Abdominopelvic complications of gynecologic malignancy: Essentials for radiologists

Gynecologic cancers are among the leading causes of cancer-related deaths among female patients, with over 80 % of patients experiencing persistent or long-term effects even after curative treatment. Abdominopelvic complications can arise from the disease itself or treatment-related factors. Tumor-related complications include effects from locoregional invasion (malignant bowel obstruction, obstructive uropathy), tumor rupture (and associated hemorrhage), hypercoagulability (leading to deep vein thrombosis), and infections (including tumor fistulization to the bowel or lower urinary tract, abscesses, pyometra, and/or superinfected necrosis). Treatment-related complications can be subdivided into those following surgery, radiotherapy, or systemic therapy, including immunotherapy. Postoperative complications include paralytic ileus, obstructions, fistulas, anastomotic leaks or strictures, vaginal cuff dehiscence, wound infections, lymphocele, and lymphedema. Radiotherapy-related toxicities include acute toxicities of diarrhea, cystitis, and vaginal mucositis, as well as chronic toxic effects, including radiation enteritis, bladder dysfunction, fistulas, pelvic insufficiency fractures, and sexual dysfunction. Complications of cytotoxic chemotherapy and targeted agents include myelosuppression, neuropathy, mucositis, neutropenic enterocolitis, pneumatosis intestinalis, bowel perforation, tumor-to-bowel fistula, pancreatitis, nephrotoxicity, osteoporosis, and bone loss. Immunotherapy-related toxicities include colitis, enteritis, hepatitis, and pancreatitis. The role of the radiologist in the detection and characterization of these complications is paramount, as imaging is integral to timely diagnosis and multidisciplinary management. An awareness of the spectrum of abdominopelvic complications affecting gynecologic oncology patients is essential to maximal diagnostic accuracy and optimal patient care.