o
Effects of Therapy on All
Body Sites
CHAPTER
30
Effects of Therapy on Cytologic Specimens
Larry F Kluskens
Contents
In tro d u c tio n
T h y r o id -s u p p r e s s iv e T h e ra p y
R a d ia tio n B io lo g y
C a r b im a z o le
S t r o m a
R a d io a c tiv e I o d in e
E p it h e liu m
T h e rm a l In ju ry
G e n e r a l C e llu la r C h a n g e s
E le c tr o c a u te r y o f t h e U te r in e C e rv ix
F e m a le G e n ita l T r a c t
C t
y
o t h e r a p y
O ra l M u c o s a
L a s e r T h e r a p y
L o w e r R e s p ira to ry T r a c t
L o o p E le c tr o s u rg ic a l E x c is io n a l P ro c e d u re
U rin a ry T r a c t
B re a s t
P r o s ta te
T h y r o id
A n tin e o p la s tic C h e m o th e ra p y
B le o m y c in
B u s u lfa n
B la d d e r
F o re ig n B o d y : In tra u te rin e D e v ic e s
C y t o lo g y
T ra n s u re th ra l R e s e c tio n a n d C o re N e e d le B io p sy
o f T h e P ro sta te
C y t o lo g y
H o rm o n a l T h e r a p y
D ru g R e s ista n c e
A n tin e o p la s tic B io lo g ic R e sp o n se M o d ifie rs
A s s e s s m e n t o f C e ll D e a th
B a c illu s C a lm e t t - G u é r in
T r a n s p la n t Im m u n o s u p p re s s iv e T h e r a p y
I m m u n o t o x ic it y a n d N e o p la s ia A ft e r T r a n s p la n t I m m u n o s u p p r e s s iv e T h e r a p y
E v a lu a tio n o f A llo g r a ft T r a n s p la n t R e je c tio n a n d I m m u n o s u p p r e s s iv e T o x ic ity
C o n c lu d in g R e m a rk s
Introduction
N u m erous therapeutic m od a lities are und er c on tin u ou s devel-
o p m e nt and are available fo r treating patients w ith m alig n an -
cies and fo r tra nsp lan tatio n rejection. These includ e ra d ia tio n
therapy, chem otherapy, b iolog ic response m od ifiers, m echani-
cal/physical techniques, and m olec ular b io lo g y techniques. The
d iversity o f techniques leads to a w id e range o f changes th a t m ay
m im ic neoplastic o r physiologic changes in the cell p op ulations
fro m these samples. Som e o f the changes fo llo w in g chem o-
therapy and ra d ia tio n therapy m ay m o d ify the genome, have
the p o ten tial to be propagated in any subsequent cell divisions,
and m ay pass the changes o n to subsequent generations o f cells.
These changes m ay be seen in surviving neoplastic and n o r-
m al cell p op ulatio ns fo r years after the in itia l therapy. System ic
effects m ay be seen in p atient samples fro m patients receiving
one o f the m an y types o f chem otherapies, h o rm o n a l therapies,
o r im m unotherap ies. In a d d itio n, these therapies m ay interact
synergistically w ith ra d ia tio n therapy. Those therapies th a t do
n o t produce lasting changes in the genome, such as b iolog ic
therapy and physical means, are m ore lik e ly to cause changes
th a t stim u la te a h ost reparative response and produce systemic
effects. The background and specific examples o f each type o f
therapy w ith respect to d iffe re n t anatom ic sites are detailed in
the fo llo w in g sections.
Radiation Biology
The tw o types o f io n iz in g ra d ia tio n are particle and electrom ag-
netic. B oth cause ejection o f electrons w ith release o f energy.
Electrom agnetic ra d ia tio n consists o f x-rays and gam m a rays.
Particle ra d ia tio n consists o f alpha, beta, p roton, n eu tron , m es-
ons, o r deuterons. B oth particle and electrom agnetic rad ia tio n
are fast and exert th e ir effects in less th a n 10-8 s.
The rad io b io lo g ic effect com pared w ith a standard dose o f
ra d ia tio n is dependent on the type o f rad ia tio n, the tissue being
irradiated, and the response o f the tissue. Som e tissues, such as
bone m a rro w and g astrointestinal e p ith e liu m , w h ic h have hig h
tu rn o ve r rates, are h ig h ly sensitive, whereas others, such as brain,
w ith a lo w tu rn o ve r rate, are relative ly insensitive.
R ad iation is generally m easured in term s o f rads (rad) and
grays (G y). T he conversions are as fo llow s: 1 rad = 1 cG y=
100 ergs/g, and 1 G y = 100 rad. F o r m ost tum ors, these doses are
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