Abstract
Gynecologic cancers account for 10–15 % of female malignancies, but the genital organs may also be affected in pelvic irradiation of other organs and in systemic treatment.
Depending on cancer type and stage, surgery, radiotherapy, and chemotherapy are treatment options. Advances in therapy result in markedly improved survival rates in pelvic malignancies. In these patients treatment-related side effects are more common than recurrence, but their differentiation may be challenging. This is why it is pivotal that the radiologist is aware of the type of treatment and the spectrum of normal posttreatment findings, pitfalls, and complications. Postirradiation sequelae may complicate the early phase but may also occur with a latency of many years. Side effects of targeted agents differ from those of classical cytotoxic agents, and particularly in the latter ovarian function may be impaired.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- CT:
-
computed tomography
- MRI:
-
magnetic resonance imaging
- RT:
-
radiotherapy
- WI:
-
weighted imaging
References
Addley HC, Vargas HA, Moyle PL, Crawford R, Sala E (2010) Pelvic imaging following chemotherapy and radiation therapy for gynecologic malignancies. Radiographics 3:1843–1856
American College of Obstetricians and Gynecologists (2014) Committee opinion. Number 601
Antunes D, Cunha TM (2013) Recurrent cervical cancer: how can radiology be helpful. OMICS J Radiol 2013(2):138. doi:10.4172/2167-7964 1000138
Ascher S, Johnson JC, Barnes WA, Bae CJ et al (1996) MR imaging appearance of the uterus in postmenopausal women receiving tamoxifen therapy for breast cancer: histopathologic correlation. Radiology 200:105–110
Blomlie V, Rofstad EK, Tvera K, Lien HH (1996) Noncritical soft tissues of the female pelvis: serial MR Imaging before, during, and after radiation therapy. Radiology 199:461–468
Bluemke DA, Fishman EK, Kuhlman JE, Zunreich ES (1991) Complications of radiation therapy: CT evaluation. Radiographics 11:581–600
Boran N, Cil AP, Tulunay G et al (2004) Chylous ascites following para-aortic lymphadenectomy: a case report. Gynecol Oncol 93:711–714
Brand AH, Bull CA, Cakir B (2006) Vaginal stenosis in patients treated with radiotherapy for carcinoma of the cervix. Int J Gynecol Cancer 16:288–293
Brown MA, Mattrey R, Stamato S, Sirlin CB (2005) MRI of the female pelvis using vaginal gel. Am J Roentgenol 185:1221–1227 www.cancer.gov/cancertopics/…/treatment
Capps GW, Fulcher AS, Szucs RA, Turner MA (1997) Imaging features of radiation induced changes in the abdomen. Radiographics 17:1455–1473
Conzen SD (2014) Managing the side effects of tamoxiphen. www.update.com 2014
Critchley H, Wallace W, Shalet SM et al (1992) Abdominal irradiation in childhood: the potential for pregnancy. Br J Obstet Gynecol 99:392–394
Engin G (2006) Cervical cancer: MR imaging findings before, during and after radiation therapy. Eur Radiol 16:313–324
ESMO clinical practice guidelines. Gynecologic cancers www.esmo.org/Guidelines/Gynaecological-Cancers
Feddock J, Randall M, Kudrimoti M et al (2014) Impact of post-radiation biopsies on development of fistulae in patients with cervical cancer. Gynecol Oncol 133:263–267
Flueckinger F, Ebner F, Poschauko H et al (1992) Cervical cancer before and after primary radiation therapy – a 2 year follow-up study. Radiology 184:89–93
Golabebek T, Szymanska A, Szopinski T, et al. (2013) Enterovesical fistula: aetiology, imaging, and management. Gastroenterol Res Pract 2013(617967):8 www.hindawi.com/journals/grp/2013/617967
