Question #7, part A

Colon

cancer can be treated with surgery alone, or with a combination of surgery and chemotherapy. Surgery is used to cure local or encapsulated tumors, the entire diseased area is removed and no further treatment is necessary. Surgery is also used as a palliative treatment to debulk tumors causing symptoms from obstruction or compression when a surgical cure is not expected. Surgical intervention also allows for lymph node removal and biopsy, which are used for staging of the tumor. Tumor staging is essential and guides which treatment modalities will be used. Tumors are staged and graded 0 – IV, depending on the size of the tumor, existence of metastasis and differentiation of the tumor cells. (Smeltzer & Bare, 1992) Patient prognosis becomes poorer as the disease progresses through the stages. In stages 0 & I, surgical intervention is curative and is the only treatment needed. In stage II tumors, surgical resection is usually the only treatment needed; but it may be advantageous to add chemotherapy to prevent reoccurrence. Stage III tumors are poorly differentiated, involve surrounding tissue and have lymph node involvement. Surgical intervention is followed by chemotherapy. Surgery removes as much of the tumor as possible and chemotherapy is used to destroy any remaining cell and metastasis. Stage IV tumors are poorly differentiated, there is a progressive increase in size of the tumor with invasion into surrounding tissue, increased involvement of lymph nodes and metastatic disease. Surgery at this point is used to relieve symptoms. Chemotherapy is also used to treat stage IV tumors. Symptoms such as pain, bleeding and infection are caused when the increasing size and involvement of the tumor causes compression, obstruction or ulcerations. Surgery at this stage is palliative with the goal of relieving symptoms and improving quality of life. Surgery is not done with the expectation of curing the cancer. Stage IV tumors have a very poor prognosis. (colonsurgeryinfo.com, 2008)

In

summary, Surgery is always advantageous for colon cancer. It is curative for localized tumors, it is used for palliative care in extensive tumors, and all colon cancers need surgical intervention for staging and grading to determine treatment. Chemotherapy is required to treat dissemated disease. It helps shrink tumors and relieve symptoms of advanced disease. Chemotherapy is a systemic treatment. It can have effects on any body system, causing a wide range of side effects. Nausea, vomiting, anemia, renal failure, infertility and heart failure are some of the commonly seen side effects of chemotherapy. (Smeltzer&Bare, 1992) Although the side effects are a disadvantage to the use of chemotherapy, it is a highly necessary treatment in conjunction with surgical intervention.


Question 7,Part B

A

hemicolectomy is the removal of the tumor, some surrounding tissue and some lymph nodes. Mr. Jamison’s tumor was well differentiated and localized; therefore surgical removal of the entire tumor is curative. There was no lymph node involvement and no metastasis so chemotherapy and radiation are not indicated.

The

additional tissue and lymph nodes were removed for tumor staging and grading. We are looking to see if the cancer has spread. The tissue is examined to see if there is invasion by the tumor into surrounding tissue, and lymph node involvement. Lymph node involvement indicates metastasis. Lymph node involvement would make for a poorer prognosis. If lymph nodes had been involved, chemotherapy would have been added to his treatment plan to treat disseminate disease.




Question 8
FOBT

Hidden

blood in the stool is often the first sign of colon cancer. Some tumors or polyps cause a small amount of bleeding in the bowel. This blood is passed in the stool, but is not visible to the eye. The Fecal Occult Blood Test is a screening tool used by health care providers to test for hidden or occult blood in the stool. This is a noninvasive, low cost test. It is nonspecific in that it indicates bleeding in the GI tract, but does not show the source of the bleeding. Bleeding could have occurred anywhere in the GI tract: the mouth, esophagus, stomach or intestines. Further workup is required if a positive result is obtained. Colonoscopy is usually recommended.

There

are two types of FOBTs available. The first is the traditional quiac smear test. A small amount of stool is placed on a slide, and then a drop of developer is applied. If the result is positive, the clear developer will change to a blue color indicating the presence of blood in the stool. A negative result will have no color change. This test is completed and interpreted by a medical professional in a hospital, doctor’s office or lab. The second type of FOBT is available to consumers in drug stores. It is a flushable regent pad. While this test is convenient to the public, studies have shown the quiac tests done by health care providers to be a more reliable indicator for cancer screening. (NIH/Medline, Leher, 2006) The American Cancer Society recommends screening beginning at age 50, and requires three days of serial testing. (Smeltzer&Bare, 1992)


SIGMOIDOSCOPY AND COLONOSCOPY

Sigmoidoscopy

and Colonoscopy are endoscopic procedures. They allow for direct visual examination of the colon. A Sigmoidoscopy is a lighted scope, which allows inspection of the lower 1/3 of the colon. There are two types of sigmoidoscopes. A rigid sigmoidoscopy allows inspection of the anus, rectum and 25cm of the lower sigmoid colon. A flexible sigmoidoscopy allows inspection of up to 50cm of the lower colon. A colonoscopy is a flexible, fiber optic, lighted tube that contains a small camera. Colonoscopy examines the entire length of the colon. Indications for colonscopy and sigmoidoscopy are rectal bleeding, anemia, positive FOBT, abdominal pain, change in bowel habits or weight loss. Both tests are used to look for early signs of cancer. The health care provider examines the rectum and colon for inflammation, ulceration, tumors and polyps. Biopsy and polypectomy can be performed during both sigmoidoscopy and colonoscopy. (NIH/Medline, Leher, 2006)