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This information is about a condition called a fistula which can sometimes happen because of cancer or its treatment. A fistula is an abnormal tunnel-like connection between two parts of the body that are not usually connected.
A fistula is an abnormal opening or channel, which joins two or more structures or spaces within the body. For example, a fistula can develop between two organs of the body, such as the bowel and the bladder, or between the bowel and the skin.
A cancer fistula is rare. It develops because of cancer or its treatment. If it is caused by cancer treatment, it‘s often a late side-effect and may take many months or years to develop. Some conditions or treatments that are not related to cancer can also cause a fistula.
Fistulas can occur almost anywhere in the body, although they are more common in the pelvic area. A fistula is usually named after the parts of the body involved.
A fistula can develop between:
Less commonly, fistulas can develop between:
There are some risk factors that can increase the chance of developing a fistula. But most people with cancer, even with these risk factors, will never develop one.
Some of the factors that can increase the chances of a cancer fistula are:
The symptoms will depend on the part of the body that is affected and the organs, or tissues that have become joined.
Common symptoms include:
Sometimes the symptoms of a fistula can be mistaken for another condition. A number of tests and investigations may be done to find out exactly what is causing the symptoms.
It’s important to know if a fistula has happened because of a cancer that is growing, or as a result of previous treatment. This is because the way the fistula is managed will be different depending on why it has developed.
Your doctor will ask about your symptoms and will talk to you about any surgery or treatment you have had in the past. They may also need to do a physical examination of the area affected. As many fistulae can develop in the pelvic area, some people feel embarrassed by this procedure. If you would prefer to be examined by a doctor of the same sex as you, just let your doctor or nurse know.
The kind of tests used will depend upon the symptoms you have and the area of the body that is affected. Your doctor or nurse will explain the investigations to you and will be able to answer any questions that you may have. Some of the tests that can be used are:
Methylene blue test This is used to help diagnose a fistula involving the vagina and bowel. A tampon is placed into the vagina and then some harmless blue dye (methylene) is placed into the back passage. After about 10–15 minutes the tampon will be removed. Blue staining on the tampon shows that there is a fistula.
CT scan (computerised tomography) A CT scan takes a series of x-rays which build up a three-dimensional picture of the inside of your body. The scan is painless but takes about 10–30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan. A CT scan can be used to identify a fistula and show exactly which parts of the body are affected.
MRI scan (magnetic resonance imaging) This test is similar to a CT scan, but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. During the scan you will be asked to lie very still on the couch inside a long tube for about 30 minutes. It is painless but can be uncomfortable, and some people can feel a bit claustrophobic during the scan. It is noisy, but you will be given ear plugs or headphones.
Contrast x-rays Sometimes a liquid that shows up on x-rays is used to help show the structures of the body affected by the fistula. The liquid, called a contrast medium, can be injected into a vein in your arm, or inserted into the part of the body that is affected, such as the bladder, the vagina, or a fistula opening on the skin. The liquid is completely harmless.
Intravenous urogram (IVU/IVP) This test (also known as an intravenous pyelogram) can help to show a fistula involving the bladder and kidneys. It is done in the hospital x-ray department and takes about an hour.
A dye is injected into a vein, usually in the arm, and goes through the bloodstream to the kidneys. The doctor can watch the passage of the dye on an x-ray screen and see any abnormalities in the kidneys, bladder and the rest of the urinary system.
The dye will probably make you feel hot and flushed for a few minutes, but this feeling gradually disappears. You may feel some discomfort in your abdomen, but this will only be for a short time. You should be able to go home as soon as the test is over.
Barium x-rays These tests can be done to look for a fistula involving the digestive system. Barium is a substance that shows up on x-rays and can be given as a drink or in an enema. You may need to have an empty bowel before your barium x-ray so that a clear picture can be seen. Your hospital will give you instructions, but it is likely that you will be asked to take a laxative on the day before the test, and to drink plenty of fluids.
Depending on which part of the body is being investigated, you will either be given a drink of liquid containing the barium (a barium meal or swallow) or an enema of a liquid containing the barium (a barium enema). The doctor can watch the passage of the barium through your digestive system on a screen and any abnormalities can be seen.
Examination under anaesthetic (EUA) This allows your doctor to carefully examine the areas affected by the fistula while you are under a general anaesthetic. The doctor can do a thorough examination without causing you any discomfort.
The treatment of a fistula will often depend upon its cause. If the fistula has developed because of damage caused by radiotherapy it may be possible to do an operation to close the opening. If the fistula has formed as a result of a recurrence of the cancer, surgery may not be possible and treatment to manage the symptoms may be given.
Sometimes a fistula will close without surgery and can be managed with treatment to control symptoms.
You may be seen by a number of different doctors. If you have a fistula affecting your bowel and bladder, your cancer doctor may involve a bowel specialist (gastroenterologist) and a bladder specialist (urologist). You may also see a plastic surgeon.
Surgery may only be possible if the tissue in the area around the fistula is healthy. Previous radiotherapy treatment to the area or scarring caused by previous surgery can affect healing. In these situations, healing may take longer than normal and in some circumstances the area may not heal at all.
The type of operation will depend upon the areas of the body affected and your team of specialists will discuss with you what the surgery will involve. They will explain and discuss with you how the operation will affect you and whether there are any possible risks.
