Betty – pathophysiology, diagnosis, aetiology and common treatment options for cancer.
Betty has recently been diagnosed with colorectal cancer. Pathological examination of biopsy from Betty’s colonoscopy and excsion reveal moderately differentiated Adenocarcinoma of descending colon, stage 3A (Duke’s C).
Discuss the following in relation to this case:
- Succinctly discuss the pathophysiology of cancer tumours in general (Approx 250 words)
- Discuss the pathophysiology of colorectal cancer disease in relation to Betty’s biopsy results (moderately differentiated adenocarcinoma grade 3) (Approx 250 words)
- Discuss ONE of the chemotherapeutic treatment available for Betty. Link your discussion to the relevant pathophysiology of Betty’s condition (Approx 250 words)
total 750 words ONLY NEED 65 -75 % MARK as i am a average student
Betty visits her GP with some worrying signs
Mrs Betty Hill aged 62 presents to her GP, Dr Sharon Glasson with a history of recent bowel changes including episodes of diarrhea, bloating, and incomplete empyting of bowel and some pain on defecation. During Betty’s appointment she mentions that she has had the “odd spot of blood” on her undergarments after having a bowel motion over the past few months. Unconcerned about this, she mentions that she has a haemorrhoid that she has had for many years now and brushed this off as coming from a bleeding haemorrhoid. While discussing other symptoms, Betty mentions that she is quite often fatigued but has put this down to her busy lifestyle
Dr Glasson attends a full physical examination and finds the following-
- History- hypertension, family history (father) of colorectal cancer.
- Screening- Faecal Occult Blood Test (FOBT) attended 2 and a half years ago, result negative.
- General appearance– no evidence of jaundice, some palor present
- Physical Examination- Vital signs: BP- 145/82; P- 82; Temp- 36.9; RR- 26
- Abdominal examination- inspection- evidence of abdominal distention (this is consistent with Betty’s reports of bloating); palpation- reveals a small firm mass in lower left quadrant of abdomen, possibly faeces; some tenderness over lower left quadrant on deep palpation; ausculation- normal bowel sounds present in right upper and lower quadrants, but slightly diminished in left upper and lower quadrants; percussion- localised tenderness over lower left quadrant; nil evidence of hepatamegaly or spenomegaly; nil evidence of abdominal ascites.
- Rectal examination- presence of formed stool in lower rectum, haemorrhoid visible on exterior peri-anal region.
After the physical examination, Dr Glasson tells Betty that further tests are needed to determine the cause of Betty’s symptoms. Dr Glasson draws blood for pathology testing. The following pathology tests are ordered and Betty is sent for a CT Scan.
- Pathology- Full Blood Count- White blood cell count; Red blood cell count (including Hct and Hb); platelets; Urea and electrolytes (U & E); Liver function test (LFT); Carcinoembryonic antigen (CEA)- for baseline tumor marking.
- CT Scan- CT of chest, abdomen and pelvis
Pathology tests are mostly unremarkable except for Hb- 110 g/L and CEA- 5.5mcg/L.
Betty returns to Dr Glasson accompanied by her husband Bob to receive what she expects to be bad news regarding the tests she has had done. Consulting Betty’s results, Dr Glasson reveals that Betty’s CT Scan shows a small lesion in her lower bowel and the descending part of her large bowel (colon), which is likely cancerous, and that her pathology results reveal mild anaemia, most likely as a result of the tumour in her colon.
She also advises that the raised CEA level is also suggestive of colorectal cancer. Betty is visibly distressed by this news, clutching on to Bob for support. Dr Glasson spends some time reassuring Betty and Bob that diagnosis needs to be confirmed by Colonoscopy and biopsy of the lesion. Focusing on the positives of results that these indicate early diagnosis highlighting statistics of successful treatment in the early stages. She also reassures Betty that there is no indication at this stage that the tumour has spread. Betty is referred to a general surgeon for an urgent Colonoscopy and Flexible Sigmoidoscopy
Upon consultation with a general surgeon, Betty is booked into day surgery for a colonoscopy and flexible sigmoidoscopy. 3 days before her colonoscopy Betty very carefully follows the dietary restrictions and starts to prepare for her surgery by drinking her bowel prep (PicoPrep).
On the day of her colonosopy, Betty is very anxious about what this might show. Bob accompanys Betty to the day surgery unit. The colonoscopy, flexible sigmoidoscopy and biopsy of the lesion proceed without any complications and Betty is instructed to followup with Dr Glasson for the results.
Results of Betty’s Colonosocpy confirm presence of adenomcarcinoma of the descending colon.
Betty returns to her GP, Dr Glasson to receive the results of her colonoscopy. Betty’s worst fears are confirmed and she is told she has adenocarcinoma of the descending colon and that further consultation has been arranged with the general surgeon to undergo excision of the tumour.
Betty undergoes a Left Hemicolectomy with successful excision of lesion and re-anastomosis of the colon.
Betty is nursed in the hospital’s High Dependency Unit overnight. A PCA of morphine manages her pain effectively, however, the side effects of this soon make her feel unwell and she suffers severe post operative nausea and vomiting (PONV). Betty remains in hospital for 5 days following her surgery. Once her nausea and vomiting settled she had an uncomplicated recovery.
Post surgery, Betty is referred to a medical oncologist for adjuvant chemotherapy.
athological examination of biopsy from Betty’s colonoscopy and excsion reveal moderately differentiated Adenocarcinoma of descending colon, stage 3A (Duke’s C).
Betty sees the medical oncologist and chemotherapy is scheduled to commence the following day.
After consultation with the medical oncologist, a treatment regime is put into place for Betty.
Her treatment includes FOLFOX6: Oxaliplatin, Leucovorin (in oncology over 4 hours), and Fluorouracil (over 2 days via a pump at home). Her cycle of treatment is every 14 days and 12 cycles of treatment recommended. Betty is given a Chemotherapy Patient Information guide that outlines her treatment and what to do if she has side effects of her treatment.
Following each treatment, Betty experiences severe nausea and vomiting, sore mouth, fatigue and episodes of diarrhea.
Betty has been following the protocol of taking her temperature each day in order to monitor for infection. She has been advised that during chemotherapy the usual signs and symptoms of infection could often be often absent because the treatment commonly affects the immune system, which therefore does not display the normal signs of infection such as redness, pus, pain, etc. However the presence of infection willdisplay as an increase in temperature.
On day 9 post cycle three of her chemotherapy Betty’s temperature has risen to 38.6oC. As she has been instructed, she waits 20 minutes and takes her temperature again. The reading has increased to 38.9oC. Betty’s husband Bob, calls the chemotherapy unit. Bob is advised to take Betty straight to their local hospital.
On arrival, Betty identifies herself as a chemotherapy patient. She is admitted and a series of tests is undertaken to identify the source of infection. Betty is found to have a urinary tract infection. A course of the appropriate antibiotics is begun, together with close monitoring.