How to treat the intestines after irradiation


Gastrointestinal complications after irradiation or chemotherapy

Complications from the mucous membrane of the oral cavity, such as ulcers, infections and inflammations, are common phenomena in the treatment of cancer. Oral candidiasis can be treated with a suspension of nystatin 5-10 ml 4 times a day, the appointment of clotrimazole 10 mg 4 times a day or fluconazole 100 mg orally 1 time per day. Mucositis in radiation therapy interferes with normal peroral administration of drugs, leading to eating disorders and weight loss. Irrigation of the oral cavity with analgesics and local anesthetics (2% viscous form of lidocaine 5-10 ml or other available medicines) before eating, a soft diet without the use of citrus fruits, juices, without sudden temperature deviations can allow the patient to eat and support the weight. If the above measures are ineffective, feeding through the probe can be effective if the function of the small intestine is maintained. In the case of severe mucositis, diarrhea or impaired b

owel function, parenteral nutrition is prescribed.

Diarrhea. which occurs after pelvic irradiation or chemotherapy, can be stopped with antidiarrheal drugs (kaolin / pectin suspension 60-0 ml of usual form or 30-60 ml concentrated, orally at the first manifestations of diarrhea and after each liquid stool; loperamide 2-4 mg orally; di-phenoxylate / atropine 1-2 tablets orally). Patients receiving antibiotics, it is necessary to monitor the stool for the presence of Clostridium difficile.

Constipationmay be a consequence of the use of opioids. Taking a laxative, for example senna 2-6 tablets inside at night or bisacodyl 10 mg orally at night, is effective for repeated use of opioids. Persistent constipation can be treated by various means (eg, bisacodyl 5-10 mg orally after -24 h, milk magnesia 15-30 ml orally at night, lactulose 15-30 ml after -24 h, magnesium citrate 250-500 ml orally once). In patients with neutropenia and thrombocytopenia, enemas and suppositories should be avoided.

Appetiteis secondary reduced in cancer patients in response to ongoing antitumor treatment or as a consequence of paraneoplastic syndrome. Glucocorticoids (dexamethasone 4 mg orally once a day, prednizolone 5-10 mg orally once a day) and megestrol acetate 400-800 mg once a day are the most effective. However, increased appetite and weight do not improve survival and quality of life of patients.

Pain must be prevented and actively suppressed. Simultaneous use of drugs from different groups can provide better control over pain with no or minor side effects than using a single drug class. It is necessary to avoid the use of non-steroidal anti-inflammatory drugs in patients with thrombocytopenia. Opioids are the basis of treatment, appointed periodically and in sufficient dosage, with additional administration in cases of impairment. In the absence of oral administration, fentanyl is administered parenterally. When using opioids, it is often necessary to administer antiemetics and to apply preventive cleansing regimens. Pain in neuropathy can be treated with tricyclic antidepressants (for example, nortriptyline 25-75 mg orally at night), although most doctors prefer gabapentin. The dose necessary to relieve neuropathic pain is high (, g / day), but the application can begin with small doses followed by a rise in a few weeks.

Sometimes it is useful to use non-medicinal means of fighting pain, for example, local radiotherapy, conductive blockade, surgical intervention.

Depression in cancer patients is often not noticed. In patients receiving interferon, depression can develop as a side effect of the drug. A frank conversation with a patient can remove anxiety. Depression in many cases is well treatable.

Tumor lysis syndrome

Tumor lysis syndrome may be secondary in response to the release of intracellular components into the bloodstream as a result of the breakdown of malignant cells after chemotherapy. Mostly it occurs in acute leukemias and non-Hodgkin's lymphomas, but can be observed in other hematological tumor diseases and less often after treatment of solid tumors. The presence of this syndrome can be suspected in patients with a large tumor mass, in whom renal insufficiency develops after the onset of chemotherapy.

The diagnosis is confirmed by the presence of impaired renal function, hypocalcemia (8 mg / dl), hyperuricemia (15 mg / dL) and / or hyperphosphatemia (8 mg / dL). It is necessary to prescribe allopurinol (200-400 mg / m 2 once a day, maximum 600 mg / day) and intravenous infusion physiological solution of sodium chloride to achieve diuresis more than 2 liters / day with laboratory and cardiological monitoring. Patients with fast-growing tumors should receive allopurinol at least 2 days prior to chemotherapy and throughout the course. In patients with a large tumor mass, this regimen should be extended to 10 days after chemotherapy. All these patients should receive significant intravenous hydration with a diuresis of at least 100 ml / h before the start of therapy. Although some physicians prefer the intravenous administration of NaHC03 to alkalinize urine and increase the solubility of uric acid, alkalization can contribute to the deposition of Ca phosphate in patients with hyperphosphatemia, and therefore it is necessary to avoid a pH above 7. Alternatively, Rawburikas, an enzyme that oxidizes uric acid to allantoin (a more soluble molecule) can be used to prevent tumor lysis. The dose is, 5, mg / kg intravenously for more than 30 minutes, once a day for 5-7 days and usually starts 4 to 24 hours before the first course of chemotherapy. Side effects may include anaphylaxis, hemolysis, hemoglobinuria, methemoglobinemia.