Plastic surgery will either involve a skin graft or a tissue flap. A skin graft involves taking some skin from a different part of the body (known as the donor site) and using it to repair the operation site. A tissue flap is a larger operation and uses tissue and skin. The plastic surgeon will explain your operation to you and answer any questions you may have.
If the fistula involves part of the bowel, it is sometimes necessary to bring the bowel out onto the skin of the abdominal wall (tummy) to make a false opening (stoma). The stoma is called a colostomy if it uses part of the colon, and an ileostomy if it uses the small bowel. A bag is worn over the stoma to collect bowel motions.
The stoma may be temporary or permanent. A temporary stoma may be needed to divert the bowel and allow symptoms, such as infection and inflammation, to improve before an operation. It can also allow for the area to heal after surgery. Your surgeon and specialist nurse will discuss stomas with you if you need to have one.
If the fistula involves the urinary system, a stoma to collect urine, called a urostomy, is sometimes needed. The urostomy, like a stoma involving the bowel, may be temporary or permanent.
If the fistula has developed because of a growing cancer, treatment may be given to reduce the size of the cancer. This may help the fistula to close up.
Depending on the type of cancer and the position of the fistula, chemotherapy, and sometimes radiotherapy, may be used. Your doctor or specialist nurse will explain the treatment and give you information about any possible side effects.
Treatment will be given to help control the symptoms. It’s important that you tell your nurse or doctor how the fistula is affecting you. This means that they can give you advice on the best way to manage your symptoms.
Skin care The skin can often become sore and red, and may become infected and ulcerated. Barrier creams or films that cover the area can help to reduce symptoms. Some creams and films contain local anaesthetic, which helps to reduce pain and discomfort. Your specialist nurse can advise you on the best cream to use and can prescribe those that aren’t available over the counter.
It‘s important to keep the area as clean as possible to help prevent infection. The area should be washed gently and patted dry, rather than rubbed, with a clean, soft towel. If patting with a soft towel is too painful, a cool hairdryer or electric fan can be used to dry the area. If your skin becomes infected you may be given antibiotics, either as tablets or as a cream.
Nutrition It’s possible to become poorly nourished if you are losing a lot of fluid from the bowel, especially the small bowel. A dietician can give you advice about the best way to maintain your nutrition while slowing down the amount of leakage. It may help to have a low fibre diet, but your dietician can advise you about this. It may be necessary to feed you with a drip into a vein. This is called parenteral nutrition and is sometimes used before surgery.
Fluid loss You may lose a lot of fluid through your fistula if it is affecting the bowel, especially the small bowel. This can lead to dehydration and can affect the balance of nutrients in the body. If you’re losing a lot of fluid, you will be encouraged to drink plenty of liquid and may be given fluids by a drip (infusion) into a vein (intravenously). You may also be given artificial feeding in the same way.
A group of drugs called somatostatin analogues are sometimes used along with fluid replacement, to slow down the amount of fluid that is lost. They help increase the amount of fluid and nutrients absorbed in the bowel and reduce the natural secretions that are produced. Somatostatin analogues (such as octreotide) are given by injection under the skin (subcutaneously) or into a vein (intravenously).
Continence advice If you are having problems with abnormal leakage of urine or loose bowel motions it can be distressing and embarrassing. Your nurse can help by giving you advice about continence pads and aids, and by giving you emotional support. You can ask to be referred to a continence adviser or a stoma nurse.
Pain control If you have pain or soreness (due to broken, sore or infected skin) tell your doctor or nurse. They can prescribe effective painkillers and anaesthetic creams that can help relieve your symptoms.
Diarrhoea/constipation If you have diarrhoea or are constipated, changing your diet may help this. A dietician or specialist nurse can give you further advice. Avoiding too much fibre and eating small meals made from light foods can often slow diarrhoea down. Anti-diarrhoea tablets can also help. If you have constipation, increasing the amount of fluid you drink and eating a diet high in fibre can often help relieve this. Laxatives, and sometimes enemas, may also be needed. Your doctor or nurse will give you more advice.
Unpleasant smell Sometimes a fistula can smell unpleasant. Many people find this symptom the most distressing.
Different dressings may help to control an unpleasant smell. Some contain silver, which can reduce the number of bacteria in the wound, and so control the smell. Charcoal dressings can help to filter any smell. If there’s an infection in the fistula, antibiotics can help control it, and reduce the smell. Applying antibiotic gels directly on to the area can also help. Your doctor or nurse will be able to tell you more about this.
Often people feel self conscious about an unpleasant smell, particularly when in company. Air fresheners, environmental air filters and aromatherapy oils may disguise unpleasant smells and can help you to feel more comfortable with friends and family.
Having a fistula can cause many feelings, including anxiety, embarrassment and depression. Many people can feel isolated and worry about leaving the house. You may be worried or embarrassed if you have a fistula that affects your appearance, or if there is an unpleasant smell. It can also be demanding on relationships as people can feel very aware of the fistula which can affect how they relate to the people close to them.
You will probably be much more aware of the fistula than other people. Talk to your nurse about the most acceptable way to dress it comfortably. Some people find complementary therapies such as relaxation or aromatherapy helpful. Others find it helps to talk things over with their doctor or nurse. Close friends and family members can also offer support.
Our cancer support service can give you details of how to find counsellors in your local area or see our list of counselling organisations.
This section has been compiled using information from a number of reliable sources, including:
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