Radiation proctocolitis: Difference between revisions
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==Background== | ==Background== | ||
* Injury to the colon following radiation therapy most commonly affecting the sigmoid colon and rectum. | * Injury to the colon following radiation therapy most commonly affecting the sigmoid colon and rectum. | ||
* Acute ( up to three months), Chronic ( 3 months to years later) | |||
*Results in majority from radiation to the lower abdomen and pelvis as in the cases of cancers of the rectum, colon, gonads, uterus, bladder, and prostate. | *Results in majority from radiation to the lower abdomen and pelvis as in the cases of cancers of the rectum, colon, gonads, uterus, bladder, and prostate. | ||
==Clinical Features== | ==Clinical Features== | ||
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*Endoscopy and biopsy | *Endoscopy and biopsy | ||
**Nonspecific findings | **Nonspecific findings | ||
**Pallor, friability | **Pallor, friability, ulcerations, bleeding | ||
**Telangiectatic | **Telangiectatic with bleeding | ||
**Avoid | **Avoid biopsy unless malignancy is suspected as facilitate fistula/non healing wound formation | ||
*Imaging | *Imaging | ||
**CT if obstructive symptoms are present | **CT if obstructive symptoms are present | ||
**MRI if suspicion is high for radiation-induced fistulae | **MRI if suspicion is high for radiation-induced fistulae | ||
==Management== | ==Management== | ||
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===Chronic=== | ===Chronic=== | ||
*Non-invasive | *Non-invasive | ||
** | **Anti-inflammatories | ||
** | **Sucralfate enema | ||
**short-chain fatty acids | **short-chain fatty acids | ||
**Hyperbaric O2 | **Hyperbaric O2 | ||
**Antioxidants | **Antioxidants: Vitamin A, E, C. | ||
*Invasive | *Invasive | ||
**ablation | **Endoscopic treatment with ablation therapy : Topical formalin, Laser, Argon plasma coagulation | ||
** | **Surgical resection last resort | ||
==Disposition== | ==Disposition== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
Vanneste BGL, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN. Chronic radiation proctitis: tricks to prevent and treat. International Journal of Colorectal Disease. 2015;30:1293-1303. doi:10.1007/s00384-015-2289-4. | |||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
[[Category:GI]] | [[Category:GI]] | ||
Revision as of 18:34, 22 November 2017
Background
- Injury to the colon following radiation therapy most commonly affecting the sigmoid colon and rectum.
- Acute ( up to three months), Chronic ( 3 months to years later)
- Results in majority from radiation to the lower abdomen and pelvis as in the cases of cancers of the rectum, colon, gonads, uterus, bladder, and prostate.
Clinical Features
Uncomplicated
- Diarrhea
- Urgency
- Mucus discharge
- Tenesmus
- Bleeding is more common in chronic radiation proctitis than acute radiation proctitis
Complicated
- Radiation injury extending to genitourinary system
- urethral stenosis
- Cystitis
- Ureteral scarring
- Radiation injury extending to small bowel
- Small bowel obstruction
- Small intestine bacterial overgrowth
- Fistulae
Differential Diagnosis
- Ulcerative colitis
- Crohns disease
- Inflammatory Bowel Disease
- CMV Colitis
- Infectious/parasitic enterocolitis
- Diversion colitis
- Ischemic colitis
- Diverticular colitis
- Chronis graft-versus-host diease
Evaluation
- Labs
- Stool C.diff toxin along with routine stool cultures
- Specific testing for E.coli 0157:H7
- Ova and Parasite assay including giardia
- CBC, electrolytes, albumin, ESR, CRP
- Endoscopy and biopsy
- Nonspecific findings
- Pallor, friability, ulcerations, bleeding
- Telangiectatic with bleeding
- Avoid biopsy unless malignancy is suspected as facilitate fistula/non healing wound formation
- Imaging
- CT if obstructive symptoms are present
- MRI if suspicion is high for radiation-induced fistulae
Management
Acute
- Generally self-limited
- approximately 20% of patients will need to lengthen time intervals between radiation therapy to recover
- Hydration, steroids, +/- 5-aminosalicylate enema.
Chronic
- Non-invasive
- Anti-inflammatories
- Sucralfate enema
- short-chain fatty acids
- Hyperbaric O2
- Antioxidants: Vitamin A, E, C.
- Invasive
- Endoscopic treatment with ablation therapy : Topical formalin, Laser, Argon plasma coagulation
- Surgical resection last resort
Disposition
- Treat outpatient
- Severe cases that are candidates for surgery should be admitted
See Also
External Links
References
Vanneste BGL, Van De Voorde L, de Ridder RJ, Van Limbergen EJ, Lambin P, van Lin EN. Chronic radiation proctitis: tricks to prevent and treat. International Journal of Colorectal Disease. 2015;30:1293-1303. doi:10.1007/s00384-015-2289-4.