Case Study 92
R.T. is a 64-year-old man who comes to his primary care provider’s (PCP’s) office for a yearly examination. He initially reports having no new health problems; however, on further questioning, he admits to having developed some fatigue, abdominal bloating, and intermittent constipation. His nurse practitioner completes the examination, which includes a normal rectal exam with a stool positive for guaiac. Diagnostic studies include a CBC with differential, chem 14, and carcinoembryonic antigen (CEA). R.T. has not had a recent colonoscopy and is referred to a gastroenterologist for this procedure. A 5-cm mass found in the sigmoid colon confirms a diagnosis of adenocarcinoma of the colon. A referral is made for surgery. The pathology report describes the tumor as a Dukes’ stage B, which means that the cancer has extended into the mucous layer of the colon. A metastatic work-up is negative.
1. What is a risk factor?
64-year-old (no information about heredity, diet, polyps, etc)
2. Identify six risk factors for colon cancer.
Age older than 50 yo
Polyps of the colon / rectum
Family Hx of colorectal cancer
Inflammatory bowel disease
Exposure to radiation
Diet: high animal fat and kilocalorie intake
3. Discuss the American Cancer Society’s recommended screening procedures related to colon cancer.
Screening is recommended beginning at age 50. Yearly fecal occult blood / fecal immunochemical test (take home, multiple sample); flexible sigmoidoscopy every 5 years; double-contrast barium enema every 5 years; colonoscopy q 10 years.
4. According to the American Cancer Society, what warning signs did R.T. have?
stool positive for guaiac = rectal bleeding
abdominal bloating, and intermittent constipation
5. Discuss common early versus late signs and symptoms (S/S) found in individuals with colorectal cancer.
Often there's no Sx until advanced (grows slowly 5-15 years). Manifestations depend on its location, type and...
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