HISTORY:

Chief of complaint: Recently vague abdominal pain

Past Medical History:

 Patient had a removal of the adenocarcinoma in his sigmoid colon

 Patient had significant coronary artery disease and underwent CABG
 Both surgeries went well
 Patient also underwent adjuvant 5FU leucovorin chemotherapy

Family History:

 Mother died of cancer of unknown etiology

 Brother died of lymphoma at age of 46

NURSING PHYSICAL ASSESSMENT:

Inspection:

Indicates Normal
Color Normal Perfusion to the
tissues
Found spider Usually found in
Skin angiomata over patients who has
upper torso liver disease
Indicates absence of
Healed sternotomy
infection
Healed midline scar Indicates absence of
in abdomen infection
No carotid bruits in
the neck

Palpitations:

Soft non-tender
Indicates absence of
midline scar in the Normal
infection
abdomen
Indicates absence of
Negative palpable
in palpable mass in
mass
the body
Indicates absence of
Negative ascites
infection
Indicates absence of
Negative edema
edema
PATHOPHYSIOLOGY:

Colorectal cancer is a cancer that starts in the colon or the rectum. These cancers can also be named
colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often
grouped together because they have many features in common. Cancer starts when cells in the body
start to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to
other areas of the body.
The patients’ risk factors are his family history of cancer, his age, and his
past medical history of cancer.

His family history or let’s say his hereditary is one of the great factors that
causes him to have colorectal cancer. According to germ-line mutation,
every cell in the affected persons colonic and rectal mucosa has one
normal copy of the gene of one mutated copy of the gene that has
inherited from his mother. Meaning there is an inevitable 50% chance that
he would develop cancer.

His past medical history of gives him a great chance that the cancer will
appear again or in another system. This is because of the chance that the cancer has spread to the
nearby lymph nodes which is called angiolymphatic invasion. Thus, this may cause widespread
dissemination of the cancer cells and may cause implantation of cancer cells in the tissue.

His age is also a factor to the appearance of cancer. According to the oxidative damage theory of aging.
Aging occurs as a result of the accumulation of molecular damage caused by reactive oxygen species
(ROS) which are normally produced as a by-product of metabolism. ROS are capable of damaging
cellular constituents including proteins, lipids and DNA (where they cause double strand breaks and
oxidative lesions). This damage then triggers the activity of cellular machinery involved in damage
repair. Genes that code for proteins involved in rectifying damage to DNA are known as tumor
suppressor genes. Tumor suppressor genes or APC genes are responsible for clearing up cells that are
prone to be neoplastic, i.e., cells in which the DNA has already undergone such extensive damage or
mutation that it will be difficult to repair. Tumor suppressors usually ‘clear up’ these cells by causing
them to senesce or undergo apoptosis. Although this mechanism sounds good for tumor suppression
and cancer prevention, it can have terrible consequences for ageing and longevity. This is due to the fact
that when cells undergo senescence, they secrete certain substances such as growth factors and
degradative enzymes including matrix metalloproteinases which affect their immediate surroundings.
Thus as one ages, the environment around senescent cells becomes a fertile place for the development
of pre-cancerous cells (cells which have undergone sufficient mutations) that have accumulated
throughout the person's life and this is what leads to cancer as one increases in age.

This cancer causes clinical manifestations such as vague abdominal pain, which is the early sign and
symptom of the course of malignancy because an individual may sometimes be asymptomatic. While,
Spider angiomata being seen on the patient usually appears on the persons with liver disease. Liver is
the most frequent site of metastatic involvement. Thus, if the patients has a liver damage this might
cause inadequate production of insulin. That is why the patient has an elevated blood glucose level
175mg/dL
 AGE APC gene

Responsible for clearing up cells

that are prone to be neoplastic
Hx of cancer
‘clear up’ cells by causing them to
Chance that
undergo apoptosis
HERIDETARY cancer cell The cancer has spread to
may appear the nearby tissues and to
Cell undergo senenscence the vascular system
Germ-line
Secrete substances such as growth
mutation factors and degradative enzymes Once tumor cells invade the
including matrix metalloproteinases vascular system,
widespread dissemination
Affect immediate surrounding of the disease follows

Being fertile place for development

of pre-cancerous cells

Accumulated through the persons life

COLORECTAL
CANCER

Spider Angiomata over

Vague Abdominal Pain upper torso

Early sign of This usually appears in

colorectal Cancer person who has liver disease

Liver is the most frequent site

of metastatic involvement

Inadequate production of
insulin

Increased blood glucose level

175mg/dL