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Possible Contributions to Diarrhea in Cancer
| Cancer-related [5,18] |
Carcinoid syndrome |
| Colon cancer |
| Lymphoma |
| Medullary carcinoma of the thyroid |
| Pancreatic cancer, particularly islet cell tumors (Zollinger-Ellison syndrome) |
| Pheochromocytoma |
| Surgery- or procedure-related [14] |
Celiac plexus block |
| Cholecystectomy, esophagogastrectomy |
| Gastrectomy, pancreaticoduodenectomy (Whipple procedure) |
| Intestinal resection (malabsorption due to short bowel syndrome) |
| Vagotomy |
| Chemotherapy-related [19,20] |
Capecitabine, cisplatin, cytosine arabinoside, cyclophosphamide, daunorubicin, docetaxel, doxorubicin, 5-fluorouracil, interferon, irinotecan, leucovorin, methotrexate, oxaliplatin, paclitaxel, topotecan |
| Radiation therapy–related (refer to the Radiation Enteritis section of this summary) [21,22] |
Irradiation to the abdomen, para-aortics, lumbar, and pelvis |
| Bone marrow transplantation–related [23] |
Conditioning chemotherapy, total-body irradiation, graft-versus-host disease after allogeneic bone marrow or peripheral blood stem cell transplants |
| Drug adverse effects [5,18] |
Antibiotics, magnesium-containing antacids, antihypertensives, colchicine, digoxin, iron, lactulose, laxatives, methyldopa, metoclopramide, misoprostol, potassium supplements, propanolol, theophylline |
| Concurrent disease [5,18] |
Diabetes, hyperthyroidism, inflammatory bowel disease (Crohn disease, diverticulitis, gastroenteritis, HIV/AIDS, ulcerative colitis), obstruction (tumor-related) |
| Infection [24] |
Clostridium difficile, Clostridium perfringens, Bacillus cereus, Giardia lamblia, Cryptosporidium, Salmonella, Shigella, Campylobacter, Rotavirus
|
| Fecal impaction [5,18] |
Constipation leading to obstruction |
| Diet [5,18] |
Alcohol, milk, and dairy products (particularly in patients with lactose intolerance) |
| Caffeine-containing products (coffee, tea, chocolate), specific fruit juices (prune juice, unfiltered apple juice, sauerkraut juice) |
| High-fiber foods (raw fruits and vegetables, nuts, seeds, whole-grain products, dried legumes); high-fat foods (deep fat–fried foods, high-fat containing foods) |
| Lactulose intolerance or food allergies |
| Sorbitol-containing foods (candy and chewing gum); hot and spicy foods; gas-forming foods and beverages (cruciferous vegetables, dried legumes, melons, carbonated beverages) |
| Psychological factors [18] |
Stress |
References
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Sykes NP: Constipation and diarrhoea. In: Doyle D, Hanks GW, MacDonald N, eds.: Oxford Textbook of Palliative Medicine. 2nd ed. New York, NY: Oxford University Press, 1998, pp 513-26.
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Yahanda AM: Hepatobiliary cancers. In: Berger DH, Feig BW, Fuhrman GM, eds.: The M.D. Anderson Surgical Oncology Handbook. Boston, Mass: Little, Brown, 1995, pp 194-224.
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Mercadante S: Diarrhea in terminally ill patients: pathophysiology and treatment. J Pain Symptom Manage 10 (4): 298-309, 1995.
[PUBMED Abstract]
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Gupta E, Lestingi TM, Mick R, et al.: Metabolic fate of irinotecan in humans: correlation of glucuronidation with diarrhea. Cancer Res 54 (14): 3723-5, 1994.
[PUBMED Abstract]
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Wadler S, Benson AB 3rd, Engelking C, et al.: Recommended guidelines for the treatment of chemotherapy-induced diarrhea. J Clin Oncol 16 (9): 3169-78, 1998.
[PUBMED Abstract]
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Makrauer FL, Oates E, Becker J, et al.: Does local irradiation affect gastric emptying in humans? Am J Med Sci 317 (1): 33-7, 1999.
[PUBMED Abstract]
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Donaldson SS: Nutritional consequences of radiotherapy. Cancer Res 37 (7 Pt 2): 2407-13, 1977.
[PUBMED Abstract]
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Charuhas PM: Medical nutrition therapy in bone marrow transplantation. In: McCallum PD, Polisena CG, eds.: The Clinical Guide to Oncology Nutrition. Chicago, Ill: The American Dietetic Association, 2000, pp 90-8.
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DuPont HL: Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 92 (11): 1962-75, 1997.
[PUBMED Abstract]
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