Diarrhea and Cancer

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April 4, 2013 at 11:16 am  #1255364    

njliu

While diarrhea is a common side effects from various cancer treatments including Tarceva/iressa, can it be a direct effect caused by progression of disease, leading to continuous weight loss and muscle wasting?
NJ


Wife, 56, Asian, 11/11 Dx Adenocarcinoma 3B, EGFR+. 12/11 Iressa, great response. 12/12 asymptomatic brain mets with possible lepto, 1/13 WBR, continue Iressa, 9/13 Local Progression at primary tumor, 10/13 focal radiation, 1/14 PET Scan:Tumor Resolution, continue Iressa, 6/14 PET shows flare up at same primary. 9/14 CT stable/MRI reappearance of brain mets, 4/15 stable brain mets, 5/15 increase in SUV and slight pleural effusion. 6/15 Afatinib + Cetuximab

April 4, 2013 at 1:15 pm  #1255367    
catdander forum moderator
catdander forum moderator

Hi NJ, Here is a quote from Dr. Harman on the subject of diarrhea culprits, ” The main culprits among types of cancer are the endocrine (metabolic hormone) cancers, such as medullary thyroid cancer or malignant carcinoid cancer. Small cell lung cancers can secrete certain intestinal hormones that cause diarrhea because these hormones abnormally signal the gut to release fluid and not absorb fluid at the same time. If a cancer metastasis affects the spinal cord, this can cause difficulty controlling stooling and diarrhea. Among chemotherapy agents, 5-FU (5-fluorouracil) and oral capecitabine (Xeloda), paclitaxel, and irinotecan (Camptosar) are some of the usual suspects, as well as oxaliplatin in combination treatments. Less commonly, some of the new molecular agents such as the EGFR inhibitors (erlotinib, aka Tarceva, for example) can cause diarrhea as well. If the gut lies in a field of radiation, a radiation “enteritis,” or intestinal inflammation, can occur which manifests as diarrhea. Other causes of diarrhea include non-cancer-directed medications such as metoclopramide (Reglan) or excessive laxatives; infection, i.e. the proverbial stomach flu; and antibiotics (ironically).” Of course there is further conversation about ways to control the effects, http://cancergrace.org/cancer-treatments/2011/04/08/glamorous-topics-in-cancer-symptoms-diarrhea/

I don’t know that this answers your specific question about weight loss and muscle wasting. That has more to do with the proteins cancer creates. http://cancergrace.org/cancer-treatments/2009/02/16/acs-mgmt/

Janine

April 4, 2013 at 2:05 pm  #1255370    

njliu

Hi Janine, thanks. Can these two be direct cause and effect where quick bowel movement allows no time for proteins to be absorbed and thus losing weight?
NJ


Wife, 56, Asian, 11/11 Dx Adenocarcinoma 3B, EGFR+. 12/11 Iressa, great response. 12/12 asymptomatic brain mets with possible lepto, 1/13 WBR, continue Iressa, 9/13 Local Progression at primary tumor, 10/13 focal radiation, 1/14 PET Scan:Tumor Resolution, continue Iressa, 6/14 PET shows flare up at same primary. 9/14 CT stable/MRI reappearance of brain mets, 4/15 stable brain mets, 5/15 increase in SUV and slight pleural effusion. 6/15 Afatinib + Cetuximab

April 4, 2013 at 2:39 pm  #1255371    
catdander forum moderator
catdander forum moderator

I’ll ask a doctor to give some input here. I hope your wife can get comfortable soon.

Janine

April 4, 2013 at 4:00 pm  #1255375    

double trouble

Add Xalkori to that list! :( I hope you are able to get it under control soon.
Debra

April 4, 2013 at 4:03 pm  #1255376    
Dr West
Dr West

I don’t think that’s likely. There are certainly malabsorption syndromes that can lead to muscle wasting and weight loss, but the cancer tends to lead to muscle wasting and weight loss through diminished appetite and oral intake far more than through diarrhea. Lung cancer in particular would be very, very unlikely to cause diarrhea that would lead to malnutrition.

Good luck.

-Dr. West

April 5, 2013 at 1:08 am  #1255389    

certain spring

I just wanted to add that I had a similar worry at a time when the Tarceva was really giving me trouble. I became convinced that I was absorbing nothing nutritionally useful because the diarrhoea was so bad. I asked my oncologist about this and she didn’t seem concerned. I’m happy to say – and I hope this will prove true for others suffering from this nasty side effect – that things got better.
Losing weight, however, is a worry in itself, and I don’t know how one could tell if that would be happening even without the effects of the TKI.


49-year-old non-smoker, dx stage IV NSCLC May 2010 (squamous tumour of the left lung with multiple brain metastases). Radiotherapy to chest and brain; progressed through two cycles carbo/gemcitabine. Repeated lung collapses; pneumonia in collapsed lung, Nov 2010; bronchial stent placed, Dec 2010. Declined second-line Taxotere. Mutation testing Feb 2011, surprise EGFR exon deletion 19. Started Tarceva (150mg), Feb 2011. Progression in liver and elsewhere, May 2013.

