Abdominal and Pelvic Complications of Nonoperative Oncologic Therapy

Abstract

Oncologic patients are treated with a combination of chemotherapy, radiation therapy, and surgery. Advances in therapeutic options have greatly improved the survival of patients with cancer. Examples of these advances are newer chemotherapeutic agents that target the cell receptors and advanced radiation therapy delivery systems. It is imperative that radiologists be aware of the variety of imaging findings seen after therapy in patients with cancer. Complications may occur with classic cytotoxic therapies (eg, 5-fluorouracil), usually at higher or prolonged doses or when administered to radiosensitive areas. Newer targeted systemic agents, such as bevacizumab and imatinib, have associated characteristic toxicities because their effects on cells do not depend on dose. Radiation may induce early and late effects in local normal tissues that may be seen at imaging. Imaging findings after chemotherapy include fatty liver, pseudocirrhosis, hepatic veno-occlusive disease, and splenic rupture. Complications of radiation therapy include large and small bowel strictures and radiation-induced hepatitis and tumors. Awareness of the various therapeutic options and knowledge of the spectrum of posttherapeutic complications allows radiologists to provide a comprehensive report that may impact patient management.

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

“…Cytotoxic agents exert antineoplastic activity by directly targeting DNA, RNA, intracellular proteins, or cell membranes of rapidly dividing cancer cells, resulting in cell death. The different classes of cytotoxic agents and their mechanisms of action are detailed in Table 1, while other systemic agents are discussed in Table 2 (2)(3)(4). The toxicity profiles of cytotoxic agents are usually dose dependent.…”

“…New immunologic agents stimulate the body's immune system to mount an antitumor response. Molecular targeted and immunologic agents are discussed in Table 3 (2,(6)(7)(8). The toxicity of these agents is not always cumulative or dose dependent.…”

“…Other vascular complications include both arterial and venous thromboembolic events; however, it can be difficult to differentiate treatment versus hypercoagulable state due to malignancy as the cause. Arterial thrombi are most often associated with anti-angiogenic therapies, specifically VEGF inhibitors (2,47). Bevacizumab is a frequently reported cause of arterial thrombosis (3.6% incidence vs 1.7% in controls), while some reports have shown no increased risk for venous thromboembolism (89).…”

Imaging after treatment in uterine malignancies: Spectrum of normal findings and most common complications

“…) and can enable to distinguish focal thickness from clots which appears hyperintense on T1WI. In the chronic phase, the bladder has a small volume and cannot be fully distended due to the fibrosis, appearing as a thin band of low signal intensity on T2WI on the inner aspect of the bladder wall . The distal ureters are less commonly affected by pelvic irradiation, but their involvement may cause stricture formation, resulting in hydroureter and, ultimately, hydronephrosis .…”

Consumption of Lactose, Other FODMAPs and Diarrhoea during Adjuvant 5-Fluorouracil Chemotherapy for Colorectal Cancer

“…It is well-known that chemotherapy and radiotherapy exert toxic effects on the intestinal mucosa [10]. Indeed, a non-controlled pilot-study demonstrated that a low FODMAP diet alleviated symptoms and improved the quality of life in cancer patients with radiation-induced acute intestinal injury [11], i.e., further evidence for a link between a high FODMAP intake and cancer-therapy-induced diarrhoea, thus encouraging us to examine if a low FODMAP diet could also benefit patients receiving chemotherapy.…”