Rectal Bleeding after SBRT Radiation

[jumpman50512]

Hello Everyone It has been a while since I posted hope everyone is doing well

I have a question about SBRT radiation I had it on my pelvis and rectum. Ever since I had radiation I started having rectal bleeding and now it's getting worse. I do have a colonoscopy due soon like in two weeks or so. I'm still on chemo. But not full-blast chemo it is just too much for me. Anyways has anyone had this issue it's like the blood is getting worse and it's every time I have to push to pass stool. I did have a PET scan before and everything looked fine but I am just wondering if anyone has had this issue before.

thanks

[Rock_Robster]

Hi Jumpman,

Buttblood sure is distressing! How far out of SBRT are you now? Bright or dark/dried? And would you say there’s more than a tablespoon at a time? In the bowl or just on the paper?

Could potentially be the result of inflammation/colitis from the radiation, and/or tumour damage and bleeding. Inflammation could cover the strained movements too. Really keep up your fluids like mad.

I don’t like that it’s getting worse though unless you’re still only some days out from radio.

It’s good you’re having a scope but in the meantime if you’re worried please don’t delay going to ER - for example a bowel perforation is very rare but very very time sensitive (hours?, especially if you’ve ever had Avastin.

Good luck.

[jumpman50512]

both bright and dark. It's never dried sometimes mucus with it. The doctor didn't look worried. I still pass stool but sometimes its watery stool and diarrhea because chemo gives me diarrhea usually. And its on both bowl and paper sometimes not all the time. I showed my doctor a pic and he didn't seem to worry much.

[jumpman50512]

I forgot to say I am around 5 months out of SBRT

[Rock_Robster]

I forgot to say I am around 5 months out of SBRT

Ok that’s definitely too long to be ‘normal’ post radio bleeding. Could be tumour bleeding, radiation-induced colitis, or another injury from radiotherapy. I’d suggest giving your rad onc or oncologist a call, and if it’s anything more than modest (single tbsp) amounts from time to time, head to ER. They may also want to back off the chemo temporarily if you aren’t able to heal internal wounds effectively.

Likewise any light-headedness, dizziness, confusion or paleness please call an ambulance. What we don’t want is a slow bleed becoming a full perforation overnight. I don’t want to alarm you, this is unlikely. But we prefer you alive here.

PS: in your signature, I couldn’t find “Vervutux” chemo. Is this perhaps Vectibix, or something similar?

[jumpman50512]

I forgot to say I am around 5 months out of SBRT

Ok that’s definitely too long to be ‘normal’ post radio bleeding. Could be tumour bleeding, radiation-induced colitis, or another injury from radiotherapy. I’d suggest giving your rad onc or oncologist a call, and if it’s anything more than modest (single tbsp) amounts from time to time, head to ER. They may also want to back off the chemo temporarily if you aren’t able to heal internal wounds effectively.

Likewise any light-headedness, dizziness, confusion or paleness please call an ambulance. What we don’t want is a slow bleed becoming a full perforation overnight. I don’t want to alarm you, this is unlikely. But we prefer you alive here.

PS: in your signature, I couldn’t find “Vervutux” chemo. Is this perhaps Vectibix, or something similar?

yes you are right lol. Well i read online it can last up to 12 months bleeding but im not sure. Actually when i had sbrt I started to have blood on my stool very little and it increased. I was told it could be a ulcer but I have no idea I hope its not a tumor but we will see

[Rock_Robster]

I forgot to say I am around 5 months out of SBRT

Ok that’s definitely too long to be ‘normal’ post radio bleeding. Could be tumour bleeding, radiation-induced colitis, or another injury from radiotherapy. I’d suggest giving your rad onc or oncologist a call, and if it’s anything more than modest (single tbsp) amounts from time to time, head to ER. They may also want to back off the chemo temporarily if you aren’t able to heal internal wounds effectively.

Likewise any light-headedness, dizziness, confusion or paleness please call an ambulance. What we don’t want is a slow bleed becoming a full perforation overnight. I don’t want to alarm you, this is unlikely. But we prefer you alive here.

