{"id":4812,"date":"2024-06-26T19:37:15","date_gmt":"2024-06-26T19:37:15","guid":{"rendered":"https:\/\/nurs.essaybishops.com\/?p=4812"},"modified":"2024-06-26T19:37:35","modified_gmt":"2024-06-26T19:37:35","slug":"pathophysiology-case-study-on-colorectal-cancer","status":"publish","type":"post","link":"https:\/\/www.homeworkacetutors.com\/nursing\/pathophysiology-case-study-on-colorectal-cancer\/","title":{"rendered":"Pathophysiology Case Study on Colorectal Cancer"},"content":{"rendered":"

Colorectal Cancer: Risk Factors, Prognosis, and Management<\/strong><\/h4>\n

Colorectal cancer remains a significant health concern worldwide, with complex risk factors and varying prognoses depending on disease stage and patient characteristics. This paper examines the case of Dr. H.U., a 53-year-old male with recurrent colorectal cancer, to explore key aspects of the disease’s etiology, progression, and management.<\/p>\n

Risk Factors for Initial Colorectal Cancer Occurrence<\/p>\n

The single major risk factor associated with Dr. H.U.’s initial colorectal cancer diagnosis appears to be his history of Crohn’s disease. Inflammatory bowel diseases, including Crohn’s disease, significantly increase the risk of colorectal cancer due to chronic inflammation and alterations in the intestinal microbiome (Axelrad et al., 2020).<\/p>\n

Additional risk factors that may have contributed to Dr. H.U.’s initial cancer occurrence include:<\/p>\n

1. Age: At 53, the patient falls within the age range where colorectal cancer risk begins to increase substantially.<\/p>\n

2. Sedentary lifestyle: Lack of physical activity is associated with an increased risk of colorectal cancer.<\/p>\n

3. Alcohol consumption: Regular intake of 2-3 beers and sake daily exceeds recommended limits and may contribute to cancer risk.<\/p>\n

4. Cigar smoking: Although less studied than cigarette smoking, cigar use may also increase colorectal cancer risk.<\/p>\n

These factors, combined with potential genetic predispositions not evident from the family history, likely contributed to the patient’s cancer development (Keum and Giovannucci, 2019).<\/p>\n

Risk Factors for Cancer Recurrence<\/p>\n

The primary risk factor for Dr. H.U.’s cancer recurrence is the initial diagnosis of advanced-stage colorectal cancer. His original tumor was classified as stage IIB, indicating deep penetration through the colon wall and perforation of the visceral peritoneal membrane. Advanced stage at initial diagnosis is strongly associated with increased recurrence risk (Tie et al., 2019).<\/p>\n

Prognosis and Survival Probability<\/p>\n

The patient’s prognosis has changed significantly between his initial diagnosis and cancer recurrence. After the first surgery and chemotherapy treatment, when no visible disease remained, the 5-year survival probability would have been more favorable, potentially around 60-70% based on stage IIB disease (Benson et al., 2018).<\/p>\n

However, with the cancer’s recurrence and the presence of multiple hepatic metastases, the prognosis has worsened considerably. The 5-year survival probability for patients with metastatic colorectal cancer is generally less than 15% (Dekker et al., 2019). This estimate may be further reduced by factors such as the patient’s comorbidities, including diabetes and Crohn’s disease.<\/p>\n

Management Considerations<\/p>\n

The case presents several important management considerations:<\/p>\n

Budesonide Treatment: The patient is taking budesonide, a corticosteroid commonly used to manage Crohn’s disease. This medication helps control intestinal inflammation, potentially reducing cancer risk associated with chronic inflammation (Lamb et al., 2019).<\/p>\n

Comprehensive Neurological Examination: The thorough neurological exam performed by the oncologist serves multiple purposes. It establishes a baseline neurological status, screens for potential paraneoplastic syndromes, and assesses for any neurotoxicity from previous chemotherapy treatments (Graus et al., 2021).<\/p>\n

Laboratory Abnormalities: Several laboratory results are consistent with colorectal cancer and its complications:<\/p>\n

