Question about bleeding

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Volfan
Posts: 73
Joined: Sat Mar 11, 2017 7:58 am

Question about bleeding

Postby Volfan » Tue Sep 19, 2017 5:56 am

I had treatment yesterday and am still on the pump until tomorrow morning.
My first bowel movement this morning was hard and fairly big around.
When I wiped I had a small amount of bright red blood streaked on the paper. And my butthole was a little sore after.
Do you think this is something I should call the doctor about or just wait until next appointment.
Little background I have rectum cancer that's about 1 1/2" up from the butthole that bled until I started chemo.
Also the chemo seems to play havoc with my butthole. About 5 days out after chemo my butthole gets real sore when I have a bowel movement. Almost like it's gotten smaller. Then the itching starts. I make sure I'm clean but my god at the itching. Sometimes I break down and scratch and I think my eyes roll back in my head it feels so good.
The doc asks every visit about bleeding since I started the avastin. Just wondering whether to see if it continues or go ahead and call.
Stage IV Rectal cancer with liver mets
Oxaliplatin, avastin, 5fu
48 yr dude

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Shana
Posts: 401
Joined: Sun Jul 30, 2017 9:45 pm
Location: Sonoma, CA

Re: Question about bleeding

Postby Shana » Tue Sep 19, 2017 10:37 pm

My cancer is colon so can't comment on what's expected from rectal cancer or your treatment but I'd call doctore because it's always best to report changes as they occur.

I learned the hard way earlier this year that my nausea was related to chemo induced colitis and it caused a world of complications that I didn't need.

Hopefully it's not a big deal but you'll rest easier if your doctor says so!
DX - 12/16
MSS - KRAS wild
Well-differentiated adenocarcinoma at splenic flexure
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17
Irinotecan and Erbitux ran it's course. CEA rising
Primary tumor invaded tail of pancreas and spleen. Liver mets major concern
Y-90 radioembolization on 9/17/18, liver enzyymes have dropped. 10 Radiation treatments to primary tumor completed too. CT scan Nov to assess overall situation...

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JJH
Posts: 408
Joined: Mon Apr 24, 2017 7:26 am

Re: Question about bleeding (Avastin)

Postby JJH » Wed Sep 20, 2017 1:57 am

I was never on Avastin, but I would say that it is a!ways important to keep the doctor advised of any treatment-related adverse event, whatever it might be. This is because a Grade 2 adverse event could quickly escalate to a Grade 3 or Grade 4 level where it may be difficult or impossible to treat it effectively. In my opinion, it's best to report relevant Grade 1 and Grade 2 events in a timely fashion so that the doctor can put an effective action plan in place to stabilize or reduce the adverse event. If you wait too long the adverse event may reach Grade 4 (life-threatening) level, in which case they would probably stop your chemo regimen completely. Forever.

It should be noted that in the official Avastin product insert document, 'Hemorrhage' is included in the special Black Box Warning at the top of the document, signifying that this is a particularly important type of event that needs to be closely monitored. Further details are given in Section 5.4 of that document.

5.4 Hemorrhage
Avastin can result in two distinct patterns of bleeding: minor hemorrhage, most commonly Grade 1 epistaxis; and serious, and in some cases fatal, hemorrhagic events. Severe or fatal hemorrhage, including hemoptysis, gastrointestinal bleeding, hematemesis, CNS hemorrhage, epistaxis, and vaginal bleeding occurred up to five-fold more frequently in patients receiving Avastin compared to patients receiving only chemotherapy. Across indications, the incidence of Grade ≥ 3 hemorrhagic events among patients receiving Avastin ranged from 0.4 to 6.9 %. [See Adverse Reactions (6.1).]

Serious or fatal pulmonary hemorrhage occurred in four of 13 (31%) patients with squamous cell histology and two of 53 (4%) patients with non-squamous non-small cell lung cancer receiving Avastin and chemotherapy compared to none of the 32 (0%) patients receiving chemotherapy alone.

In clinical studies in non–small cell lung cancer where patients with CNS metastases who completed radiation and surgery more than 4 weeks prior to the start of Avastin were evaluated with serial CNS imaging, symptomatic Grade 2 CNS hemorrhage was documented in one of 83 Avastin-treated patients (rate 1.2%, 95% CI 0.06%–5.93%).

Intracranial hemorrhage occurred in 8 of 163 patients with previously treated glioblastoma; two patients had Grade 3–4 hemorrhage.

