• Anorectal abscess - can it be caused by Avastin?

    Asked by fuzzylinux on Monday, April 29, 2013

    Anorectal abscess - can it be caused by Avastin?

    I am presently in hospital after having an anorectal abscess surgically opened and requiring the abscess to be packed twice per day. Living 100 kms out of the city there is no home care so I am left in hospital. The real question is the possibility of the Avastin causing this as it was introduced into into my Folfiri regime January this year. The side effects of the Bevacizumab (Avastin) list Gastrointestinal perforation/ fistula formation as rare and the doctors are not willing to say yay or nay as to the cause of the abscess because it does have a fistula formed into the rectum.

    I have to wait a minimum 28 days after Avastin before an operation and they want want to do a colostomy immediately after as they are not convinced the abscess will heal fast enough to resume chemo. and I have to wait now until the colostomy heals well enough to resume chemo. With stage IV cancer the clock is nervously ticking away.

    7 Answers from the Community

    7 answers
    • carm's Avatar
      carm

      Fuzzylinux,
      Hello, I am an oncology nurse and so maybe I can attempt an answer from a nursing standpoint. I have never heard of or had a patient who had suffered an anorectal abscess or fistula from Avastin. However, I have had a few patients suffer from fistulas that formed as an aside from radiation therapy more so that I thought possible. Avastin is not a chemotherapy, it is a biotherapy. It does not attack cells like chemotherapy does. It is an antibody drug that attached to an antigen and then prevents that antigen on your tumor from sending out a signal that it needs a blood supply. Prior to becoming a nurse, I worked in drug research as a coordinator. My role was to document a study patient through the trial so I recorded every side effect big or small, filled out the required documents, and then forwarded them on to the FDA. When a drug lists a side effect as rare, it does not necessarily mean that the drug causes it. For instance: lets say you are in a trial for a chemotherapy trial. It is the mddle of winter with snow and ice is everywhere. In the morning you go outside to get the morning paper. You slip on a patch of ice, lose your balance and fall off the steps and twist your ankle. The next day you come to me for your trial drug. I ask you if you have any side effects since your prior visit and you inform me if any. But, then I notice your ankle swollen and wrapped. I ask you what happened and you tell me. By law, I have to report that to the FDA as an adverse event and they have to decide if the trial drug caused you to have a moment of lost balance, or the ice did. Because there is no way to prove that the drug didn't cause the fall, they have to list it as a side effect. It then becomes that rare side effect as, "may cause unsteady gait." I would be suprised to find out if Avastin caused an abscess or a fistula. Knowing the pharmacogenetics of the drug it wouldn't seem rationale. I hope this sheds some light on this for you. As targeted therapies go, Avastin is a good drug and it is leading us from the darkness into the world of targeted therapies and away from the "one size fits all therapies." Best of luck to you, Carm RN.

      about 4 years ago
    • Peroll's Avatar
      Peroll

      Carm has a great explanation of why it is impossible to know the cause for anything like your abcess. Avastin is almost never given by its self and any chemo, by design, weakens the immune system to help the drugs work better so infections are an issue with most chemo treatments. This also explains why you have to wait for the surgery and then have to wait to resume chemo after surgery. I know that the waiting is hard. I have had to do it several times. the good news is that usually it takes the cancer some time to recover from the chemo and start growing again so usually it will not get much if any bigger during the off time. the best thing you can do is enjoy your break from the chemo side effects. Good Luck and let us know how things go.

      about 4 years ago
    • fuzzylinux's Avatar
      fuzzylinux

      Thank you Carm for your very layperson explanation to "rare" side effects. Being of the engineer sort and not understanding the artsie or biological side of life I have a tendency to read the hard facts as just that and didn't stretch it to the understanding that you put so clear. The simple explanation of ice and swollen ankle make it very clear. Thanks.

      And Peroll, yes the waiting is the worst part. My question was probably more to have a shoulder to cry on and instead found an unusual look at "side effects". As far as enjoying the break from chemo, unable to sit whatsoever and living 100 km+ from the hospital, they admitted me to to the hospital as the abscess must be dressed twice per day and the commute would be nearly impossible. Today is day 21 stuck in a hospital bed but the good news is they are scheduling surgery for the colostomy this week so the carnival can get back on the road. This makes me extremely happy once again.

      May we all be strong and happy.

      Mike D.

      about 4 years ago
    • Peroll's Avatar
      Peroll

      Mike, As an engineer myself, I have had to learn the medical language and learn to do tramslate a lot of the things said to my way of seeing things. At least I have a good deal of experience understanding how to interpert statistical data and know what it really means. You would have enjoyed the discussion I had with my Oncologist about the tollerances associated with tumor measurement. I clearly have a much better uynderstanding of tollerances than he does and can now read the radiologists reports more percisely than he does.

      Enjoying the time off chemo is hard in the hospita I realize. I had a foot infection during my first round of chemo that landed me in the hospital for a week on anti-biodics with demolition going on right below my room starting every morning at 7 am. At least my boss brought me pizza that time. I am personally looking forward to a break from chemo I am starting the end of this week for a little relief from diahrrea which is getting old right now.

      I was wondering if that is a dog or a moose in your profile picture?

      about 4 years ago
    • carm's Avatar
      carm

      Fuzzylinux,
      Thank you for the kind words, they are most appreciative. If you should have any other questions please do not hesitate to ask. If you have not gotten the colostomy yet, I would ask if they can internalize it so that you do not have to wear an appliance. Let me know if you need information on this and I will supply you with information to bring with you. Peroll is really the colon expert here as is his wife Queen Tatiana. I am humbled just to participate in any post they reply to. Best of luck, Carm RN.

      about 4 years ago
    • hessteh's Avatar
      hessteh

      I had a perineal wound from abdominal perineal resection and subsequent radiation that took a long time to heal. My oncologist did not want to use Avastin, since it is problematic with wound healing. Good luck.

      about 4 years ago
    • fuzzylinux's Avatar
      fuzzylinux

      Carm, I have done research on internal pouch solutions and they all involve the redirection of stool matter eventually to the anus. Unfortunately it's my anus that we are trying to heal. It works but the fisture from the abscess to the rectum means stool matter wants to go through the abscess will never heal unless we give it a break. We are hoping to reverse the colostomy in 6 - 8 months but that will be determined by how the chemo goes. If you had any further information you could send me it would be greatly appreciated.

      Peroll, I know what you mean by having to learn the medical language and reading the radiologist reports yourself. I have caught a couple of things myself that were obscure and required further explanation. I really respect what your 8 years of learning has resulted in in terms of knowledge and your dedication to spreading the "good news" on the whatnext site. I only have 8 months and it it is a real eye opener to find out what what the medical system is really about as we spend so much time in and out of hospital and see so many doctors and nurses on an almost daily basis.

      I had a most enjoyable day pass yesterday and got to to go home for a few hours. The dogs and cats all missed me (as I did them). It was nice to sit in my living room and have the sun shine in. I had a nap in my own bed after 21 days in hospital. I just collapsed and had a 2 hour coma like sleep that my better half said I hadn't slept like the that in ages. The animal in my profile picture is one of our alpacas on sheering day. It's the one day of the year we get to hug them real close like that as they are really strapped down for 6 minutes. :-)

      Hessteh, yes, my oncologist will not be putting me back on the Avastin when I resume chemo as I will be still healing.

      about 4 years ago

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