Late toxicity printout — GI

Cited monitoring paradigm

Acute: ACS names nausea, heartburn, cramps, diarrhea or constipation, bowel urgency, and rectal or anal skin irritation. Late: radiation proctitis, bowel incontinence, ostomy or chronic bowel change, neuropathy, adhesions, urinary trouble after pelvis RT, fertility effects, sexuality changes, lasting fatigue, cavities after chemo, and cognitive change after chemo. Monitor: on-treatment diarrhea; proctitis after 3 to 6 months; lasting fatigue or sleep problems; sexuality or body-image change; fertility after pelvis, belly, or spine treatment; cavity risk after chemo; memory, thinking, or focus change after chemo; a treatment summary and second-cancer watching. Those names are not encoded. Official esophagus share-of-new-cases figures are not restated. Not a Lynch or endoscopy engine.

Not a fourth printout section. Cadences stay placeholders. Named tests are not encoded.

Questions to ask

ACS long-term page lists questions to ask the care team: possible long-term and late effects, whether fertility or second-cancer risk is higher, which cancer screening tests belong later, which specialists should follow those effects, whether cancer rehabilitation could help, and when to call primary care versus cancer care. Those questions are not encoded. Not a screening, fertility, rehab, or specialist-interval engine.

ACS long-term page says not everyone who has cancer treatment gets long-term or late effects. Who does can depend on the cancer type, the type and dose of treatment, side effects during treatment, age at diagnosis, health before treatment, genetics, eating and exercise during and after treatment, care-team expertise, and support from others. Those reasons are not encoded. Not a late-effect risk-score engine.

ACS follow-up-care page lists questions to ask: how to get a treatment summary and follow-up care plan, who is in charge of follow-up, how often visits and which tests or screens belong later, signs of recurrence or a second cancer, and which survivor support services are available. Follow-up may stay with the cancer care team, move to a survivorship clinic, or return to primary care, depending on the cancer type and stage, the treatment, remaining side effects, insurance, and wishes. Those questions and choices are not encoded. Not a visit-interval, screening, or clinic-routing engine.

ACS long-term and follow-up-care lists, named not encoded. Not a fourth printout section.

Treatment summary and care plan

ACS follow-up-care page names what a cancer treatment summary most often includes: diagnosis date; cancer type, including where it started, stage, and grade if known; treatments and dates, including type, dose, and number of cycles; side effects and how they were managed; test results; and names and contacts for the treating doctors. A survivorship care plan most often names remaining treatment, how often follow-up should happen, which tests including screens for other cancers, possible long-term or late effects, and ways to improve overall health. Those named contents are not encoded. Not a records, visit-interval, or screening engine.

ACS follow-up-care named contents. Not a fourth printout section.

How late effects are managed

ACS follow-up-care page says long-term side effects begin during treatment and continue after, and late side effects can start months or years later. Follow-up care may include a review of symptoms, a physical exam, blood tests to check blood counts and how the liver, kidneys, and other organs are working, and other tests as needed. Special tests after some treatments stay named on this printout. Those named steps are not encoded. Not a lab-panel, visit-interval, or screening engine.

ACS follow-up-care named steps. Not a fourth printout section.

Acute toxicities

During or shortly after RT. ACS early side effects.

• Nausea and vomiting — ACS names nausea and vomiting after abdomen or pelvis RT.ACS-radiation-body
• Heartburn and belly cramps — ACS names heartburn and belly cramps.ACS-radiation-body
• Diarrhea or constipation — ACS names diarrhea or constipation during abdomen RT.ACS-radiation-body
• Bowel urgency — ACS names bowel urgency during pelvis or rectum RT.ACS-radiation-body
• Skin irritation of the rectum and anus — ACS names rectal and anal skin irritation, including after anal-field RT.ACS-radiation-body

Late toxicities

Months to years after RT. ACS delayed effects.

