Pathophysiology Discussion
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Pathophysiology Discussion
Name
University
Pathophysiology Discussion
The majority of colorectal carcinomas are adenocarcinomas, which are preceded by colonic adenomas that derive from mutations of the adenomatous polyposis coli (APC) gene. Other causes of the disease include hereditary non-polyposis colorectal cancer (HNPCC) and ulcerative colitis dysplasia. For the majority of cases, the disease begins with the inactivation of the APC gene, which results in uninhibited replication of cells at the crypt surface, subsequently allowing increased cellular mutations due to the increase of replicating cells. This process hinders tumor suppressive gene function and in turn, prolonging the life of the mutated cells (Cagir, 2015).
The American Cancer society has found that more than 93,000 new cases of rectal cancer are diagnosed each year, and of these, 49,700 are estimated to result in death (Cagir, 2015). The etiology of colon/rectal cancer is relatively unknown, however the origin of the disease may be dependent on multiple factors, such as diet, genetics, and environmental risks. In addition, chronic inflammation may also lead to alterations in genes, forming dysplasia and carcinoma. The clinical manifestations of colon/rectal cancer are rectal bleeding, which is the most common symptom and bleeding with the passing of mucus. Other presentations of the disease include a change in bowel habits, usually diarrhea, or obstructions caused by large tumors. Patients may also have abdominal pain, although these patients are in the minority overall because the early stage of colon cancer is painless for most individuals. Back pain may also be reported and happens when large tumors become pressed against the nerve trunks, which can also cause urinary issues when the tumor presses on the bladder or prostate. Fatigue is also a symptom for some patients (Cagir, 2015).
The patient had a loop ileostomy procedure performed to relieve a distal obstruction, caused by obstructing colorectal cancer. Large tumors low in the bowel can obstruct or hinder bowel functions and cause feelings of incomplete evacuation, abdominal pain, bloating as well as tenesmus. Comorbid conditions related to ileostomy include dehydration and electrolyte imbalance due to the nature of the consistent and liquid stools, as diarrhea is the most frequent problem in patients. Another common issue with patients who have been treated with ileostomy is the occurrence of obstructions due to diet and the small stoma. Dietary considerations include avoiding foods that absorb water, such as nuts, corn, dried fruit and anything high in fiber as these foods contribute to obstructions which may require the need for surgical removal.
There is also the risk of vitamin B12 deficiency, as the removal of the intestinal section that absorbs the vitamin hinders its absorption. Side effects of B12 deficiency include fatigue, palpitations, dyspnea, and loss of appetite. In addition, risk of the stoma widening, narrowing, or even retracting to below the skin level are also considerations, especially with an external bag needing attachment. In addition to the physical effects, comorbid conditions also include psychological/social impact, which may require additional care.
The patient’s prognosis is dependent on multiple factors, including stage and recurrence. For Stage I patients, their overall five year survival rate is around 90%. Stage II patients rank at 60%-85%, Stage III is 27%-60% and Stage IV is 5% to 7% survival rate. In a review of over 100,000 early stage patients, it was found that increased age, male gender, and high rate of comorbidity lowered survival rates. Recurrence happens typically within the first year and can occur as distal, local or both. Recurrence is strongly connected to higher rates of mortality and can be influenced by the type of tumor and the location, as low rectal cancers recur more often (Cagir, 2015).
References
Cagir, B. Rectal cancer. (2015). Medscape. Retrieved from:
Name
University
Pathophysiology Discussion
The majority of colorectal carcinomas are adenocarcinomas, which are preceded by colonic adenomas that derive from mutations of the adenomatous polyposis coli (APC) gene. Other causes of the disease include hereditary non-polyposis colorectal cancer (HNPCC) and ulcerative colitis dysplasia. For the majority of cases, the disease begins with the inactivation of the APC gene, which results in uninhibited replication of cells at the crypt surface, subsequently allowing increased cellular mutations due to the increase of replicating cells. This process hinders tumor suppressive gene function and in turn, prolonging the life of the mutated cells (Cagir, 2015).
The American Cancer society has found that more than 93,000 new cases of rectal cancer are diagnosed each year, and of these, 49,700 are estimated to result in death (Cagir, 2015). The etiology of colon/rectal cancer is relatively unknown, however the origin of the disease may be dependent on multiple factors, such as diet, genetics, and environmental risks. In addition, chronic inflammation may also lead to alterations in genes, forming dysplasia and carcinoma. The clinical manifestations of colon/rectal cancer are rectal bleeding, which is the most common symptom and bleeding with the passing of mucus. Other presentations of the disease include a change in bowel habits, usually diarrhea, or obstructions caused by large tumors. Patients may also have abdominal pain, although these patients are in the minority overall because the early stage of colon cancer is painless for most individuals. Back pain may also be reported and happens when large tumors become pressed against the nerve trunks, which can also cause urinary issues when the tumor presses on the bladder or prostate. Fatigue is also a symptom for some patients (Cagir, 2015).
The patient had a loop ileostomy procedure performed to relieve a distal obstruction, caused by obstructing colorectal cancer. Large tumors low in the bowel can obstruct or hinder bowel functions and cause feelings of incomplete evacuation, abdominal pain, bloating as well as tenesmus. Comorbid conditions related to ileostomy include dehydration and electrolyte imbalance due to the nature of the consistent and liquid stools, as diarrhea is the most frequent problem in patients. Another common issue with patients who have been treated with ileostomy is the occurrence of obstructions due to diet and the small stoma. Dietary considerations include avoiding foods that absorb water, such as nuts, corn, dried fruit and anything high in fiber as these foods contribute to obstructions which may require the need for surgical removal.
There is also the risk of vitamin B12 deficiency, as the removal of the intestinal section that absorbs the vitamin hinders its absorption. Side effects of B12 deficiency include fatigue, palpitations, dyspnea, and loss of appetite. In addition, risk of the stoma widening, narrowing, or even retracting to below the skin level are also considerations, especially with an external bag needing attachment. In addition to the physical effects, comorbid conditions also include psychological/social impact, which may require additional care.
The patient’s prognosis is dependent on multiple factors, including stage and recurrence. For Stage I patients, their overall five year survival rate is around 90%. Stage II patients rank at 60%-85%, Stage III is 27%-60% and Stage IV is 5% to 7% survival rate. In a review of over 100,000 early stage patients, it was found that increased age, male gender, and high rate of comorbidity lowered survival rates. Recurrence happens typically within the first year and can occur as distal, local or both. Recurrence is strongly connected to higher rates of mortality and can be influenced by the type of tumor and the location, as low rectal cancers recur more often (Cagir, 2015).
References
Cagir, B. Rectal cancer. (2015). Medscape. Retrieved from: