Rapid Review·General Pathology
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CELLULAR INJURY
T2High yieldIonizing Radiation
P207
Focus on
Radiation kills the fastest-dividing cells first.
Key takeaways
How radiation injures cells
- Stem cells of rapidly regenerating tissues are most susceptible: skin, bone marrow, GI tract, gonads.
- Why radiotherapy works: cancer cells have dysfunctional DNA repair on top of high replicative rates, so they are damaged more than the healthy tissue around them.
What it looks like clinically
Radiation dermatitis
acute = erythema, peeling, pain, pruritus. Chronic = atrophy, pigment change, telangiectasia, fibrosis driven by ↑ TGF-β.Years after radiation exposure, which two late complications should you expect?
Fibrosis (driven by ↑ TGF-β) and neoplasia, classically leukemia and thyroid cancer.
How it's tested
The susceptibility list is the question: radiation damages the stem cells of rapidly regenerating tissues first, so skin, bone marrow, GI tract and gonads fail before anything else, and the acute syndrome reads as cytopenias plus GI and skin toxicity.
The mechanistic layer is why radiotherapy is selective at all: tumor cells carry dysfunctional DNA repair on top of a high replicative rate, so the same dose damages them more than the tissue around them.
Go deeper
First Aid page 207, the ionizing radiation half; Pathoma Ch. 1 "Cellular injury". Anchor double-strand DNA breaks (direct plus free-radical), the four fastest-dividing tissues that fail first, and chronic radiation dermatitis as ↑ TGF-β fibrosis.
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