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Radiation treatment of rectal cancer

Cancer of the rectum (colorectal cancer) is a malignant formation in the large intestine, localized on the walls of the intestine or protruding into its lumen. According to official statistics, this terrible disease is progressing every year. Moreover, according to practical observations, the more developed the country, the more cases of registered oncological cases. Most patients with rectal cancer are observed in the US, Israel and Canada.

Malignant education affects older people to a greater extent, but there are rare exceptions. The main percentage of morbidity falls on the age after 50 years.

This polyethical disease, which has many causes of occurrence, is most often caused by such factors:

  • malnutrition (lack in the diet of plant fiber, fiber, an abundance of fatty foods of animal origin, fast food on the dry). By the way, in vegetarians malignant tumors practically do not appear;
  • abuse of alcohol-containing beverages;
  • overweight, bordering on obesity;
  • infection of the rectum or intestine, their inflammation, the presence of polyps;
  • anal sex;
  • smoking.

It is important to note that smoking people with rectal cancer have a double risk of death compared to non-smokers. Of great importance is also the genetic predisposition to the onset of this disease.

Treatment of malignant disease

Treatment of oncological disease of the rectum is based on a whole complex of treatment procedures. Before starting therapy, a person must necessarily undergo a thorough examination to confirm or deny the diagnosis, as well as to determine the degree of colorectal cancer.

If you notice the following symptoms of the disease, you should immediately consult a proctologist to exclude tumors:

  • unusual discharge from the anus: mucus, pus, blood blotches;
  • causeless constipation or diarrhea, frequent stool disorders;
  • discomfort in the anus, painful sensations;
  • false urge to natural cleansing of the intestine.

Such manifestations of the disease are peculiar not only to cancer, but also to other diseases of the anus: hemorrhoids, paraproctitis or irritable bowel syndrome.In order to make the final diagnosis, the doctor will perform an external examination, perform finger diagnostics, direct the feces (reveal the presence of hidden blood), rectal ultrasound, and sigmoidoscopy. In some cases, computed tomography (CT) may be required. Only after this, and in case of confirmation of the diagnosis, appropriate therapy based on individual manifestations of the disease will be prescribed, as well as its stages.

Radiation therapy of colorectal cancer

As a rule, the main way to treat cancer is surgical intervention, but it is ineffective in the late stages of the disease.The operation for the destruction of the tumor is carried out by an experienced doctor and can consist not only in the removal of the formation, but also in the rectum as a whole, followed by the formation of colostomy. According to official data, after surgical treatment of an anus of the anus, frequent relapses of the disease are observed, the percentage of which varies from 15 to 50. The frequency of relapse directly depends on the stage of the disease. For example, with oncology of the 1st degree, surgical removal of the neoplasm can completely free from disease.

To improve the effectiveness of treatment of colorectal cancer, additional methods are used: radiation therapy and chemotherapy.The article will deal with the features of radiation therapy (irradiation) and the possible consequences of radiation therapy.

Radiation therapy is the effect on tumor cells with the help of special ionizing radiation. A radioactive source emitting X-rays or electron beams is installed on modern apparatuses.

According to many studies, malignant cells are much more sensitive to radiation than normal ones. Under the influence of irradiation they suffer strong mutations, after which they perish. Modern devices for radiotherapy can exert a destructive effect exclusively on diseased cells, maximally concentrating in the middle of the neoplasm.

Thus, healthy organs are practically not exposed to radiation. This method of combating cancer is used both as a single remedy, and in addition to surgery, as well as chemotherapy. As an additional method of therapy, it provides a more reliable result, significantly reducing the risk of relapse.

In general, radiotherapy for rectal cancer is carried out when:

  1. It is impossible to conduct adequate surgical treatment because of the complex location of the tumor or the presence of metastases.
  2. There is a high probability of recurrence, especially if it is a question of II and III stages of the disease. Then irradiation is performed after surgery.
  3. Preparation is required for the operation. Before the removal of the tumor, a course of radiation treatment may be prescribed to reduce the risk of postoperative complications or relapses.

What are the consequences of such treatment?

