Table 2. 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 [19-21] | Capecitabine, cisplatin, cytosine arabinoside, cyclophosphamide, daunorubicin, docetaxel, doxorubicin, 5-fluorouracil, interferon, irinotecan, leucovorin, methotrexate, oxaliplatin, paclitaxel, topotecan, lapatinib |
| Radiation therapy–related (refer to the Radiation Enteritis section of this summary for more information) [22,23] | Irradiation to the abdomen, para-aortics, lumbar, and pelvis |
| Bone marrow transplantation–related [24] | 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, propranolol, theophylline |
| Concurrent disease [5,18] | Diabetes, hyperthyroidism, inflammatory bowel disease (Crohn disease, diverticulitis, gastroenteritis, HIV/AIDS, ulcerative colitis), obstruction (tumor-related) |
| Infection [25] | 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-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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- Mercadante S: Diarrhea in terminally ill patients: pathophysiology and treatment. J Pain Symptom Manage 10 (4): 298-309, 1995. [PUBMED Abstract]
- 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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- Donaldson SS: Nutritional consequences of radiotherapy. Cancer Res 37 (7 Pt 2): 2407-13, 1977. [PUBMED Abstract]
- 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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