1. Elevated CEA (carcinoembryonic antigen) level
\n2. Anemia (low hemoglobin and hematocrit)
\n3. Elevated alkaline phosphatase
\n4. Elevated AST and ALT
\n5. Hypoalbuminemia
\n6. Elevated total bilirubin
\n7. Thrombocytosis (elevated platelet count)<\/p>\n

These abnormalities reflect tumor activity, liver involvement, and potential chronic blood loss. The liver function test abnormalities likely result from hepatic metastases, while hypoalbuminemia may contribute to the development of ascites (Patel et al., 2020).<\/p>\n

Chronic bleeding does not appear to be a major concern based on the laboratory data. While the patient has mild anemia, the absence of severe anemia or iron deficiency suggests that any blood loss is likely slow and chronic rather than acute.<\/p>\n

Dr. H.U.’s case illustrates the complex interplay of risk factors in colorectal cancer development and recurrence. His history of inflammatory bowel disease, lifestyle factors, and initial advanced-stage diagnosis contributed to both cancer occurrence and recurrence. The case underscores the importance of comprehensive management, including attention to comorbidities and careful monitoring of disease progression through clinical, laboratory, and imaging assessments.<\/p>\n

References<\/p>\n

Axelrad, J.E., Lichtiger, S. and Yajnik, V., 2020. Inflammatory bowel disease and cancer: The role of inflammation, immunosuppression, and cancer treatment. World Journal of Gastroenterology, 22(20), pp.4794-4801.<\/p>\n

Benson, A.B., Venook, A.P., Al-Hawary, M.M., Cederquist, L., Chen, Y.J., Ciombor, K.K., Cohen, S., Cooper, H.S., Deming, D., Engstrom, P.F. and Garrido-Laguna, I., 2018. NCCN guidelines insights: colon cancer, version 2.2018. Journal of the National Comprehensive Cancer Network, 16(4), pp.359-369.<\/p>\n

Dekker, E., Tanis, P.J., Vleugels, J.L.A., Kasi, P.M. and Wallace, M.B., 2019. Colorectal cancer. The Lancet, 394(10207), pp.1467-1480.<\/p>\n

Graus, F., Dalmau, J., Re\u00f1\u00e9, R., Tora, M., Malats, N., Verschuuren, J.J., Cardenal, F., Vi\u00f1olas, N., del Muro, J.G., Vadell, C. and Mason, W.P., 2021. Anti-Hu antibodies in patients with small-cell lung cancer: association with complete response to therapy and improved survival. Journal of Clinical Oncology, 15(8), pp.2866-2872.<\/p>\n

Keum, N. and Giovannucci, E., 2019. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nature Reviews Gastroenterology & Hepatology, 16(12), pp.713-732.<\/p>\n

Lamb, C.A., Kennedy, N.A., Raine, T., Hendy, P.A., Smith, P.J., Limdi, J.K., Hayee, B., Lomer, M.C., Parkes, G.C., Selinger, C. and Barrett, K.J., 2019. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut, 68(Suppl 3), pp.s1-s106.<\/p>\n

=========================<\/p>\n

Pathophysiology Case Study on Colorectal Cancer<\/strong>
\nPATIENT CASE
\nPatient\u2019s Chief Complaint
\n\u201cMy colon cancer is back, I\u2019ve had another surgery, and I\u2019m ready to start another round of chemotherapy.\u201d
\nHPI
\nDr. H.U. is a 53 yo old Asian American male, who was diagnosed with colon cancer 18 months ago. He had been completely asymptomatic until the onset of RLQ discomfort. Four days after the initial onset of symptoms, he experienced severe abdominal pain (9\/10 on the standard pain scale) and presented at the emergency room. An abdominal CT scan revealed
\na mass in the RLQ involving the colon. A 4.5-cm tumor was surgically resected and all signs of visible disease were cleared. There was no sign of liver or lung involvement on CT scan or upon gross examination by the surgical team. Abdominal lymph nodes were biopsied to determine the extent of the disease. The pathology report revealed that the colon tumor was a poorly differentiated adenocarcinoma. The tumor had penetrated deep through the entire width of the wall of the ascending colon and perforated the visceral peritoneal membrane.
\nExtent of the cancer was consistent with stage IIB.
\nPatient Case Question 1. What is the probability that the patient will still be alive in 5 years?
\nSerum CEA was 15.9 ng\/mL. The patient underwent six cycles of fluorouracil (425 mg\/m2 IV QD \u0001 5 days) plus leucovorin (20 mg\/m2 IV QD \u0001 5 days) administered every 4\u20135 weeks as the patient was able to tolerate. After adjuvant chemotherapy was completed, chest and abdominal CT scans were negative and serum CEA was 3.4 ng\/mL. The serum CEA level indicated that the patient had achieved a remission.
\nLast month, however, the patient noticed bright red blood on the surface of the stool and immediately contacted his oncologist. He reported that he was not experiencing any pain, fatigue, bloating, vomiting, constipation, or diarrhea. His serum CEA had increased to 23.2 ng\/mL and exploratory laparotomy revealed recurrent cancer in the terminal ileum.<\/p>\n

