Case report Synchronous small and large bowel cancer developing after pelvic irradiation

SUMMARY This case report supports the belief that there is a causal relationship between therapeutic radiation and subsequent bowel malignancy. Case report A woman, aged 42 years, with a stage III squamous cell carcinoma of the cervix was treated with internal and external cobalt 60 irradiation for 45 days. The combined dose to the cervix (point A) was 72 Gy (7200 rad) and to areas 5 cm from the cervix (point B) 52.8 Gy (5280 rad). She remained well for six years, when she developed painless haematuria and clot retention. After an intravenous urogram and cysto-scopy, radiation cystitis was diagnosed and the bleeding was attributed to areas of telangiectasia. The bleeding stopped spontacneously. Fourteen years after treatment, she remained free of recurrent disease and was discharged from outpatient care. Twenty years after radiation therapy, aged 62 years, she was admitted to hospital with intestinal obstruction. At operation the sigmoid colon, upper rectum, caecum and terminal ileum were thickened and adherent to surrounding structures and this was thought to be caused by radiation exposure. The terminal ileum was strictured. There was a pinhole perforation on the anterior wall of the grossly distended caecum. The large bowel was obstructed at the rectosigmoid junction where a small mobile mass was noted. In view of the patient's poor general condition, a tube caecostomy was fashioned through the caecal perforation and a loop ileostomy raised proximal to the ileal stricture