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Radiation Oncology • Genitourinary Cancers
Do you stop treatment for a prostate cancer patient diagnosed with acute radiation proctitis with significant pain?
If the diagnosis was made by an outside physicain, how do you confirm/refute the diagnosis? Would an alternative diagnosis like a thrombosed hemorrhoid be a more likely cause of the patient's pain? If you would continue treatment, how would you manage the patient's symptoms?
Answer from: Radiation Oncologist at Academic Institution
I would first check the treatment fields and treatment setup to ensure that there isn't excessive dose going to the anorectum.
As with all toxicities in radiation oncology, one must exclude other possible reasons for the anorectal pain such as hemorrhoids, infection, or inflammatory bowel disease.
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Answer from: Radiation Oncologist at Academic Institution
I agree with everything above from @Alexander Slade. As an addition, start with an external anorectal exam before referring for endoscopy. I had a patient several years ago who presented with severe "rectal" pain and hematochezia when passing stool that started during the first week of standard frac...
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Radiation Oncologist at Rush University Medical Center
Circumferential or limited to the anterior wall? ...
Circumferential or limited to the anterior wall? ...
Answer from: Radiation Oncologist at Academic Institution
It would be very unusual. No. I would check the dosimetry and medical history. That said, unlike head and neck, a day or two off is not a big deal.