Unintended Consequences of Systemic and Ablative Oncologic Therapy in the Abdomen and Pelvis

Abstract

Human cancers are genetically complex and diverse. Although advances in oncologic therapy aim to define and target unique steps in carcinogenesis, oncologists often rely on less discriminate anticancer therapies that have consequences for normal tissues. Even many of the so-called targeted therapies currently employed can adversely affect normal cells, leading to complications that necessitate dose reductions or cessation of specific therapies. This article explores the unintended consequences of currently employed systemic and ablative anticancer therapies that might manifest at imaging examinations of the abdomen and pelvis, including cytotoxic, molecular targeted, and immunologic agents; ablation; and hematopoietic stem cell transplant. Each of these treatments can have both major and minor unintended effects in the targeted organ(s), in local or adjacent structures, or at distant sites. Timely detection and reporting of adverse consequences of anticancer therapies by the astute imager can result in critical treatment modifications and/or lifesaving interventions; therefore, knowledge of these unintended effects is paramount for radiologists interpreting the results of imaging examinations in cancer patients. RSNA, 2018.

Imaging of the chemotherapy-induced hepatic damage: Yellow liver, blue liver, and pseudocirrhosis

“…Similarly, an increased incidence of CASH in recent decades has been reported[ 56 , 68 , 69 ]. Although the true frequency of these pathologies is not easily determined[ 65 , 70 ], as mentioned above, the prevalence of CASH is increasing in patients undergoing treatment with 5-fluorouracil and irinotecan[ 71 ], especially when the drugs are coadministered[ 48 ]. Additionally, platinum derivatives (oxaliplatin), taxanes and methotrexate have been linked to this condition, and with a lower frequency, L-asparaginase, dactinomycin, mitomycin C and bleomycin sulfate[ 72 , 73 ].…”

“…Interestingly, steatosis and CASH occur not only during treatment for liver metastases but also in the course of systemic chemotherapy for nonmetastatic cancer[ 71 ]. Considering the pathogenesis of steatosis, as discussed above (see “Liver blood flow”), persistent hemodynamic changes determining focal metabolic alterations and the third hepatic inflow system are involved.…”

“…However, most often, in daily practice, steatosis and steatohepatitis are evaluated qualitatively. From a radiological point of view, it is impossible to differentiate between these two forms of liver disease, as they can be distinguished only by histologic alterations[ 71 ]. The distribution of CASH, as well as hepatic steatosis, can vary from diffuse to focal infiltration.…”

Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy

“…Ablation with radiofrequency or other methods (e.g., microwave) can directly cause damage to nearby organs. Ablative therapies used in liver or kidney tumors can cause the appearance of intestinal perforation due to direct, thermal or chemical injury, with subsequent formation of abscesses and fistulas or, in severe cases, peritonitis [ 39 , 40 ]. In the literature, 4–8% of patients treated with abdominopelvic radiation therapy can develop serious complications such as fistulas, perforation, or abscesses [ 41 , 42 ].…”

A hypothetical approach on gender differences in cancer diagnosis

“…However, there are still no curative treatment options available for patients, particularly for those suffering from advanced metastatic malignancies, and many aspects related to carcinogenesis process have remained mysterious even in the 21 st century. Based on the global cancer statistics, one in two men and one in three women will be diagnosed with some type of invasive cancer during their lifetime [1, 2, 3] , showing that men are more susceptible to cancer than women. On the other hand, it is also well accepted that people develop a certain number of mutations that could result in cancer each day, but by virtue of strong immune system, the body is able to eliminate this threat.…”