Radiological changes in the gastrointestinal and genitourinary tract following radiotherapy for carcinoma of the...

The radiological examinations of 67 patients who had previous radiotherapy for carcinoma of the cervix uteri were reviewed. All had evidence of radiation damage proven surgically or histologically. Patients with known recurrent or metastatic disease were excluded. The commonest abnormalities (36 patients) were in the urinary tract, where hydronephrosis due to distal ureteric stricture was the most frequent finding. Changes observed in the bladder included mural thickening, mucosal irregularity, focal ulceration and reduction in size. Thirty-one patients had abnormalities of their large bowel. The majority of these had strictures of the recto-sigmoid which showed a smooth mucosa, fine surface ulceration, focal ulceration or a 'cobble-stone' appearance. Lesions observed in the small bowel included fixity of bowel loops, thickening of the wall, coarsening of the mucosal pattern and strictures. Two new features are described; the development of high ureteric strictures and the presence of a stricture within a large bowel stenosis. These findings are significant since they show the variation in appearance which can be produced by radiotherapy damage. The differentiation of these changes from recurrent malignancy can be difficult and the differential diagnosis is discussed.