Question

CASE STUDY E Colon Cancer This case study incorporates several general aspects of malignant tumors (refer to Chapter 20 if necessary). Not all details can be included, but the events provide an opportunity to integrate information. Mrs. R.C., age 82, has a history of uterine cancer that began 12 years ago. A hysterectomy was performed at that time, fol- lowed by radiation (an implant of radioactive material). This was deemed successful. Vaginal bleeding developed 2 years later and a tumor located between the vagina and bladder was treated with radiation and eradicated. Since that time, she has remained relatively healthy and led an active life. Now Mrs. R.C. has developed some abdominal discomfort fatigue, and loss of energy, but blood tests and ultrasound failed to reveal any specific cause or abnormality. Continued pain and indigestion, combined with knowledge of her history, prompted a repeat of the tests 3 months later, again all negative. 1. Suggest possible reasons for negative tests. Pain continued, and occasional vomiting developed as well as inability to eat a large meal. A weight loss of 30 pounds was evident. Other illness delayed further tests for several months. A colonoscopy uncovered a malignant tumor in the upper descending colon. At this time a small opening was prepared in the intestine to allow passage of semiliquid foods. 2. List the signs indicating intestinal obstruction. Why have these signs been slow in developing? Two months later during surgery, a colostomy was created and healing seemed to be satisfactory. Only a small amount of the tumor had been removed. The oncologist determined that radiation was not an option given the history and chemotherapy was not effective with this malignant cell 3. Describe possible reasons why additional treatment would not be recommended in this case Following surgery, Mrs. R.C.'s food intake improved and she gained some weight. However, a pulmonary embolus developed several weeks after surgery and was treated with anticoagulants.

Answer 1

1. Possible reason for negative test results

The patient has undergone blood tests and ultrasound. The blood test could have looked for tumor markers which is usually more effective in monitoring patients with cancer, their treatment progress and the return of cancer. In some cases the tumor marker can be normal for a patient with cancer and abnormal for other reasons. Abdominal ultrasound can identify cancers in liver, gall bladder, pancreas and other areas of the abdomen but may be difficult to identify cancers in colon. So, these could be the reasons for negative test results.

2. Signs of intestinal obstruction

Vomiting, severe abdominal pain, cramping, bloating, abdominal distension, constipation, inability to pass gas, loud bowel sounds are some signs of intestinal obstruction. The tumor growth would have been slow to cause complete obstruction of intestine and so the signs would have been slow in developing.

3. Reasons for not recommending treatment:

The first reason could be age factor; since she is 82 years old she may not be able to tolerate the treatment and procedures. The other reasons could be some treatments could not to very effective in this case and the patient may not respond well. Also the risk of developing complications related to treatment may be high. So, additional treatments may not be recommended.