1 / 25

Colon Cancer

Colon Cancer. Profile. CL 54/M from Batangas C hief complaint of rectal bleeding. History of Present Illness. 2 years PTA patient noted dark/blackish stools. There were no associated symptoms at the time. 1 year PTA

megan-douglas
Télécharger la présentation

Colon Cancer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Colon Cancer

  2. Profile • CL • 54/M • from Batangas • Chief complaint of rectal bleeding

  3. History of Present Illness • 2 years PTA • patient noted dark/blackish stools. There were no associated symptoms at the time. • 1 year PTA • patient started having abdominal pain at the hypogastric area, described as squeezing in quality, intermittent, pain scale 4/10, accompanied by blood-tinged stools. No consult done.

  4. History of Present Illness • 2 months PTA • persistence of hypogastric pain VAS now 7/10. Patient consulted at PGH OPD. Colonoscopy and biopsy were subsequently done A> Colon CA, Adenocarcinoma St. I. Patient was then scheduled for elective admission.

  5. Review of Systems • (-) wtloss • (+) good appetite • (+) difficulty in defecation • (+) melena • (+) hematochezia • (+) good urine output • (-) diarrhea • (+) constipation

  6. Past Medical History • (+) Hypertensive suspect • LBP 100/80 HBP 150/100 UBP 140/100, currently no medications • (+) Benign prostatic hyperplasia, 2005, treated medically • (-) BA/DM/PTB • (-) known allergies • (-) previous hospitalizations/surgeries

  7. Family Medical History • (+) Colon Cancer- sibling • (+) CVD-mother • (-) DM/ PTB/ HPN/ BA

  8. Personal Social History • (+) Smoker, 72 pack years • (+) regular alcoholic beverage drinker, almost everyday, stopped when he was confined • Used to work as a farmer but stopped due to current illness.

  9. Physical Exam

  10. Laboratory CBC • Hgb 146 • Hct 0.446 • WBC 6.40 • Plt 155 • Monocytes 0.075 • Eosinophils 0.035 • Basophils 0.003 • Neutrophils 0.512 • Lymphocytes 0.375

  11. Laboratory • AST 32 • ALT 35 • TB 8.9 • DB 2.0 • IB 6.9 • (01-13-12) Tumor marker: CEA 1.85 (N: 0-5)

  12. Laboratory • CXR • No significant chest findings • Colonoscopy report • Scope inserted up to cecum, noted circumferential fungating mass 45cm FAV, obstructing 60% of the lumen • Abdominal CT • Irregular thickening of the anterior wall of the rectum • Distal Ileal wall thickening, consider tumor focus • Cardiomegaly • Renal cortical cysts, bilateral, Bosniak I • Compression deformity, L2 vertebra

  13. Laboratory • Histopathologic Report • Adenocarcinoma, well-differentiated

  14. Assessment • Adenocarcinoma, descending colon St. 1 • (T2 N0 M0)

  15. Clinical Presentation • Rectal bleeding • Abdominal pain • Change in bowel habits • Intestinal obstruction or perforation • Weight loss

  16. Clinical Presentation • Iron deficiency anemia • weakness, fatigue, dyspnea, or palpitations • Advanced cancer can cause cancer cachexia, involuntary weight loss, anorexia, musclse weakness

  17. Pathophysiology • arises from mucosal colonic polyps • Hyperplastic • Increased number of glandular cell s with decreased cytoplasmic mucus • Lack nuclear hyperchromatism, stratification, or atypia • Adenomatous • hyperchromatic, enlarged, cigar -shaped, and crowded together in a palisade pattern • Almost all colon cancers arise from adenomas

  18. Risk Factors

  19. Risk Factors

  20. Screening of Average Risk Patients • Fecal Occult Blood test • low cost, simple, non-invasive, safe • low specificity • Barium Enema • Flexible sigmoidoscopy • every 3 to 5 years has been recommended in conjunction with annual FOBT for screening • Colonoscopy • recommended for patients more than 50 years old at average risk for colon cancer or colonic polyps

  21. Surgical Management • Surgery is the only curative modality for localized colon cancer (stage I-III) • Removal of the primary tumor with adequate margins including areas of lymphatic drainage • Right hemicolectomy • cecum and right colon • ileocolic, right colic, and right branch of the middle colic vessels are divided and removed

  22. Surgical Management • Extended right hemicolectomy • proximal or middle transverse colon • ileocolic, right colic, and middle colic vessels are divided and the specimen is removed with its mesentery. • Left hemicolectomy • splenic flexure and left colon • left branch of the middle colic vessels, the inferior mesenteric vein, and the left colic vessels along with their mesenteries are included with the specimen

  23. Surgical Management • Sigmoid colectomy • sigmoid colon lesions • inferior mesenteric artery is divided at its origin, and dissection proceeds toward the pelvis until adequate margins are obtained

  24. Adjuvant Chemotheraphy • Standard therapy for patients with stage III and some patients with stage II colon cancer

More Related