ACS long-term late names: Bowel obstruction from adhesions · Urinary retention or incontinence after pelvis RT · Fertility after pelvis, belly, or spine RT · Sexuality after cancer treatment · Cavities and tooth loss after chemo · Cognitive impairment after brain RT or chemo

• Radiation proctitis — ACS names later rectal lining damage with pain, bleeding, incontinence, or narrowing.ACS-radiation-body
• Bowel incontinence / urgency — ACS names later trouble controlling bowels.ACS-radiation-body
• Ostomy and chronic bowel change — ACS colorectal living-as page names ostomy care and chronic bowel changes.ACS-crc-follow
• Neuropathy — ACS colorectal living-as page names neuropathy after some systemic therapy. Not a dose engine.ACS-crc-follow
• Second-cancer awareness — ACS CRC and pancreas second-cancer pages, plus esophagus, anus, and small-intestine after-treatment pages, name later cancers. Extra tests without symptoms are not recommended on the CRC, pancreas, esophagus, and anus pages. Official share-of-new-cases figures are not restated.ACS-crc-second
• Bowel obstruction from adhesions — ACS long-term page names bowel blockage from scar tissue after surgery or abdomen or pelvis radiation.ACS-long-term-effects
• Urinary retention or incontinence after pelvis RT — ACS long-term page names trouble emptying the bladder, leakage, or UTIs after abdomen or pelvis treatment.ACS-long-term-effects
• Fertility after pelvis, belly, or spine RT — ACS long-term page names fertility effects after chemo or radiation to the pelvis, belly, or spine. Named only on abdomen or pelvis fields that do not already carry their own fertility row. Not a fertility-preservation engine.ACS-long-term-effects
• Sexuality after cancer treatment — ACS long-term page names changes to sex organs, sexual drive, sexual function and well-being, and body image after cancer treatment. Named only on abdomen or pelvis fields that do not already carry their own sexual-function names. Not a sexual-function engine.ACS-long-term-effects
• Cancer-related fatigue that lasts — ACS long-term page names cancer-related fatigue as the most common long-term effect, lasting months or years and not always improving with rest. Sleep problems are also named and may have more than one cause.ACS-long-term-effects
• Joint or muscle pain after some treatments — ACS long-term page names joint or muscle pain after chemo, steroids, or hormone therapy. Symptoms may improve over time. People who are not physically active may have a higher risk. Not a rehab-interval engine.ACS-long-term-effects
• Mental health and distress after treatment — ACS long-term page names anxiety, depression, post-traumatic stress, loneliness, and fear of recurrence among common mental-health effects after cancer treatment. Not a mental-health screening engine.ACS-long-term-effects
• Cavities and tooth loss after chemo — ACS long-term page names tooth-enamel damage after chemo, which raises cavity and tooth-loss risk. Named only on fields that already name chemo. Not a dental-calendar engine.ACS-long-term-effects
• Cognitive impairment after brain RT or chemo — ACS long-term page names changes in memory, thinking, or focus after brain radiation or chemo, also called chemo brain or brain fog. New or worsening change should be reported right away. Named only on the brain field and on fields that already name chemo. Not a cognitive-screening engine.ACS-long-term-effects
• Second cancers after radiation or chemo — ACS adult second-cancers hub says a second cancer is a new unrelated cancer, not a recurrence. Radiation is linked to later AML, CML, ALL, or MDS, and to solid tumors that more often show up 10 years or more later, including breast, lung, thyroid, or bone and soft-tissue sarcomas. Chemo is linked most often to MDS and AML; ALL is also named. Chemo is named as a greater leukemia risk factor than radiation. Those names are not encoded. Complementary to the CRC and pancreas second-cancer pages. Official esophagus share-of-new-cases figures are not restated. Not a Lynch or second-primary engine.ACS-second-cancers-adults
• Follow-up care plan after treatment — ACS follow-up-care page, developed with ASCO review, names a cancer treatment summary and a survivorship care plan, plus watching for recurrence and for a second cancer. Regular cervical, breast, colorectal, or lung screening may be named. Those plans and screens are not encoded. Complementary to the CRC and pancreas second-cancer pages. Official esophagus share-of-new-cases figures are not restated. Not a Lynch or endoscopy engine.ACS-follow-up-care

Named conditions to monitor

Red flags and suggested follow-up cadence placeholders. Not a personal calendar.

• Diarrhea that starts during abdomen RT

  Diarrhea that starts during abdomen RT — ACS names diet-change and medicine instructions from the care team. Home remedies are not encoded. On-treatment bowel-care placeholder — not encoded. Not an endoscopy surveillance engine.

