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Is inflammation a symptom of cancer? Niggling pain in location of polyp, history of Clostridium difficile, cervix removal

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Hello - my mother is a 61 year old who has been poorly for the past few years. She has had various bouts of vomiting and diarrhoea over the past few years, several of which have meant she's ended up in hospital through dehydration. She's lost a fair bit of weight over that time and last year had an endoscopy, ultra sound and colonoscopy. The latter showed 3 polyps - one of which was large and bleeding (mum was quite anemic) and was located on the right hand side of her colon very low down (near groin area). She had this removed but continued to feel poorly - vomiting etc. She had the metal plate in her leg removed but continued to feel extremely nauseous every day. A couple of weeks ago, she had another bout of D and V and was hospitalised. She had lots of blood and stool tests and nothing showed up so it was thought Mum had a virus. The gastro enterologist suggested she come off co-codamol (which she has been on for several years for rheumatism). She has done this and thinks it's making a difference but it's difficult to tell due to after effects of virus still in system. Today, she had a follow up colonoscopy to the one last year and the bowel prep hadn't worked properly so it was difficult to get a clear view. However, the gastroenterologist said that he couldn't see any large polyps but it was possible that small polyps were present and hidden by waste still in the colon. He did say that at one point, her colon was very narrow and he struggled to get the scope through. He said there was a patch of inflammation at this point and it was immediately above the spot where the large polyp had been removed last year. He said he did manage to get the scope through and couldn't see a growth. However, he seemed quite concerned and said he had taken a sample of the inflammation. We now have to wait 2 weeks for the results. Also mum probably will have to have another colonoscopy as bowel wasn't entirely clear. I am worried what might be causing this. He didn't think it diverticular as there were no pockets. Mum has had radiotherapy 30 years ago when she had cancer of the cervix. She ended up having the cervix removed but her ovaries (such as they are) remain. She has had a niggling pain in the spot where they initially found the polyp for quite some time. She had a bone x XXXXXXX on her hip in case it was that, but it was clear. She still does get the niggling pain though not as much. I suppose what's going through my mind is what's the likelihood of this inflammation being a symptom of cancer? Also, could it be likely that the narrowing of the colong is due to something behind it, rather than in it? Could it be something affecting her reproductive organs that's impacting on the colon? Mum does have a history of Clostridium Difficile - which she has had 3 times over the past 10 years. She recently had a lot of blood and stool tests (the latter mainly for bacteria) but they have all come back clear. We have recently had 2 bereavements and Mum is physically and emotionally exhausted. She is upset and I now can't get hold of the Consultant she saw today as he is on leave. Is there any light you can shed on this for us??? Thanks so much, XXXXXXX
Posted Mon, 30 Apr 2012 in Digestion and Bowels
Answered by Dr. Shanthi.E 38 hours later

Thank you for posting your query.

I understand your concern towards your mother. I also understand your mother's current health situation.

I am an associate to Gastroenterologist and I have taken a curbside consult with an experienced Gastroenterologist before attempting to assist you.

You mentioned that your mother has survived Cervical Cancer. This is a good thing to know.

Her current symptoms of vomiting and diarrhoea definitely suggets an intestinal problem which needs attention and treatment.

It is good that one of the 3 large colonic polyps was removed.

Regarding the follow up Colonoscopy that was done now, I want to discuss a few things with you.

- It is absolutely necessary to redo the colonoscopy as you said, since the preparation was not sufficeint enough.

- Regarding the narrowing in the colon while passing the scope, there are many possibilities.

1. Chronic underlying inflammation is the commonest cause.

2. Stricture formation is also one cause.

3. The chronic inflammation may have caused ulceration and subsequent stricture formation.

4. It can also be a Pre- cancerous lesion.

5. Also a benign or malignant colonic polyp.

- You mention that the sample from the same was taken, Histopathology of the sample will definitely let us know if it is either Cancerous or non - cancerous.

Regarding your query on what might be causing this:

It most probably seems to be a continuation of the earlier polyp that was removed.

It seems like the earlier Polyp has left behind a chronic inflammatory response, most probably an underlying secondary small polyp causing the symptom of diarrhoea.

The chances of Colonic polyps getting malignant are always high.

This together with her vomiting and loss of weight may be attributed to a Pre- cancerous state. However, it needs to be confirmed.

Please go in for a repeat colonoscopy.

Again, Your query on what's the likelihood of this inflammation being a symptom of cancer?

The chances are moderately high as she has a history of Cervical cancer and also recurrent colonic polyps.

Could it be likely that the narrowing of the colon is due to something behind it, rather than in it?

