Imaging of Gastrointestinal Complications and Toxicity Following Tumor Therapy

Abstract

With the recent advances in drug therapy, it is more important than ever to understand the possible gastrointestinal complications of the different chemotherapeutic agents and their imaging manifestations. The targeted agent bevacizumab causes delayed wound healing, perforation, and fistulae. Enterocolitis due to immune-modulating agents such as ipilimumab requires rapid diagnosis and treatment in order to prevent bowel damage. Splenic side effects such as splenomegaly and rupture can occur with chemotherapy. Pancreatitis can occur with the targeted agents sunitinib and sorafenib. Changes to the liver due to oxaliplatin may have adverse effects on plans for surgical resection and should be conveyed to the clinician. Complications in the bowel due to radiation include stricture, enteritis, and proctitis. Radiation-induced liver disease can be seen after radiation for tumors of the esophagus, pancreas, and stomach. Radiation-induced malignancies can occur any time from a few years to many years after the initial radiation therapy. Many of these treatment-related complications may be clinically occult until late stages. It is imperative that the radiologist be able to recognize the abdominal toxicities of cancer therapy to make a rapid and correct diagnosis and to convey these findings to the clinician to impact management and prevent misdiagnosis.