Radiation proctitis other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rekha, M.D., Mahshid Mir, M.D. [2]

Overview

Other diagnostic studies such as colonoscopy, tissue biopsy and histological analysis can help with the diagnosis of radiation proctitis.

Other Diagnostic Studies

Colonoscopy

Colonoscopy is usually avoided in the acute radiation induced proctitis due to the risk of bleeding. However it can be done to confirm the diagnosis, to determine the extent and severity of chronic radiation proctitis, rule out other causes of inflammation and to treat bleeding. Endoscopic findings in radiation proctitis include the following:

Edematous, dusky red rectal mucosa with friability and telangiectasias in case of acute injury
Pale and noncompliant rectum with telangiectasias associated with strictures, ulcerations, fistulas, and areas of mucosal hemorrhage in case of chronic radiation proctitis.

Histology and tissue biopsy

Histological findings include:^[1]^[2]

Eosinophilic infiltrates
Epithelial atypia
Atrophy of the overlying mucosa
Obliterative arteritis
Fibrosis
Capillary telangiectasia

Rectal biopsy is usually avoided as they is no role in diagnosis of chronic radiation proctopathy and risk of the fistula formation. However it can be done from the posterior and lateral rectal walls to avoid the anterior irradiated high-dose areas, if any malignancy is suspected or in case of important therapeutic consequences.^[3]

References

↑ Goldner G, Tomicek B, Becker G, Geinitz H, Wachter S, Zimmermann F; et al. (2007). “Proctitis after external-beam radiotherapy for prostate cancer classified by Vienna Rectoscopy Score and correlated with EORTC/RTOG score for late rectal toxicity: results of a prospective multicenter study of 166 patients”. Int J Radiat Oncol Biol Phys. 67 (1): 78–83. doi:10.1016/j.ijrobp.2006.08.055. PMID 17189064.
↑ Babb RR (1996). “Radiation proctitis: a review”. Am J Gastroenterol. 91 (7): 1309–11. PMID 8677984.
↑ Theodorescu, Dan; Gillenwater, Jay Y.; Koutrouvelis, Panos G. (2000). “Prostatourethral-rectal fistula after prostate brachytherapy”. Cancer. 89 (10): 2085–2091. doi:10.1002/1097-0142(20001115)89:10<2085::AID-CNCR8>3.0.CO;2-Q. ISSN 0008-543X.

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[pmid17189064-1] Goldner G, Tomicek B, Becker G, Geinitz H, Wachter S, Zimmermann F; et al. (2007). “Proctitis after external-beam radiotherapy for prostate cancer classified by Vienna Rectoscopy Score and correlated with EORTC/RTOG score for late rectal toxicity: results of a prospective multicenter study of 166 patients”. Int J Radiat Oncol Biol Phys. 67 (1): 78–83. doi:10.1016/j.ijrobp.2006.08.055. PMID 17189064.

[pmid8677984-2] Babb RR (1996). “Radiation proctitis: a review”. Am J Gastroenterol. 91 (7): 1309–11. PMID 8677984.

[TheodorescuGillenwater20002-3] Theodorescu, Dan; Gillenwater, Jay Y.; Koutrouvelis, Panos G. (2000). “Prostatourethral-rectal fistula after prostate brachytherapy”. Cancer. 89 (10): 2085–2091. doi:10.1002/1097-0142(20001115)89:10<2085::AID-CNCR8>3.0.CO;2-Q. ISSN 0008-543X.

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