  ACS-radiation-body

• Radiation proctitis after 3 to 6 months

  Radiation proctitis after 3 to 6 months — ACS names later rectal bleeding, pain, incontinence, or narrowing. ACS names 3 to 6 months after RT. Placeholder only — not encoded.

  ACS-radiation-body

• Second-cancer testing

  Second-cancer testing — ACS says most experts do not recommend additional testing to look for second cancers unless there are symptoms. Inherited syndromes are named, not encoded. Symptom-directed placeholder — not a Lynch or second-primary engine.

  ACS-crc-second

• Bowel blockage or bladder-emptying trouble

  Bowel blockage or bladder-emptying trouble — ACS long-term page names bowel obstruction from adhesions and urinary retention or incontinence after abdomen or pelvis treatment. Symptom-directed placeholder — not encoded. Not an endoscopy or cystoscopy-interval engine.

  ACS-long-term-effects

• Cancer-related fatigue or sleep problems that last

  Cancer-related fatigue or sleep problems that last — ACS long-term page names cancer-related fatigue as the most common long-term effect, plus sleep problems after treatment. Named months-or-years window is not encoded. Placeholder only — not a fatigue-score engine.

  ACS-long-term-effects

• Joint or muscle pain after chemo, steroids, or hormone therapy

  Joint or muscle pain after chemo, steroids, or hormone therapy — ACS long-term page names joint or muscle pain after those treatments and says symptoms may improve over time. Named activity and rehab steps are not encoded. Placeholder only — not a rehab-interval engine.

  ACS-long-term-effects

• Anxiety, depression, or fear of recurrence after treatment

  Anxiety, depression, or fear of recurrence after treatment — ACS long-term page names those as common types of mental distress among cancer survivors and says very worried, depressed, or angry feelings can affect daily life. Named support steps are not encoded. Placeholder only — not a mental-health screening engine.

  ACS-long-term-effects

• Sexuality or body-image change after treatment

  Sexuality or body-image change after treatment — ACS long-term page says to talk with the cancer care team or primary care provider about sexuality changes. A referral to a sex educator, counselor, therapist, or sexual-health specialist may be named. Referral placeholder — not encoded. Not a sexual-function engine.

  ACS-long-term-effects

• Fertility after pelvis, belly, or spine treatment

  Fertility after pelvis, belly, or spine treatment — ACS long-term page names fertility effects after chemo or radiation to the pelvis, belly, or spine and may name a specialist referral. Referral placeholder — not encoded. Not a fertility-preservation engine.

  ACS-long-term-effects

• Cavity risk after chemo

  Cavity risk after chemo — ACS long-term page names a dentist at least once every 6 months after treatments that raise cavity and tooth-loss risk, including chemo. Named 6-month dental interval is not encoded here. That named interval stays on the head-and-neck printout. Not a dental-calendar engine.

  ACS-long-term-effects

• New or worsening memory, thinking, or focus

  New or worsening memory, thinking, or focus — ACS long-term page says to tell the care team right away about new or worsening memory, thinking, or focus changes after brain radiation or chemo. Named effects are not encoded. Not a cognitive-screening engine.

  ACS-long-term-effects

• Second-cancer awareness after radiation or chemo

  Second-cancer awareness after radiation or chemo — ACS adult second-cancers hub names later MDS or leukemia after some chemo or radiation, and later solid tumors after radiation. Complementary to the CRC and pancreas second-cancer pages. Official esophagus share-of-new-cases figures are not restated. Not a Lynch engine. Named several-year and 10-year windows are not encoded. Symptom-directed placeholder — not a second-primary screening engine.

  ACS-second-cancers-adults

• Ask which late-effect tests belong on the follow-up plan

  Ask which late-effect tests belong on the follow-up plan — ACS follow-up-care page names special tests after some treatments. Ask which tests belong on the plan after abdomen or pelvis treatment. Those named tests are not encoded. Official esophagus share-of-new-cases figures are not restated. Not a Lynch or endoscopy engine. Named yearly and age-30 intervals are not encoded. Placeholder only — not a second-primary screening engine.

  ACS-follow-up-care