Radiation Enteritis in Mesothelioma Patients

Mesothelioma radiation therapy stops the growth of rapidly dividing cells, such as cancer cells. Since normal cells in the lining of the bowel also divide rapidly, radiation treatment can stop those cells from growing, making it difficult for bowel tissue to repair itself. As bowel cells die and are not replaced, gastrointestinal problems develop over the next few days and weeks.

Patients with acute enteritis may have the following symptoms:

• Nausea
• Vomiting
• Abdominal cramps
• Frequent urges to have a bowel movement
• Rectal pain, bleeding, or mucus-like discharge
• Watery diarrhea. With diarrhea, the gastrointestinal tract does not function normally, and nutrients such as fat, lactose, bile salts, and vitamin B 12 are not well absorbed.

Symptoms of acute enteritis usually get better 2 to 3 weeks after treatment ends.

Assessment of Radiation Enteritis

Patients will be given a physical exam and be asked questions about the following:

• Usual pattern of bowel movements.
• Pattern of diarrhea, including when it started; how long it has lasted; frequency, amount, and type of stools; and other symptoms (such as gas, cramping, bloating, urgency, bleeding, and rectal soreness).
• Nutritional health of the patient, including height and weight, usual eating habits, any change in eating habits, amount of fiber in the diet, and signs of dehydration (such as poor skin tone, increased weakness, or feeling very tired).
• Current level of stress, ability to cope, and changes in lifestyle caused by the enteritis.

Treatment

Treatment of acute enteritis includes treating the diarrhea, loss of fluids, poor absorption, and stomach or rectal pain. These symptoms usually get better with medications, changes in diet, and rest. If symptoms become worse even with this treatment, then cancer treatment may have to be stopped, at least temporarily.

Medications that may be prescribed include antidiarrheals to stop diarrhea, opioids to relieve pain, and steroid foams to relieve rectal inflammation and irritation. If patients with pancreatic cancer have diarrhea during radiation therapy, they may need pancreatic enzyme replacement, because not having enough of these enzymes can cause diarrhea.

Nutrition

Nutrition also plays a role in acute enteritis. Intestines damaged by radiation therapy may not make enough or any of certain enzymes needed for digestion, especially lactase. Lactase is needed for the digestion of milk and milk products. A lactose-free, low-fat, and low-fiber diet may help to control symptoms of acute enteritis. For more general discussion of nutrition, check our section on nutrition for mesothelioma patients.

Foods to avoid:

• Milk and milk products, except buttermilk and yogurt. Processed cheese may not cause problems because the lactose is removed during processing. Lactose-free milkshake supplements, such as Ensure, may also be used.
• Whole-bran bread and cereal.
• Nuts, seeds, and coconut.
• Fried, greasy, or fatty foods.
• Fresh and dried fruit and some fruit juices (such as prune juice).
• Raw vegetables.
• Rich pastries.
• Popcorn, potato chips, and pretzels.
• Strong spices and herbs.
• Chocolate, coffee, tea, and soft drinks with caffeine.
• Alcohol and tobacco.

Foods to choose:

• Fish, poultry, and meat that are cooked, broiled, or roasted.
• Bananas, applesauce, peeled apples, and apple and grape juices.
• White bread and toast.
• Macaroni and noodles.
• Baked, boiled, or mashed potatoes.
• Cooked vegetables that are mild, such as asparagus tips, green and waxed beans, carrots, spinach, and squash.
• Mild processed cheese, eggs, smooth peanut butter, buttermilk, and yogurt.
  

Helpful hints for mesothelioma patients dealing with enteritis:

• Eat food at room temperature.
• Drink 3 liters (about 12 eight-ounce glasses) of fluid a day.
• Allow carbonated beverages to lose their fizz before drinking them.
• Add nutmeg to food to help decrease movement of the gastrointestinal tract.
• Start a low-fiber diet on the first day of radiation therapy.

Side effects

Hair loss