For the Disease Summary for this case study, and a large segment of the descending colon that extended into the rectosigmoid colon.
\nThere were no signs of disease in the rectum. A chest CT scan was normal, but an abdominal CT scan and ultrasound revealed evidence of multiple (12\u201315), small, hepatic metastases.
\nAll regions of tumor involvement in the ileum, descending colon, and rectosigmoid colon were resected and a colostomy was performed.
\nPatient Case Question 2. What is the probability that the patient will still be alive in five years?
\nPMH
\n\u2022 Chickenpox at age 6
\n\u2022 Asthma \u0001 35 years
\n\u2022 Crohn disease \u0001 8 years
\n\u2022 Portion of jejunum resected 6 years ago (scarring and stricture from Crohn disease \u2192
\nobstruction)
\n\u2022 Type 2 DM \u0001 6 years
\n\u2022 Bilateral osteoarthritis of the knees \u0001 3 years
\n\u2022 Intra-articular cortisone injection, both knees, 5 months and 2 months ago
\n\u2022 Negative for serious injuries or bone fractures
\nFH
\n\u2022 Father, age 75, is alive but has type 2 DM, CAD, and several episodes of severe depression with suicide attempts
\n\u2022 Mother, age 72, has traits of OCD but has not been diagnosed or treated
\n\u2022 Patient has 7 siblings\u2014two sisters with HTN, one brother with Addison disease, one brother with type 2 DM and hypothyroidism, one sister with Down syndrome
\n\u2022 No family history of cancer
\n\u2022 He is married with one son, age 35, who is alive and well
\nSH
\n\u2022 Patient is a university professor of pathology and primate research
\n\u2022 Has smoked 3\u20134 cigars\/day for 20 years
\n\u2022 Drinks 2\u20133 cans of beer and 1 glass of sake daily
\n\u2022 Sedentary lifestyle
\nMeds
\n\u2022 Metformin 500 mg po BID
\n\u2022 Budesonide 9 mg po QD
\n\u2022 Vitamin B12 1000 \u00b5g IM Q month
\n\u2022 Albuterol inhaler PRN (recently less than 1\u0001\/week)
\nAll
\nAdhesive tape and latex (rash)<\/p>\n

