Irradiation injury to the gastro-intestinal tract: clinical features, management and pathogenesis.

Abstract

SUMMARYCure of cancer by radiotherapy may be achieved only at the expense of some damage to healthy tissue. In so far as the abdomen is concerned, the bowel is particularly vulnerable. In the treatment of abdominal cancer, it may be justifiable, on occasions, to risk limited bowel necrosis to produce adequate tumour destruction if there is a reasonable chance of a net gain in health status. In the present communication the signs, symptoms and pathology of irradiation injury to the stomach and bowel are illustrated by the description of three patients, treated for carcinoma of the cervix uteri, seminoma of the testis and malignant teratoma of the testis respectively. In all three cases the primary tumour had been removed, and irradiation was given for proven or suspected recurrence of the cancer. The irradiation caused both direct irradiation injury to the intestinal epithelium and injury to blood vessels with depletion of blood supply ; the latter process probably produced the greater damage. A variety of lesions occurred in the bowel, including ulceration, hæmorrhage, perforation, fibrosis, obstruction and malabsorption. Limited bowel resection became necessary in all three cases. Two patients have survived, with impaired health but without clinical evidence of recurrence ; the one treated for carcinoma of the cervix is surviving after two years, and the one treated for seminoma of the testis is surviving after three years. Improved methods of irradiation are discussed.