PS: in your signature, I couldn’t find “Vervutux” chemo. Is this perhaps Vectibix, or something similar?

yes you are right lol. Well i read online it can last up to 12 months bleeding but im not sure. Actually when i had sbrt I started to have blood on my stool very little and it increased. I was told it could be a ulcer but I have no idea I hope its not a tumor but we will see

Could well be an ulcer, I just don’t like that it isn’t healing after so long. Good that you’re having a scope soon. I wonder if you played the bleeding getting worse card, maybe they might see you even sooner…

Good luck mate

[roadrunner]

The most likely candidate here is radiation proctitis. It is common after rectal RT. There are acute and chronic presentations, with this sounding like the latter. It can start years after therapy. I was diagnosed with it after my IMRT, and it continues years later. Fortunately for me, mine is limited to mucus production and some very occasional, very light bleeding after longer runs. The spectrum, however, is very broad. It can just be inflammation in the lumen, or it can be life-threatening (rare). It is easy to diagnose with a flexible sigmoidoscopy, so I’d suggest that, but if your doctor isn’t concerned or particularly interested, he is either a bad doctor or already believes it’s radiation proctitis, and judges the symptoms aren’t too bad. It is quite hard to treat (though there are some options), so unless it gets too bad it is often left alone. Can spontaneously resolve, be static, or worsen over time.

Of course, as you’re aware, there are *many* other possible causes for this. If it were me (it was), I’d get a diagnosis asap. In case it’s unclear, “I don’t know, I wouldn’t worry too much” is not a diagnosis. But if I were a betting man (I’m not), I would guess that your doctor suspects or has diagnosed RP and just isn’t saying anything. It’s a VERY common finding after rectal radiation, so often just viewed as “anticipated changes,” or similar.

Finally, if it is RP, it’s generally not too dangerous and is generally manageable, though that may take some focus/effort. I would be aggressive about getting it addressed now, though.

[roadrunner]

Here’s a really good article on RP. Of course, I have to re-iterate that the in the Stage 4 context *everything* is more complex, so I wouldn’t just assume this is your problem, but the description and your doctor’s attitude suggest that it may be.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575375/

[Edited to add: The amount of blood you’re losing is significant if this is RP. You didn’t say, but rectal
bleeding often looks worse than it is. It’s worth looking up how to estimate amounts (there are useful articles in the context of menstruation) for this purpose and for talking with doctors. Pix, of course, are great (in a sense ; )

Finally, pushing out hard stools also makes this sound like RP, as bleeding makes sense in the context of friable, inflamed rectal tissue. But only endoscopy can diagnose.]

[roadrunner]

Sorry, just realized one other thing. Your sig isn’t clear about your initial cancer or surgical procedure. You note RT and “colo-rectal surgery,” but usually those two process don’t leave a rectum behind, with most radiated tissue removed (most often via TME). That would be a different picture than what I assumed. So I’d ask: Do you still have your rectum, and what kind of surgery was performed?

[Peregrine]

Sorry, just realized one other thing. Your sig isn’t clear about your initial cancer or surgical procedure. ...

Jumpman50512-

Yes, your signature is not clear about quite a lot of things, and the dates are all out of order.

It would help if you could edit your signature and put everything in correct chronological order so that people can understand what treatments/ scans/ tests you've had and when.

DRAFT of reorganized signature (subject to correction):

2017/xx/xx - Stage IV (Diagnosed @ 29)
201x/xx/xx - 1 Met to the Liver
201x/xx/xx - Colo-Rectal cancer surgery
201x/xx/xx - 12 rounds of chemo + Radiation + Oral Chemo
2021/02/01 - 2/1/21 CT scan Clean
2021/02/01 - 2/1/21 CEA at 5.8
202x/xx/xx - Signatera Positive
2021/04/01 - 4/1/21 CEA currently at 8.8
2021/04/10 - FOLFIRI start Round 1
2021/04/15 - Clean CT Scan 4/15/21
2021/05/27 - 5/27/21 CEA currently at 13
2021/06/24 - It's back 6/24/21
2021/07/10 - FOLFIRI finish Round 10
2021/12/01 - 12/1/21 Colonoscopy Clean
202x/xx/xx - On Xeloda for a while
202x/xx/xx - Chemo pills + chemo + Vectibix
2022/xx/xx - ??
2023/xx/xx - ??
2023/08/xx - SBRT radiation ?
2024/01/12 - Rectal bleeding 5 months after SBRT radiation,
2024/01/12 - currently 36 years old

[Richie410]

I just saw this post.

I finished up 3DCRT back on 10/18 after 30 sessions. I'm still having some real pain every time I have a bowel movement and there is bleeding at times but it's very sporadic and its usually when it's a "harder" push. I'm thinking this is probably due to my proctitus but not entirely sure. Has anyone else experienced this? The pressure I experienced when I had my primary regrow almost immediately went away after the first 5 sessions but the "pressure" is back after I completed radiation.

I really want to have some level of normalcy back when it comes to my BMs. What have the rest of you found helpful in healing and managing the pain?