Do not administer Avastin to patients with recent history of hemoptysis of ≥ 1/2 teaspoon of red blood. Discontinue Avastin in patients with hemorrhage. [See Boxed Warning, Dosage and Administration (2.4).]
http://medlibrary.org/lib/rx/meds/avastin/page/2/#S5.4
"The darkest hour is just before the dawn" - Thomas Fuller (1650)
●●●

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juliej
Posts: 3114
Joined: Thu Aug 05, 2010 12:59 pm

Re: Question about bleeding

Postby juliej » Wed Sep 20, 2017 6:01 pm

Since it was just a small amount of blood after a hard bowel movement, odds are it's nothing. However, when you're on Avastin (which causes bleeding), it's always good to ask your doc so make sure you bring it up at your next visit.

I know this might sound weird, but I could actually feel the chemo shrinking my rectal tumor, so your "itching" might indicate the chemo is kicking butt down there (so to speak)! :D

Also, if you continue to have hard bowel movements, you might try Colace (a stool softener). Chemo seems to cause alternating constipation and diarrhea so I found it best to keep Colace and Imodium around. And make sure you're drinking plenty of water post-chemo. Dehydration can cause hard bowel movements.

Hope this helps!
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 12/18/2019, CEA<1

Basil
Posts: 275
Joined: Thu Mar 16, 2017 12:33 pm

Re: Question about bleeding

Postby Basil » Wed Sep 20, 2017 7:46 pm

Rectal bleeding led to my colonoscopy and diagnosis. The bleeding stopped during neoadjuvant therapy and my bowel function went back to normal (which I interpreted as a good sign - it was!). Later in neoadjuvant I noticed small amounts of blood on tp, which I attributed to hemorroids. I assume that was it because preadjuvant led to a complete response. Can't offer you any advice other than listening to what your body is telling you. The later bleeding is something that should have freaked me out but my body and brain were saying it was hemorroids caused by my newly restored bowel function.
40 y/o male (now 46), kids 11 & 14.
Dx 3/16/17, rectal cancer s3,t3,n1,m0
PROSPCT trial (FOLFOX in lieu of chemorad)
FOLFOX 4/5/17 - 6/26/17
LAR 7/31/17, temp ileo
pathological complete response
Adjuvant chemo cancelled (IDEA Study)
Ileo reversed 9/25/17
NED
1 year scans - clear
2 year scans - clear
3 year scans - clear
4 year scans - clear
5 year scans - clear (considered cured)

orlar
Posts: 65
Joined: Fri Jul 21, 2017 12:51 am
Location: oregon

Re: Question about bleeding

Postby orlar » Wed Sep 20, 2017 8:24 pm

I have colon cancer and am on FOLFOX only (cycle 6 of 12 started today), but noticed a somewhat similar occurrence. I did call my ONC and as my next appt. with the PA ONC was a few days away, we spoke more about it then. She believes it's a fissure and will keep an eye on it. Mine first started after a hard stool that was large and felt like it was ripping things the last few inches. I also had hemorrhoids at the same time. Every BM was somewhat painful and spotted blood on the TP for several days after. Things finally settled down after using ointment and occasionally softener as needed. It still happens once in a while with hard stools, but for the most part is dealt with. The ONC wants to know immediately if anything changes or there's blood in the toilet. I should note I had this happen years ago, long before the big C, and the ER doc at the time said it was a vein he found in the anus area. At that time it had a significant amount of blood in the bowl. I never pursued it further back then (dumb a** me!) as it healed up and hadn't been a problem since. I have only called the one time to the ONC, but they were very insistent that I call with any concerns. It can't hurt to call and check with them. Good luck with things!
56yo male DX 5/17, Right Hemi colectomy 6/17
Stage 3c 12 of 21 LN
7/17-12/17 Folfox(no Oxi round 9-12)
12/17 liver/lung mets-Stage 4 MSS KRAS G13D
2/18 liver doubled to 8.5cm+new met, lung mets to 1.4cm, multi peri/omen
2/18-7/18 Folfiri+Avastin(no 5FU after C2)
4/18 mets shrinking
7/18 liver/lung mets growing, Folfiri stopped
10/18 In Clinical Trial
CEA 5/17-16.2, 12/17-16.1, 02/18-43.0, 3/18-16.9, 4/18-9.0, 5/18-5.5, 6/18-6.9, 7/18-7.8, 9/18-56


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