Colorectal Cancer Case Study

COLORECTAL CANCER CASE STUDY 7

ColorectalCancer Case Study

Question1

Describethe pathogenesis of Briana’s colorectal cancer from the initialcellular mutation to the diagnosis of stage II A colorectal cancer

Whencancer forms in the polyp, it eventually begins to grow into the wallof the colon or the rectum referred as stage 0. It is from this pointthat the cancer cells begin to grow into blood vessels or lymphvessels, which are the tiny and thin channels that carry away wasteand fluid. Once the cancer cells have spread into the blood or lymphvessels, they can then travel to the close lymph nodes or farthersections of the body, for instance, the liver at what point thecancer is referred to as metastasis.

Nearlyall colon cancers arise from adenomas as illustrated by multipleepidemiologic, clinical, and pathologic findings. Colon cancer isbelieved to be caused by a cascade of genetic mutations leading tothe increasingly spoilt local DNA reproduction and a heightenedcolonocyte duplication. The continued and progressive accumulation ofmultiple genetic are because of transitioning from the normal mucosato benign adenoma to serve dysplasia and finally, frank carcinoma,which is stage A of the cancer. Mutations of various mismatch repairgenes are said to account for about 15% of sporadic colon cancer.Adenomatous Polyposis Coli (APC) mutation accounts for about 80% ofsporadic colon cancer (De Leon and Percesepe, 2000).

Inthe case of Brian, the cancer has been confirmed the stage isreferred to as stage 0 or the carcinoma in situ and the cancer isconfined to the inner lining or the mucosa of the colon or rectum. Atstage 1, the cancer will spread to the muscular layer of the colon orrectum, however, not to the lymph nodes or nearby tissue. At stage IIA, the cancer has now spread throughout the colon wall however, ithas not reached the nearby tissues and lymph nodes. Thus, stage Apenetrates beyond Brian’s colonic muscularis mucosa into thesubmucosa (De Leon and Percesepe, 2000).

Question2

Describemodifiable and non-modifiable risk factors for colorectal cancer andexplain how theseriskfactors may have contributed to the development of colorectal cancer

Modifiablerisk factors and how they contribute to colorectal cancer

Accordingto studies, almost half of all cancer incidents in developingcountries are preventable should measures be implemented to preventbehaviors sure as reducing tobacco use, control weight, limit alcoholconsumption, improving diet, and increase physical activities asdiscussed below according to Kim (2009).

Inthe case of Brian, the following modifiable risk factors might havecontributed to his condition:

Tobaccouse- smoking contributes to nearly 30% of all cancers in the worldcausing various cancers including cancer of the mouth, larynx,stomach, colon, and cervix cancer to mention but a few. Brian mighthave been a smoker smoking acts on multiple stages of carcinogenesisand causing irritation and inflammation interfering with body’snatural protective barriers.

Physicalactivities inactivity of Brian may have increased the risk of coloncancer and likely endometrial cancer as well. High levels ofactivities have proven to reduce the risk of colon cancer by morethan 50%. Evidence suggests that lack of physical activities isassociated the risk of in elevation of various forms of cancer.

Anothermodifiable factor that may have been responsible for Brian’scondition is weight control and obesity prevention: in individualswho are overweight, the risk of dying from colorectal cancer isincreased. Thus, obesity increases the of colon cancer in both sexeshowever, the risk is much higher in men.

Uncontrolledalcohol consumption: colorectal cancer has been associated to heavyalcohol use alcohol use has been linked to lowering levels of folicacid in the body. Thus, alcohol consumption could have led to Brian’scondition (Kim, 2009).

Non-Modifiablerisk factors and how they contribute to colorectal cancer

Age-younger adults can develop colorectal cancer, nevertheless, chancesincrease markedly after the age of 50. Therefore, Brian’s age isthe likely cause of his medical condition. A second non-modifiablefactor is the personal history of colorectal polyps, wherebyindividuals with a history of the cancer have higher chances ofdeveloping colorectal cancer. Thirdly, individuals with a history ofinflammatory bowel disease with the dysplasia cells, likely thecondition changes into cancer cells over time. Brian had problemswith his bowel, which had changed considerably. Also, people with ahistory of colorectal in their family have an increased risk ofgetting the cancer. The Turcot syndrome which is an inheritedcondition within which, people are at a higher risk of colorectalcancer and brain tumors. Other non-modifiable risk factors forcolorectal cancer include the Peutz-Jeghers syndrome,MUTYH-associated polyposis, and people with type 2 diabetes all whichmight have played a part in Brian’s case (Kim, 2009).

Question3 a) Describe the action and mechanism of action ofmetronidazole (Flagyl)

Metronidazole(Flagyl) is used in this case to reduce the development of drugresistant bacteria at the same time maintaining the effectiveness offlagyl and other antibacterial drugs. Thus, metronidazole employs thefollowing mechanism once it has entered the organism, intracellularelectron transport proteins significantly reduce the drug, from whicha concentration gradient is created promoting drug’s intracellulartransport. From this point radicals are formed and they react withcellular components killing the bacteria (Paice, 2003).

b)Describe the action and mechanism of action of Morphine in relationto its administration to Brian

Accordingto Paice (2003), morphine causes a markedly increased secretion ofuPA in MCF-7 for breast cancer cells, thus, morphine regulates of uPAand uPA mRNA levels verifying the contribution of the opioidreceptors in this process, in the case of colon cancer morphinestimulates uPA secretion in HT-29 colon cancer cells.

Question4 &nbspDiscuss the nursing responsibilities with associatedrationales in relation to administeringMorphineto Briana

Patientsare to be advised that morphine is a narcotic pain reliever as such,it should only be taken as directed. The nurse is also to advise thepatient that morphine has various side effects including drowsiness,dizziness, lightheadedness, and at times it may weaken both mentaland physical ability required in normal operations, thus, they are toavoid driving and operation of machineries. The nurse is to adviceagainst mixing morphine with central nervous system depressants suchas sleep aids and general anesthetic, in addition to which they arenot to combine it with alcohol to avoid addictive effects. Thepatient is also to be made away the safe use of the drug in pregnancyhas not yet been established. Finally, the patient is to be advisedto keep morphine safely out of the reach of children, and when it isno longer needed, and then the remaining tablets should be destroyedby flushing them down a toilet (Paice, 2003).

References

DeLeon, M. P., &amp Percesepe, A. (2000). Pathogenesis of colorectalcancer. Digestiveand Liver Disease&nbsp32(9),807-821.

Kim,D. H. (2009). Risk factors of colorectal cancer.&nbspJournalof the Korean Society of Coloproctology&nbsp25(5),356-362.

Paice,J. A. (2003). Mechanisms and management of neuropathic pain incancer.&nbspJsupport Oncol&nbsp1(2),107-120.