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Proctological Problems in Relation to Chemotherapy
Tom Lagaert1, Bruno Vanduyfhuys1, Beatrijs Strubbe1, Ingrid Bruggeman1, Koen Gorleer1, Pieter Hindryckx1, Daan De Maeseneer2, Ine Moors3, StéPhanie Laurent1, Karen P. Geboes1, Tessa Kerre3, Simon Van Belle2, Martine De Vos1, Danny De Looze*1
1Gastroenterology, University Hospital Gent, Gent, Belgium; 2Medical oncology, University Hospital Gent, Gent, Belgium; 3Hematology, University Hospital Gent, Gent, Belgium
Background: In daily practice anal problems in patients under chemotherapy are often seen, cause significant morbidity and are difficult to treat.
Aims: Literature about this problem is scarce, even unexisting. Therefore, we want to make a survey of proctological problems in patients under chemotherapy, and evaluate factors that promote the development of anal disease.
Methods: From March, 15th until November 30th, 2012 all patients spontaneously reporting anal complaints at the different departments of oncology and currently under chemotherapy, are selected for this study. Informed consent is obtained from all patients. The following data are systematically collected: performance status (grade 0 is normal-grade 4 is severe), medical history, current oncological disease and chemotherapy, chemotherapy-related toxicity (grade 0-4), proctological complaints, diagnosis and outcome.
Results: Twenty-three people, 14 women and 9 men, with a mean age of 50 years (range 20-80) are collected. The main presenting symptom is anal pain (n=21) and in 2 patients anal blood loss. Proctological diagnoses were anal fissure (n=12), external hemorrhoidal thrombosis (n=3), anal abscess (n=2), anal ulceration (n=2), internal hemorrhoidal bleeding (n=2), no diagnosis (n=2).
Mean WHO performance status was 1,72 (range 1-4), mean toxicity scores for respectively oral mucositis, nausea-vomiting, diarrhea and constipation are 0,76-0,88-0,94 and 1,50 (ranges 0-4). Patients were under chemotherapy for breast cancer (n=8), AML (n=3), renal cell carcinoma (n=2), rectal carcinoma (n=2), ALL (n=2), MDS (n=2), sarcoma (n=1), testis carcinoma (n=1), aplastic anemia (n=1) and non-Hodgkin lymphoma (n=1).
Conclusion: Anal fissure is the most frequent encountered proctological problem in patients under chemotherapy. Constipation was the most commonly seen toxicity of chemotherapy, while oral mucositis was rarely seen in this patient cohorte. Treatment of anal problems is most often conservative, but preventive measures should be directed towards prevention of constipation.
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