Diarrhea in cancer patients

Abstract

The causes of diarrhea among cancer patients are diverse and include paraneoplastic, chemotherapy-induced, radiation-induced, and infectious etiologies. Malignant diseases such as neuroendocrine tumors (VIPoma, gastrinoma, medullary thyroid carcinoma, carcinoid tumors) may cause paraneoplastic syndromes with severe secretory diarrhea. Treatment-induced diarrhea can result from cytotoxic chemotherapy agents such as fluorouracil, capecitabine, irinotecan, paclitaxel, docetaxel, and vinorelbine, as well as exposure of the gastrointestinal tract during radiotherapy. In addition to food poisoning and infectious gastroenteritis (including Clostridium difficile), immunocompromised neutropenic cancer patients are at risk for ileitis, typhlitis, and colitis that may be life threatening. Treatment with immune checkpoint therapy agents (e.g., ipilimumab, nivolumab) and graft-versus-host disease after allogeneic stem cell transplantation can cause diarrhea through immune mechanisms. In addition to supportive clinical management, diagnosis of the cause of diarrhea is very important in order to safely apply cause-specific treatment.