Radiation therapy is able not only to relieve the painful symptoms of the disease, but also cause some harm to the body. It is known that irradiation has a very negative effect on the normal healthy cells of the human body. Of course, every therapy session begins with setting up the equipment in such a way as to minimize the impact on neighboring organs. When carrying out irradiation, the X-ray may not extend to the whole pelvic area, however inevitably passes through some healthy organs and tissues before it reaches its goal - a tumor of the direct guts. That is why there can be some consequences of such therapy, namely:

  • nausea, vomiting;
  • loss of appetite;
  • dilution of stools;
  • problems with urination (false urges);
  • pain in the anus;
  • irritation near the anus;
  • in women, vaginal discharge;
  • decrease in blood counts (leukocytes and platelets), which causes a decrease in overall immunity;
  • against a background of reduced resistance of the body there can be an infection of the genitourinary system.

Such consequences of therapy of a tumor of a rectum are incomparable with risk for a life of the person because of absence of treatment. According to the patients' reports, in order to significantly reduce the manifestations of the aforementioned effects of irradiation, it is enough to sit on a strict diet, and also take medications to improve digestion.

An effective remedy for hemorrhoids exists. Follow the link and find out what Elena Malysheva recommends.

Side effects of radiation therapy

When carrying out radiation therapy, radiation reactions and damage to tissues surrounding the tumor and entering the irradiated volume can be observed.

Radiation reactionscalled temporary, usually self-passing functional changes in the tissues surrounding the tumor. The degree of severity of side effects of radiation therapy depends on the location of the irradiated tumor, its dimensions, methods of irradiation, the general condition of the patient (presence or absence of accompanying diseases).

Radiation reactions can becommonandlocal. The general radiation reaction is the reaction of the whole organism of the patient to treatment, which manifests itself:
• worsening of the general condition (short-term fever, weakness, dizziness);
• impaired gastrointestinal function (decreased appetite, nausea, vomiting, diarrhea);
• violation of the cardiovascular system (tachycardia, chest pain);
• hematopoietic disorders (leukopenia, neutropenia, lymphopenia, etc.).

General radiation reactionsarise, as a rule, when large volumes of tissues are irradiated and terminate at the end of treatment.

More often when carrying out radiation therapylocal radiation reactions.

• In the case of remote radiation therapy, the appearance of the radiation field often causes dry skin, peeling, itching, redness, the appearance of small bubbles. To prevent and treat such a reaction, ointments are used (on the recommendation of a radiologist), Panthenol aerosol, creams and lotions for the care of baby skin. The skin after irradiation loses its resistance to mechanical influences and requires a careful and sparing relationship.
• With radiation therapy of head and neck tumors, hair loss, hearing loss, and a feeling of heaviness in the head can occur.
• When irradiating the tumors of the face and neck, dry mouth, throat swelling, swallowing pain, hoarse voice, loss and loss of appetite may occur. In this period, food cooked for a couple, as well as cooked, grated or chopped, is useful. Eat often in small portions. It is recommended to drink more liquid (jelly, fruit compotes, broth of dogrose, non-acidic cranberry juice). To reduce dryness and perspiration in the throat, a decoction of chamomile, calendula, mint is used. It is recommended to bury the sea buckthorn oil in the nose at night, and in the afternoon take several tablespoons of vegetable oil on an empty stomach. Teeth should be cleaned with a soft toothbrush.
• Irradiation of the chest cavity can cause pain and difficulty in swallowing, dry cough, shortness of breath, tenderness of muscles.
• When the breast is irradiated, muscle soreness, swelling and tenderness can be noted mammary gland, inflammatory skin reaction in the area of ​​irradiation, sometimes cough, inflammatory changes in the throat. It is necessary to take care of the skin according to the method described above.
• Irritation of the abdominal cavity may result in loss of appetite, weight loss, nausea and vomiting, loose stools, and pain. When irradiating the pelvic organs, side effects are nausea, loss of appetite, loose stools, disorders of urination, soreness in the rectum, in women - dryness of the vagina and discharge from him. For the timely elimination of these phenomena it is better to eat diet food. Multiplicity of meals should be increased. The food should be boiled or steamed. Not recommended sharp, smoked, salty dishes. When bloating, you should abandon dairy products, recommended mashed porridge, soups, kissels, steam dishes, wheat bread. The consumption of sugar should be limited. It is recommended to put butter in ready meals. Possible use of drugs that normalize the intestinal microflora.
• When carrying out radiation therapy, patients should wear loose clothing that does not constrain the place where the irradiation is carried out, or rub the skin. Underwear should be made of linen or cotton fabric. To conduct hygienic procedures, use warm water and non-alkaline (baby) soap.

In most cases, all the above changes are transient, with adequate and timely correction are reversible and do not cause the termination of radiotherapy. Careful implementation of all the recommendations of a radiologist during and after the treatment is necessary. Remember that it is better to prevent a complication than to treat it.

Yu.V. Гуменецкая, according to the journal Together Against Cancer

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