The narrowing can be due to both, either inside the colon itself due to ulceration and stricture or an underlying polyp or it can also be due to external lesions outside the colon compressing on it.

Could it be something affecting her reproductive organs that's impacting on the colon?

Chances are less likely as she was operated for cancer cervix and X- XXXXXXX of the hip region seemed normal. Means to say there is no evidence of secondaries.

Vomiting is mostly associated with cancer and cachexia.

Hence by taking all these points into consideration, I want to conclude by saying that it may be cancerous, so please redo the colonoscopy and confirm.

But, always hope for the best.

Hope my suggestions are helpful. I will be available for your follow up queries if any.


Above answer was peer-reviewed by
Follow-up: Is inflammation a symptom of cancer? Niggling pain in location of polyp, history of Clostridium difficile, cervix removal 3 hours later
Hi Dr Shanthi

Thanks so much for your very clear reply.

Can I ask what cachexia is please?

Also, the gastroenterologist, Dr XXXXXXX said that although the bowel prep hadn't worked well, he could tell there were definitely no large polyps. He wanted to redo the colonoscopy as there was residue of waste products lining the colon and might possibly be hiding small polyps. He confirmed that the narrowing could be generally caused by a growth but he said he couldnt' see one.

The vomiting has been going on since XXXXXXX 2009. It began after my mother broke her leg and had a metal plate and screws inserted. Every 10 days or so, she would have attacks of vomiting to the point of dehydration. She would then collapse and be hospitalised. So many tests were done and only the polyps were found last year which seemed to be causing anemia.

Mum then had the metal plate out of her leg this year in February and the vomiting ceased. However, she's had nausea (she describes it like travel sickness or morning sickness) every day for varying periods.

It seems she might be wheat intolerant and she can certainly not now take iron since the metal plate was inserted. That has a dreadful effect on her - vomiting profusely. Also, certain antibiotics bring about the same reaction. When she had the last bout of vomiting 2 weeks ago, it was actually following diarrhoea. This was following her having taken a betaine hydrochloride tablet as one gastroenterologist thought her stomach acid levels might be low and she might not be digesting her food properly (she has also been diagnosed with gastritis).

We are wondering if Mum is just too sensitive to certain chemicals and this causes upset for her. Hence, she has now stopped taking her codeine medication and up until the recent colonoscopy (which has made her feel unwell), she had started picking up a bit.

She has had changes in her bowel habit all the way along. Notably, when she first started these vomiting attacks in 2009, if she had diarrhoea, she wasn't sick. She used to say she could feel the discomfort and pain start in her stomach and work it's way through her body to the abdomen. She used to describe the feeling as like being poisoned. It was almost as though her body had to cleanse itself one way or another. One of the paramedics thought she had a blockage but the colonoscopy last year and barium enema revealed nothing. Perhaps it's possible her bowel was just constricting? Perhaps that's what is happening now, and she is struggling to get rid of her food, hence she can sometimes not go to the toilet for a couple of days then have diarrhoea.

If this recent colonoscopy and the battery of blood, stool and urine tests she had 2 weeks ago didn't reveal any growths or anomalies, would you say that if there is anything cancerous there, it sounds likely that it might be at a stage that's treatable? I know it's difficult to say with any degree of certainty but I'm just wondering what this all sounds like to you.

She has done another stool sample today to test for pancreatic functioning. However, she did have an ultra sound in the Summer of 2010, just after the endoscopy to look for anything to do with gallbladder etc. She had a general sweep of her abdomen too and nothing could be seen.

Although she has lost a lot of weight since she broke her leg nearly 3 years ago, she has maintained this for a while now and is not underweight. She doesn't have a huge appetite but is quite low in mood due to the prolonged length of time she's been ill and all the tests she's had. She is finding it difficult to get on with her life. She's also scared to eat in case something in the food is triggering a reaction in her stomach and bowel. So, she isn't eating a great deal.

She is intending to go back for the repeat colonoscopy but each time she has a test, it seems to knock her back. She was just starting to pick up before this and now is tired and feels off colour.

Thanks for listening and for your help.
PS - The polyps she had last year - 2 smaller ones very close to the anus and the larger one in the proximal sigmoid. This is where the current patch of inflammation is and narrowing of the colon. The Consultant said it wasn't present in last year's colonoscopy.
Answered by Dr. Shanthi.E 4 hours later
Hello again XXXXXXX

Thanks for writing back.

Cachexia is loss of weight, muscle atrophy, fatigue, weakness, and significant loss of appetite in someone who is not actively trying to lose weight.

Having repeated episodes of Vomiting to the point of dehydration every 10 days or so, definitely suggests a major health issue in the gastro-intestinal tract. You mention that after having the metal plate removed, her vomiting has ceased.