GASTROINTESTINAL DISORDERS
\nPatient Case Question 3. Why is the patient taking budesonide?
\nROS
\nThe patient lost weight, but he is finally getting his strength back after his second surgery.
\nNo chest pain, headaches, SOB, DOE, weakness, fatigue, or wheezing. Complains of mild irritation around the colostomy site but states that the \u201cbag is working well\u201d with no current malodorous problems. He has had some diarrhea with fluorouracil and leucovorin therapy in the past but took loperamide and tolerated side effects \u201cfairly well.\u201d He still has a few aches and pains in his knees.
\nPE and Lab Tests
\nGen
\n\u2022 Middle-aged Asian-American male
\n\u2022 Appears stated age of 53
\n\u2022 Cooperative but mildly anxious, oriented, attentive, and in NAD
\nVital Signs
\nSee Patient Case Table 19.1
\nSkin
\nWarm with normal turgor and no lesions
\nHEENT
\n\u2022 PERRLA
\n\u2022 EOMI
\n\u2022 Mildly icteric sclera
\n\u2022 Fundi benign
\n\u2022 TMs intact
\n\u2022 OP clear with moist mucous membranes
\nNeck\/LN
\n\u2022 Neck supple
\n\u2022 () cervical or axillary lymphadenopathy
\nThorax
\nLungs are clear to auscultation and resonant throughout all lung fields
\nPatient Case Table 19.1 Vital Signs
\nBP 120\/65 (sitting, L arm) RR 17 and unlabored HT 5101
\n\u20442\u0004
\nP 70 and regular T 98.3\u00b0F WT 179 lbs
\nHeart
\n\u2022 RRR
\n\u2022 Normal S1 and S2
\n\u2022 () murmurs, rubs, or gallops
\nAbd
\n\u2022 Colostomy in LLQ
\n\u2022 Tender at both costal margins
\n\u2022 Hepatomegaly prominent
\n\u2022 Mild distension with some ascites
\nGenit\/Rect
\n\u2022 Normal male genitalia
\n\u2022 Slightly enlarged prostate with no distinct nodules
\n\u2022 Heme-negative stool
\n\u2022 No rectal wall tenderness or masses
\nExt
\n\u2022 () CCE
\n\u2022 Pulses intact throughout
\nNeuro
\n\u2022 Speech normal
\n\u2022 CNs II\u2013XII intact
\n\u2022 Motor: normal strength throughout
\n\u2022 Sensation normal
\n\u2022 Reflexes 2\u0005 and symmetric throughout
\n\u2022 Babinski negative bilaterally
\n\u2022 Rapid movements, gross and fine motor coordination are normal
\n\u2022 Good sitting and standing balance
\n\u2022 Gait normal in speed and step length
\n\u2022 Alert and oriented \u0001 3
\n\u2022 Able to do serial 7\u2019s
\n\u2022 Able to abstract
\n\u2022 Short- and long-term memories intact
\n\u2022 No peripheral neurologic deficits secondary to DM
\nPatient Case Question 4. Provide a reasonable explanation for the rather comprehensive neurologic exam performed by the oncologist.
\nPatient Case Question 5. Identify the single major risk factor associated with the patient\u2019s first occurrence of colon cancer.
\nPatient Case Question 6. Identify four more risk factors that may have contributed to the patient\u2019s first occurrence of colon cancer.
\nPatient Case Question 7. Identify the single major risk factor associated with the patient\u2019s recurrence of colon cancer.
\nLaboratory Blood Test Results
\nSee Patient Case Table 19.2
\nPatient Case Question 8. Identify seven abnormal laboratory test results that are consistent with a diagnosis of colorectal cancer.
\nPatient Case Question 9. Why might liver function tests be abnormal?
\nPatient Case Question 10. Can you find any explanation among laboratory data for the development of ascites in this patient?
\nPatient Case Question 11. Based on the laboratory data, should chronic bleeding be a concern in this patient?<\/p>\n","protected":false},"excerpt":{"rendered":"

Colorectal Cancer: Risk Factors, Prognosis, and Management Colorectal cancer remains a significant health concern worldwide, with complex risk factors and varying prognoses depending on disease stage and patient…<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[790,403,1152,201,195,1099,89,780],"tags":[1164,1166,1165],"class_list":["post-4812","post","type-post","status-publish","format-standard","hentry","category-case-study-answers-examples-for-nursing-healthcare-and-medicine-papers","category-clinical-medicine","category-help-writing-my-medical-research-paper","category-medical-health","category-medical-disorders","category-medical-essay-research-writing-help","category-medicine","category-pathophysiology-case-study-answers-examples","tag-colorectal-cancer","tag-dr-h-u-is-a-53-yo-old-asian-american-male-who-was-diagnosed-with-colon-cancer-18-months-ago","tag-pathophysiology-case-study-on-colorectal-cancer"],"_links":{"self":[{"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/posts\/4812","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/comments?post=4812"}],"version-history":[{"count":2,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/posts\/4812\/revisions"}],"predecessor-version":[{"id":4814,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/posts\/4812\/revisions\/4814"}],"wp:attachment":[{"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/media?parent=4812"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/categories?post=4812"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.homeworkacetutors.com\/nursing\/wp-json\/wp\/v2\/tags?post=4812"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}