April 5, 2013 at 8:14 am  #1255396    
catdander forum moderator
catdander forum moderator

When D was on tarceva emodium and magace kept him from more weight loss.

April 5, 2013 at 1:23 pm  #1255405    

Dr Sanborn

Hello NJ–

Dr. Harman’s summary is a good one, looking at different causes of diarrhea with cancer and cancer therapies. In general, we don’t expect lung cancer itself to cause a diarrhea syndrome. That would be particularly unusual as a “new” syndrome, meaning that if a person has had the cancer for a while, the cancer does not generally cause a new type of trouble like that. If a cancer causes a particular symptom like that (called a “paraneoplastic syndrome”, and causing troubles like low blood sodium levels), usually it is present when the cancer is diagnosed in the first place. They don’t generally tend to create new syndromes during their course.
However, it can be difficult to sort out different symptoms, to figure out what may be causing what. Cancer progression can indeed cause weight loss. Cancer therapies can, as well. Weight loss can occur from malnutrition or dehydration, which can be caused or aggravated by diarrhea. A person may have weight loss from one problem and diarrhea from another. Generally these are issues that are best sorted out by a good talk with the treating doctor, who can listen to the entire pattern and timing of symptoms, and put this into the context of what medications a person is taking and when changes may have been made, and look at the images and consider the entire history, to create possible suggestions of what may be causing what, and how to intervene to try to help the person feel better.

This is a long response, sorry, but I hope it helps place some perspective.

Take care–
Dr. Sanborn


Rachel Sanborn, MD
Medical Oncologist
Providence Cancer Center

Views expressed here represent my opinion, not those of GRACE or Providence Cancer Center. This information does not constitute medical advice and is intended to supplement and not replace medical information provided by your doctor.

April 5, 2013 at 8:54 pm  #1255421    

njliu

Thanks to everyone for the comments. They are of course very helpful (Thanks to GRACE for making this forum available). Janine, we shall try to get Emodium and Magace.
NJ


Wife, 56, Asian, 11/11 Dx Adenocarcinoma 3B, EGFR+. 12/11 Iressa, great response. 12/12 asymptomatic brain mets with possible lepto, 1/13 WBR, continue Iressa, 9/13 Local Progression at primary tumor, 10/13 focal radiation, 1/14 PET Scan:Tumor Resolution, continue Iressa, 6/14 PET shows flare up at same primary. 9/14 CT stable/MRI reappearance of brain mets, 4/15 stable brain mets, 5/15 increase in SUV and slight pleural effusion. 6/15 Afatinib + Cetuximab

March 14, 2016 at 2:28 am  #1273245    

aaron

Hi Grace,

I’m sorry to say that I am still on my quest to get a diagnosis and therefore still asking questions.

Amongst the fatigue and weightloss my hormones seem to be acting up, cortisol is at the high end, testosterone low (sometimes low normal), sodium low normal 135 (sometimes low 131) and some bowel issues.

In this post about diarrhea Dr Harman is quoted as saying, ” The main culprits among types of cancer are the endocrine (metabolic hormone) cancers, such as medullary thyroid cancer or malignant carcinoid cancer. Small cell lung cancers can secrete certain intestinal hormones that cause diarrhea because these hormones abnormally signal the gut to release fluid and not absorb fluid at the same time”

Do you know what hormones are released and can they be tested. I know that it is a long shot, but I am looking or anything that just might help us get a lead.

Once again, thank you,

Aaron

March 14, 2016 at 12:58 pm  #1273251    
catdander forum moderator
catdander forum moderator

I’m so sorry Aaron that you’re having to worry so much about your health. I know how difficult it is to have life interrupting symptoms but no diagnosis and no symptom relief. However this line of questioning is not our focus/expertise nor do we feel comfortable trying to answer, trying to answer would lie somewhere between unethical and unlawful. I hope you understand but especially I hope you find an explanation and cure to your problems.
Janine

March 15, 2016 at 1:45 am  #1273259    

aaron

Hi Janine and Jim,
Thank you so much for all your knowledge over the last few months and the empathy you have shown. You really do have a talent and contribute towards a wonderful resource. I understand your response and will endeavour to not jump in with questions without having carefully thought them through. When I do get a diagnosis I may send you a quick update if that is okay, it might just help someone with similar concerns and symptoms from going down the wrong route or distracting you with questions not really suited to the purpose of GRACE.
Best Wishes and with much appreciation for what you do,

Aaron.

March 15, 2016 at 11:06 am  #1273264    
catdander forum moderator
catdander forum moderator

Absolutely Aaron and thank you so much for understanding. I hope you find out what’s going on and I hope it’s not cancer. But if it is know you can contact us. All the best of luck.
Janine

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