Nausea can be due to various reasons and by itself is a more annoying symptom than vomiting. It seems to me, to be most probably related to upper Gastrointestinal (GI) lesion than the lower GI tract.

Nausea is also one of the predominant symptoms in Pancreatic inflammation and Cancers in general.

Yes, one of the commonest side effects of Iron medications is that it causes nausea and vomiting in most patients. Same with antibiotics too. So, I suggest that she does not take Iron and also keep a watch on the other oral medications she takes.

You mention to me that she has also been diagnosed with Gastritis. This may be the one and only reason for her nausea and vomiting. Hope for the best always. I suggest that your mother is being put on good antacids like drugs belonging to the Proton pump inhibitors group. Certainly, these will not cause vomiting or diarrhoea. It will help in reducing her nausea and she will feel better.

She is sensitive to certain chemicals as you said, including the facts of her advancing age of 61 years, being a Cervical cancer survivor, undergoing repeated colonic procedures and a surgery for the broken leg. All these would have caused a negative impact on her general health and immune status.

Your description is very clear to me, it seems to be most probably nothing but a chronic Gastritis that is causing the nausea, together with intermittent intestinal contractions causing diarrhoea.

Again, if there are any Precancerous lesions detected on the repeat Colonoscopy, it can be surgically removed and is definitely treatable. Do not worry about this. Most patients with Colonic cancer, survive for a good length of time after surgical removal of the lesion.

It is good to know that your mother is not underweight, this goes against the possibility of Colonic cancer.

As I said you in my earlier reply, it seems to be an ongoing inflammation and continuation of the earlier colonic lesion. Again, Colonic polyps recur often.

My conclusion:

Nausea is most probably due to Chronic Gastritis. Discuss about starting her on Proton pump inhibitors with her treating doctor.

Diarrhoea is most probably due to chronic irritation and inflammation happening in the distal part of colon.

My good thought is that, it is overall a simple health issue and can be easily resolved medically
(provided repeat Colonoscopy turns out to be normal).

Hope my suggestions will help you.

Wishing your mother a speedy recovery.


Dr. Shanthi

Above answer was peer-reviewed by
Follow-up: Is inflammation a symptom of cancer? Niggling pain in location of polyp, history of Clostridium difficile, cervix removal 1 hour later
Dear dr shanthi
Bless you for your response. My mum is very precious to me.

I have discussed your responses to me and she just wonders what medication can be given for inflammation of the colon (if that's all it is). Also, is the narrowing of the colon wall (only seems to be on one side where polyp was removed) due to the inflammation? And if so, will the colon remain narrow or will it widen? I think she is worried about it closing up altogether and whether she might have to have an operation to widen it.

Thanks so much. I'm sorry to keep asking questions but I am feeling clearer and more optimistic as a result of your answers. Its been a very touch 3 years for us. But all in all, it doesn't seem as though mum has got worse over that time. Certainly the vomiting has almost entirely ceased apart from isolated incidents. It's more the nausea that's been the problem, which we are hoping might fade now she has given up the co codamol tablets. She very occasionally has days or times when she feels "normal". It's just that these haven't lasted.

Fingers crossed for the best! We have recently lost our 2 little dogs and I know that has impacted on her mood. I so hope mum can be treated soon now so she can have more of a satisfying life. She deserves it.

Thanks again. Take care

Answered by Dr. Shanthi.E 9 hours later

Hope your mother and you are doing good.

Surely, I will suggest you on the treatment options for the ongoing inflammation in the colon.

1. The first step in medication therapy is usually aminosalicylates. The common aminosalicylate preparations available for use are sulfasalazine (Azulfidine), mesalamine (Asacol, Pentasa), balsalazide (Colazal), and olsalazine (Dipentum). All these are prescription drugs. Please discuss with her Gastroenterologist regarding these.

2. The second step is use of Corticosteroids. But these can be tried after proper judgement by the Gastroenterlogist.

3. The third step is use of Immune modifying drugs. Infliximab is one such drug. These are very effective in reducing the inflammation.

Please discuss regarding all these drug treatment with her Gastroenterologist.

The narrowing of the colon wall seems to be almost due to the ongoing inflammation at the site of polyp removal. The inflammation will heal gradually with treatment. The need for surgery depends on response to medical treatment.

A regular diet may be continued. You can consider calcium and folate supplements to decrease the risk of colonic polyp recurrence. These are available over the counter.

Definitely, your mother deserves a satisfying life. I wish her the same.

Thanks again for your response. Wish you and your mother good health.

Dr. Shanthi
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