem cells from a donor. The donor can be a relative (often a sibling) or someone unrelated with a matching tissue type.
The blood stem cells can be harvested in different ways. They can either be taken out of the blood stream (peripheral blood stem cell transplantation) or out of the bone marrow (bone marrow transplantation).
During the transplantation process, the patient often undergoes a treatment to kill the diseased bone marrow cells before receiving the new stem cells through an intravenous line, similar to a blood transfusion. After the transplant, it takes time for the new stem cells to grow and start producing healthy blood cells, during which the patient needs close medical care to prevent and manage potential complications, such as infections or graft-versus-host disease (in case of allogeneic transplants).
Other causes
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
What are the symptoms and signs of gastro-intestinal problems?
There are symptoms and signs that can tell you if you might have gastro-intestinal problems. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.
These symptoms may suggest that you have gastro-intestinal problems:
- Pain in the abdomen (belly pain)
- Unexplained weight loss
- Difficulty swallowing
- Feeling bloated, nauseous and/or vomiting
- The stool is abnormal or different from usual for a longer period of time
- Stool leaking from the anus (incontinence)
- Yellow coloured eyes and/or skin. This is also known as icterus or jaundice.
Usually gastro-intestinal problems are temporary and the problems will usually go away on their own. However, if you experience any of these symptoms or signs for a longer time period and/or if you feel very unwell, please contact your general practitioner or follow-up care specialist.
Symptoms and signs
Pain
From a physical point of view, pain is a life-sustaining biological reaction to damaging influences – even if tissue damage has not yet occurred. Due to its function as a damage indicator or warning, pain is usually associated with negative feelings so that we pay sufficient attention to it and learn as quickly as possible when it is dangerous for us. How intensely we feel a pain stimulus, whether it causes us to feel fear and panic, depends not only on the pure nerve signal, but is an interplay of biological, psychological and social factors.
All pain whose duration exceeds the extent of an acute (recent) cause and lasts for an incomprehensibly long time is called chronic pain. Strong and prolonged pain stimuli can make the transmitting nerve cells of the spinal cord and brain more sensitive to subsequent pain stimuli. This means that even mild stimuli can be perceived as severe pain. Under certain circumstances, these nerve cells, which have become hypersensitive
What happens if I have gastro-intestinal problems?
If you have gastro-intestinal problems, your general practitioner or follow-up care specialist will probably refer you to a specialist. Depending on the symptoms and/or signs you experience, you may be referred to a:
- Gastrointestinal or colorectal surgeon (surgeon specialised in the digestive system)
- Gastro-enterologist (physician specialised in the digestive system)
The specialist may do further testing and discuss treatment different options with you.
What else can I do?
Experiencing gastro-intestinal problems can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.
To lower the risk of gastro-intestinal problems, it is very important to live a healthy lifestyle. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.
It is important that you are aware of the possibility of developing gastro-intestinal problems and that you know the symptoms and signs. If you have any further questions or the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Where can I find more information?
You may find more information about gastro-intestinal problems online. However, it is important to be aware that this information is not always up to date or accurate.
Some sources of further information are:
- NHS: Here you can find more information about digestive health
- Together: Here you can find more information about digestive problems after cancer or its treatment
On this website, you can also find more information related to this topic:
Please note
This PLAIN summary is based on the PanCareFollowUp guideline about “Gastro-intestinal problems” [1], which is based on the consensus of different national guidelines.
While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.
Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.
No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.
The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.
[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext.