HemeOnc

Diarrhea in Cancer

Diarrhea in Cancer, Diarrhea in Terminally Ill Patients, Cancer Related Diarrhea, Chemotherapy Induced Diarrhea

Identify a cause!
1. Clostridium difficile
2. Cytomegalovirus Infection
3. Reactivation of latent Viral Hepatitis
4. See Chemotherapy causes above
Often associated with Radiotherapy near bowel (Abdomen, Pelvis, Rectum)
1. See Radiation Colitis
2. Consider bowel ischemia or perforation (esp. if bleeding)
Other common complications of Chemotherapy
1. Lactose Intolerance
2. Small Bowel Bacterial overgrowth
3. Bile Acid Malabsorption

Discuss with patient's oncologist
Fluid Resuscitation and Electrolyte replacement
Antiemetics (e.g. Ondansetron)
Antidiarrheals (e.g. Loperamide) AFTER infectious cause excluded
1. Loperamide 4 mg, then 2 mg for every loose stool (max 16 mg/day)
2. Octreotide 100-150 mcg SQ three times daily (or start 25-50 mcg IV three times daily up to 500 mcg tid)
  1. Indicated in Loperamide resistant Diarrhea, to reduce colon secretions
Antispasmodics for abdominal cramping
1. Dicyclomine (Bentyl)
2. Hyoscyamine (Levsin)
Other agents (if infection excluded)
1. Corticosteroids (e.g. Rectal Budesonide)