Harry VN, Semple SI, Gilbert FJ, Parkin DE (2008) Diffusion weighted MRI in the early detection of response to chemoradiation in cervical cancer. Gynecol Oncol 111:213–220
Hassouna A, Bahadur YA, Constantinescu C (2014) Assessment of air pockets in high-dose rate vaginal cuff brachytherapy using cylindrical applicators. J Contemp Brachytherapy 6:271–275
Hricak H, Swift PS, Campos Z et al (1993) Irradiation of the cervix uteri: value of unenhanced and contrast-enhanced MR imaging. Radiology 189:381–388
Irtan S, Orbach D, Helfre S, Sarnacki S (2014) Ovarian transposition in prepubescent and adolescent girls with cancer. Lancet Oncol 14:601–608
Iyer R, Jhingran A (2006) Radiation injury: imaging findings in the chest, abdomen and pelvis after therapeutic radiation. Cancer Imaging 6:S131–S139
Jeraj R, Cao J, Ten Haken RK, Hahn C, Marks L (2010) Imaging for assessment of radiation-induced normal tissue effects. Int J Radiat Oncol Biol Phys 76(3 Suppl):S140–S144
Jereczek-Fossa BA, Jassem J, Badzio A (2002) Relationship between acute and late normal tissue injury after postoperative radiotherapy in endometrial cancer. Int J Radiat Oncol Biol Phys 52:476–482
Kanthan R, Senger JL (2011) Uterine carcinosarcomas (malignant mixed Müllerian tumours): a review with special emphasis on controversies in management. Obstetr Gynecol Int. Article ID:470795
Kwek JW, Iyer RB, Dunnington J, Faria S, Silverman PM (2006) Spectrum of imaging findings in the abdomen after radiotherapy. AJR Am J Roentgenol 187:1204–1211
Lagrange JL, Ramaioli A, Chateau MC et al (2000) Sarcoma after radiation therapy: retrospective multi-institutional study of 80 histologically confirmed cases. Radiology 216:197–205
Loren AW, Mangu PB, Beck LN et al (2013) Fertility preservation for patients with cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol 31:2500–2510
Maddedu C, Gramignano G, Kotsonis P et al (2014) Ovarian hyperstimulation in premenopausal women during adjuvant tamoxifen treatment for endocrine-dependent breast cancer. Oncol Lett 8:1279–1282
Mark RJ, Poen J, Tran LM et al (1996) Postirradiation sarcoma of the gynecologic tract. A report of 13 cases and a discussion of the risk of radiation-induced gynecologic malignancies. Am J Clin Oncol 19:59–64
Maturen KE, Feng MU, Wasnik AP et al (2013) Imaging effects of radiation therapy in the abdomen and pelvis: evaluating “innocent bystanders” tissues. Radiographics 33:599–619
Mayr NA, Yuh WTC, Magnotta VA et al (1996) Tumor perfusion studies using fast magnetic resonance imaging technique in advanced cervical cancer: a new non invasive predictive assay. Int J Radiat Oncol 36:623–633
McConnell Greven K, Paunesku T (2005) Radiation complications of the pelvis. In: Small W Jr, Woloschak G (eds) Radiation toxicity: a practical guide. Chapter 6. Springer, pp 125–153. ISBN: 978-1-4020-8053-1 (Print) 978-0-387-25354-1 (Online)
Meads C, Davenport C, Malysiak S et al (2014) Evaluating PET-CT in the detection and management of recurrent cervical cancer: systematic reviews of the diagnostic accuracy and subjective elicitation. BJOG 121:398–407
Meirow D, Nugent D (2001) The effects of radiotherapy and chemotherapy on female reproduction. Hum Reprod Update 7:535–543
Morgan S, Anderson RA, Gourley C et al (2012) How do chemotherapeutic agents damage the ovary. Hum Reprod Update 18:525–535
Morice P, Juncker L, Rey A et al (2000) Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination. Fertil Steril 74:743–748
