In 2006, the colorectal cancer is 2nd most common cancer in Hong Kong; there were 2230 newly diagnosis case of colorectl cancer and it is a 3rd major cause of cancer deaths (Hong Kong Hospital Authority, 2006). Many patients with colorectal cancer will undergo bowel resection to remove the tumour. At least 40% of patients who undergo colorectal surgery are likely to have a post-operative ‘STOMA’ (Beck & Justham 2009). However, the word STOMA can raise anxieties and fears and cause psychological distress (Bokey & Shell, 1985). Patient Profile
My client is a 77 years old gentleman – Mr. Cheng. He lives with his wife. He has two daughters and a son, but they are not living with him. His wife is 75 years old. He had an operation, TURP for BPH, in 1993. He also suffered from DM and HT which requries long term medication and follow-up in general out-patient clinic, however, his DM is not well controlled. Several months ago, Mr. Cheng noted some blood coming with stool, sensation of teneumus and changing in bowel habit with reduction in diameter of stool. Initially, he did not recognize it was a health problem and thought it was normal due to aging. Afterward, he told this issue to his daughter in one family gathering. His daughter suspected that it might be a sign of medical problem and brought him to clinic for medical consultation. In the out-patient clinic, physical examination was performed and the doctor told him a rectal mass was found at 4cm from anal verge and Mr. Cheng was referred to Pamela Youde Nethersole Eastern Hospital (PYNEH) for investigation. According to the colonoscopy report, its showed 1mm polyps at proximal ascending colon and proximal transverse colon were found and polypectomy was performed. Besides, a growth at 4-10cm from anal verge with 3/4 circumference was seen and biopsy was taken. The rectum biopsy shows adenocarcinoma. From the computer tomography (CT) report, the finding was equivocal rectal wall thickening at the posterior aspect of mid-rectum which may represent the tumor. A 0.6cm perirectal lymph node was noted. No evidence of liver and lung metastases. The staging from endoscopic ultrasound of rectum was uT2N0. The tumor marker (CEA) was 38.9 and the random glucose was a bit high; otherwise the blood result was grossly normal. Patient’s son and daughter were interviewed by medical officer and the working diagnosis of CA rectum was explained. Mr. Cheng’s operation was planned on 20th August, 2009. However, Mr. Cheng and his family members were very worry about the operation and post-operative stoma. Therefore stoma specialist and patient supporting group were contacted for counselling. Applied Physiology & Pathophysiology:
Colorectal cancer, also called colon cancer or large bowel cancer, includes cancerous growths in the colon, rectum and appendix. Many colorectal cancers are thought to arise from adenomatous polyps in the colon. The risk factors include: age, most cases occur in the 60s and 70s; present of polyps, particularly adenomatous polyps; heredity (family history of colon cancer, especially in a close relative before the age of 55 or multiple relatives); familial adenomatous polyposis (FAP) carries a near 100% risk of developing colorectal cancer by the age of 40 if untreated; smoking and drinking, especially heavily, may be a risk factor. Diet with high in red and processed meat and low in fiber, are associated with an increased risk of colorectal cancer. Crohn's disease have a more than average risk of colorectal cancer, but less than that of patients with ulcerative colitis (Royle & Walsh, 1993). [pic]
The symptoms of colorectal cancer depend on the location of tumor in bowel and whether it has spread to elsewhere in the body. Symptoms and signs are divided into local, constitutional (affecting the whole body) and metastatic (caused by spread to other organs). Local symptoms are more likely if the tumor is located closer to the...