title: Toward Restored Bowel Health in Rectal Cancer Survivors.
abstract: As technology gets better and better, and as clinical research provides more and more knowledge, we can extend our ambition to cure patients from cancer with restored physical health among the survivors. This increased ambition requires attention to grade 1 toxicity that decreases quality of life. It forces us to document the details of grade 1 toxicity and improve our understanding of the mechanisms. Long-term toxicity scores, or adverse events as documented during clinical trials, may be regarded as symptoms or signs of underlying survivorship diseases. However, we lack a survivorship nosology for rectal cancer survivors. Primarily focusing on radiation-induced side effects, we highlight some important observations concerning late toxicity among rectal cancer survivors. With that and other data, we searched for a preliminary survivorship-disease nosology for rectal cancer survivors. We disentangled the following survivorship diseases among rectal cancer survivors: low anterior resection syndrome, radiation-induced anal sphincter dysfunction, gut wall inflammation and fibrosis, blood discharge, excessive gas discharge, excessive mucus discharge, constipation, bacterial overgrowth, and aberrant anatomical structures. The suggested survivorship nosology may form the basis for new instruments capturing long-term symptoms (patient-reported outcomes) and professional-reported signs. For some of the diseases, we can search for animal models. As an end result, the suggested survivorship nosology may accelerate our understanding on how to prevent, ameliorate, or eliminate manifestations of treatment-induced diseases among rectal cancer survivors.
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden. Electronic address: Gunnar.Steineck@gu.se.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.affiliation: Department of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Schmidt
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Alevronta
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Fei
authors.initials: F
authors.lastname: Sjöberg
authors.affiliation: Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Cecilia Magdalena
authors.initials: CM
authors.lastname: Bull
authors.affiliation: Deptartment of Radiation Oncology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Vordermark
mesh_terms: D006801:Humans; D011183:Postoperative Complications; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000523:psychology* / Q000628:therapy*; D017741:Survivors; D000073859:Survivorship; D013577:Syndrome; D016896:Treatment Outcome