Onsrud M, Cvancarova M, Hellebust TB et al (2013) Long- term outcomes after pelvic radiation for early-stage endometrial cancer. J Clin Oncol 31:3951–3965
Ostrzenski A, Radolinski B, Ostrzenska KM (2003) A review of laparoscopic ureteral injury in pelvic surgery. Obstet Gynecol Surv 58:794–799
Paspulati RM, Dalal TA (2010) Imaging of complications following gynecologic surgery. Radiographics 2010(30):625–642
Polin SA, Ascher SM (2008) The effect of tamoxifen on the genital tract. Cancer Imaging 8:135–145
Raja FA, Chopra N, Ledermann JA (2012) Optimal first-line treatment in ovarian cancer. Ann Oncol 23(Suppl 10):x118–x127
Sala E, Rockall A, Rangarajan D, Kubick–Huch RA (2010) The role of dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging in the female pelvis. Eur J Radiol 76:367–385
Schieda N, Malone SC, Al Danadan O et al (2014) Multi-modality organ-based approach to expected imaging findings, complications and recurrent tumour in the genitourinary tract after radiotherapy. Insights Imaging 5:25–40
Sella T, Mironov S, Hricak H (2005) Imaging of transposed ovaries in patients with cervical carcinoma. AJR Am J Roentgenol 184:1602–1610
Semelka RC, Hricak H, Kim B et al (1997) Pelvic fistulas: appearance on MR images. Abdom Imaging 22:91–95, 1997
Small W Jr, Strauss JB, Hwang CS, Cohen L, Lurain J (2011) Should uterine tandem applicators ever be placed without ultrasound guidance? No: a brief report and review of the literature. Int J Gynecol Cancer 21:941–944
Stevens SK, Moore SG, Kaplan ID (1990) Early and late bone marrow changes after irradiation: MR evaluation. AJR Am J Roentgenol 154:745–750
Sugimura K, Carrington BM, Quivey JM, Hricak H (1990) Postirradiation changes in the pelvis. Assessment with MRI. Radiology 175:805–813
Tam KF, Lam KW, Chan K, Ngan HY (2008) Natural history of pelvic lymphocytes observed by ultrasound after bilateral lymphadenectomy. Ultrasound Obstet Gynecol 32:87–90
Torrisi JM, Schwartz LH, Gollub MJ et al (2011) CT findings of chemotherapy-induced toxicity: what the radiologist need to know about the clinical and radiologic manifestations of chemotherapy toxicity. Radiology 258:41–56
Viswanathan C, Truong MT, Sagebiel TL, Bronstein J et al (2014) Abdominal and pelvic complications of non-operative oncologic therapy. Radiographics 34:941–961
Weiss E, Hirnle P, Arnold Bofinger H, Hess CF, Bamberg M (1999) Therapeutic outcome and relation of acute and late side effects in the adjuvant radiotherapy of endometrial carcinoma stage I and II. Radiother Oncol 53:37–44
West CM, Barnett GC (2011) Genetics and genomics of radiotherapy toxicity: towards prediction. Genome Med 3:52
Wo JY, Viswanathan AN (2009) Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients. Int J Radiat Biol Phys 73:1304–1312
Wysowski DK, Honig SF, Beits J (2002) Uterine sarcoma associated with tamoxifen use. N Engl J Med 346:1832–1833
Yankelevitz DF, Henschke KI, Knapp PH, Nisce L et al (1991) Effect of radiation therapy on thoracic and lumbar bone marrow: evaluation with MR imaging. AJR Am J Roentgenol 1991(157):87–92
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Forstner, R., Cunha, T.M. (2015). Female Pelvis: Genital Organs. In: Kauczor, HU., Bäuerle, T. (eds) Imaging of Complications and Toxicity following Tumor Therapy. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2015_1054
Download citation
DOI: https://doi.org/10.1007/174_2015_1054
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-12840-5
Online ISBN: 978-3-319-12841-2
eBook Packages: MedicineMedicine (R0)