a Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs , Aarhus University Hospital , Aarhus , Denmark.
b Department of Surgery , Aarhus University Hospital , Aarhus , Denmark.
Acta Oncol. 2019 May;58(5):776-781. doi: 10.1080/0284186X.2018.1562211. Epub 2019 Jan 30.
Chronic gastrointestinal symptoms are common among patients surviving surgery and/or radio-/chemotherapy for cancer in the pelvic organs. However, little is known about the pathophysiology behind symptoms or the effect of treatment. The aim of the present study was to present the results of clinical evaluation and treatment of patients with chronic bowel symptoms after treatment for cancer in the colon or pelvic organs. All patients referred to our department of gastroenterology between May 2016 and June 2018 with chronic bowel symptoms after treatment for cancer in the colon or pelvic organs were prospectively evaluated. In total, 60 patients had been referred. The patients were treated for cancer in the right colon ( = 31), sigmoid colon ( = 1), rectum ( = 14), anal canal ( = 4), cervix uteri ( = 5), corpus uteri ( = 2), ovary ( = 2), and prostate ( = 1). The median time from cancer treatment to referral was 5.5 (range 1-36) years. Symptoms mainly included frequent bowel movements (65%), loose stools (87%), urgency for defecation (57%), and fecal incontinence (50%). A specific cause of bowel dysfunction was found in 48 (80%) of the patients and 21 (35%) had more than one cause of bowel symptoms. Bile acid malabsorption was present in 35 patients and small intestinal bacterial overgrowth was detected in 32. Treatment included bile acid sequestrants ( = 36), antibiotics ( = 33), loperamide ( = 21), and dietary intervention ( = 20). Major improvement in bowel symptoms was reported by 23 (38%) patients, while another 27 (45%) reported some improvement. Most patients with chronic bowel symptoms following cancer in the colon or pelvic organs will benefit from expert clinical evaluation and targeted treatment.
慢性胃肠道症状在接受盆腔器官手术和/或放化疗的癌症患者中很常见。然而，对于这些症状背后的病理生理学以及治疗效果，人们知之甚少。本研究旨在报告接受结直肠癌或盆腔器官癌症治疗后出现慢性肠道症状的患者的临床评估和治疗结果。
2016 年 5 月至 2018 年 6 月期间，所有因结直肠癌或盆腔器官癌症治疗后出现慢性肠道症状而被转至我们胃肠科的患者均进行前瞻性评估。共纳入 60 例患者，其中右半结肠癌（31 例）、乙状结肠癌（1 例）、直肠癌（14 例）、肛管癌（4 例）、宫颈癌（5 例）、子宫体癌（2 例）、卵巢癌（2 例）和前列腺癌（1 例）。从癌症治疗到转至胃肠科的中位时间为 5.5 年（范围 1-36 年）。症状主要包括频繁排便（65%）、稀便（87%）、排便急迫（57%）和粪便失禁（50%）。48 例（80%）患者发现了特定的肠道功能障碍病因，21 例（35%）患者有多种肠道症状的病因。35 例患者存在胆汁酸吸收不良，32 例患者存在小肠细菌过度生长。治疗方法包括胆汁酸螯合剂（36 例）、抗生素（33 例）、洛哌丁胺（21 例）和饮食干预（20 例）。23 例（38%）患者报告肠道症状明显改善，27 例（45%）患者报告有所改善。大多数接受结直肠癌或盆腔器官癌症治疗后出现慢性肠道症状的患者将从专家临床评估和针对性治疗中获益。
