Book contents
- Non-Neoplastic Pathology of the Gastrointestinal Tract
- Non-Neoplastic Pathology of the Gastrointestinal Tract
- Copyright page
- Dedication
- Contents
- Preface
- Acknowledgements
- Contributors
- Chapter 1 The Value of Gastrointestinal Biopsy
- Chapter 2 Gastrointestinal Involvement by Systemic Disease
- Chapter 3 Radiation and the Gastrointestinal Tract
- Chapter 4 Transplantation, Immunodeficiency, and Immunosuppression
- Chapter 5 Drug-Induced Gastrointestinal Disease
- Chapter 6 Gastrointestinal Ischemia and Vascular Disorders
- Chapter 7 Paediatric Conditions
- Chapter 8 Gastrointestinal Dysplasia
- Chapter 9 Normal Oesophageal, Gastric and Duodenal Mucosa
- Chapter 10 Histology of Gastroesophageal Reflux Disease and Barrett’s Oesophagus
- Chapter 11 Infections of the Oesophagus and Rare Forms of Oesophagitis
- Chapter 12 Assessment of Gastric Biopsies
- Chapter 13 Types of Gastritis
- Chapter 14 Duodenitis
- Chapter 15 Coeliac Disease
- Chapter 16 Inflammatory Bowel Disease and the Upper Gastrointestinal Tract
- Chapter 17 Normal Lower Gastrointestinal Mucosa
- Chapter 18 Infectious Disorders of the Lower Gastrointestinal Tract
- Chapter 19 Jejunitis and Ileitis
- Chapter 20 Microscopic Colitis
- Chapter 21 Inflammatory Bowel Disease Diagnosis
- Chapter 22 Mimics of Inflammatory Bowel Disease
- Chapter 23 Complications of Inflammatory Bowel Disease
- Chapter 24 Approach to Reporting Inflammatory Bowel Disease Biopsies
- Chapter 25 Ileal Pouch Anal Anastomosis
- Chapter 26 Diverticular Disease, Mucosal Prolapse, and Related Conditions
- Chapter 27 Non-Neoplastic Diseases of the Anal Canal
- Index
- References
Chapter 3 - Radiation and the Gastrointestinal Tract
Published online by Cambridge University Press: 06 June 2020
- Non-Neoplastic Pathology of the Gastrointestinal Tract
- Non-Neoplastic Pathology of the Gastrointestinal Tract
- Copyright page
- Dedication
- Contents
- Preface
- Acknowledgements
- Contributors
- Chapter 1 The Value of Gastrointestinal Biopsy
- Chapter 2 Gastrointestinal Involvement by Systemic Disease
- Chapter 3 Radiation and the Gastrointestinal Tract
- Chapter 4 Transplantation, Immunodeficiency, and Immunosuppression
- Chapter 5 Drug-Induced Gastrointestinal Disease
- Chapter 6 Gastrointestinal Ischemia and Vascular Disorders
- Chapter 7 Paediatric Conditions
- Chapter 8 Gastrointestinal Dysplasia
- Chapter 9 Normal Oesophageal, Gastric and Duodenal Mucosa
- Chapter 10 Histology of Gastroesophageal Reflux Disease and Barrett’s Oesophagus
- Chapter 11 Infections of the Oesophagus and Rare Forms of Oesophagitis
- Chapter 12 Assessment of Gastric Biopsies
- Chapter 13 Types of Gastritis
- Chapter 14 Duodenitis
- Chapter 15 Coeliac Disease
- Chapter 16 Inflammatory Bowel Disease and the Upper Gastrointestinal Tract
- Chapter 17 Normal Lower Gastrointestinal Mucosa
- Chapter 18 Infectious Disorders of the Lower Gastrointestinal Tract
- Chapter 19 Jejunitis and Ileitis
- Chapter 20 Microscopic Colitis
- Chapter 21 Inflammatory Bowel Disease Diagnosis
- Chapter 22 Mimics of Inflammatory Bowel Disease
- Chapter 23 Complications of Inflammatory Bowel Disease
- Chapter 24 Approach to Reporting Inflammatory Bowel Disease Biopsies
- Chapter 25 Ileal Pouch Anal Anastomosis
- Chapter 26 Diverticular Disease, Mucosal Prolapse, and Related Conditions
- Chapter 27 Non-Neoplastic Diseases of the Anal Canal
- Index
- References
Summary
Therapeutic radiation for cancer is more than 100 years old. Side effects constitute the main limitation to its use. Side effects may be acute or chronic, but these categories overlap. As cancer survival improves, chronic radiation damage becomes more common. The gastrointestinal (GI) tract, particularly the bowel, is particularly vulnerable because of its anatomical location and the rapidity of turnover of many GI epithelial cell types. Severity of radiation damage depends also on patient factors, chemotherapy, radiotherapy regimen, and organ mobility. Histologically, common mucosal changes include ulceration, acute inflammation, eosinophilic infiltrates, and architectural abnormalities. Fibrosis may occur later. Vascular changes are more common in chronic disease, affect deeper layers, and include ectasia, intimal thickening, fibrinoid change, thrombosis, and luminal obliteration. Atypia of epithelium, fibroblasts, and endothelium is common and can mimic neoplasia. Epithelial atypia has a lower nuclear:cytoplasmic ratio than dysplasia and matures towards the mucosal surface, aiding the distinction. Features sometimes resemble viral cytopathic change. Chronic radiation colitis may resemble inflammatory bowel disease, ischaemia, and mucosal prolapse while vascular changes may resemble amyloid. In summary, histological clues to radiation damage include fibrosis, atypical fibroblasts, eosinophilic infiltrates, and vascular changes. Confident diagnosis as radiation damage requires a clinical history but this may be unavailable, especially if decades have elapsed since therapy.
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- Non-Neoplastic Pathology of the Gastrointestinal TractA Practical Guide to Biopsy Diagnosis, pp. 30 - 51Publisher: Cambridge University PressPrint publication year: 2020