Review the following case and answer the questions that follow. Collaborate with other classmates. Be sure to ask them questions that will help to keep the conversation going. You may need to do some outside research, but put your answers in your own words.
Chief Complaint: 65-year-old woman with a loss of appetite, abdominal cramps, constipation, and blood in her stool.
History: Delores Murphy, a 65-year-old white female, was in good health until about 6 weeks ago, when she noted occasional cramps in the left lower quadrant of the abdomen associated with constipation. The episodes of cramping last about 30 minutes each and are most severe in the hour following her meals. She has taken laxatives which have partially relieved her symptoms, but she has had a decreased appetite and 12-pound weight loss over the past four weeks. In addition, she has become increasingly fatigued over this period. When questioned about her bowel habits, she reported bright red blood in her stools and a smaller caliber (i.e. diameter) of stool over the past two weeks.
Physical Examination: She appeared fatigued and distressed. Head and neck exams were normal, as was her thorax. Palpation of the abdomen revealed a 10 x 10 cm mass and tenderness in the left lower quadrant. Percussion over this area revealed a hollow, tympanic sound. Hepatomegaly was noted, and a hard and slightly tender liver edge was felt in the right upper quadrant. Bowel sounds were noticeably reduced. A stool sample was tested with Guaiac paper and was positive for blood.
After extensive testing, Delores is told that she has colon cancer and that the cancer has already metastasized. She is told that her best chance for a cure is via surgery, followed by chemotherapy.
- What symptom do you think was the most alarming and why?
- What does it mean that the cancer has metastasized?
- Based on the exam, what other organs may be affected?
- What is her possible prognosis (support your answer by research and listing a reference in APA style)?
Expert Solution Preview
Introduction:
The following case highlights a 65-year-old woman who presents with gastrointestinal symptoms and is later diagnosed with colon cancer. This case study is important to medical students as it allows them to understand the presentation and evaluation of colon cancer, the significance of metastasis, and the possible prognosis of colon cancer.
1. What symptom do you think was the most alarming and why?
The most alarming symptom reported by the patient was the presence of blood in her stools. Hematochezia or the presence of bright red blood in stools is an alarming symptom as it indicates that the bleeding is occurring somewhere close to the anus or rectum. Blood in stools can be a sign of gastrointestinal bleeding, which may be caused due to various reasons, including tumors, inflammation, or infections. Colon cancer is one of the most common causes of gastrointestinal bleeding in older adults; hence the presence of blood in stools should raise concern regarding colon cancer.
2. What does it mean that the cancer has metastasized?
Metastasis means that the cancer has spread from its primary site (colon in this case) to other parts of the body. In colon cancer, the cancer cells may break away from the primary tumor (colon) and travel to other parts of the body through the lymphatic system or bloodstream. The most common sites of metastasis in colon cancer are the liver, lungs, and bones. Metastasis significantly affects the patient’s prognosis and can make treatment and cure more challenging.
3. Based on the exam, what other organs may be affected?
Based on the exam, the other organs that may be affected include the liver. The presence of hepatomegaly and a tender liver edge felt in the right upper quadrant suggests that the cancer may have spread to the liver. In colon cancer, the liver is the most common site of metastasis.
4. What is her possible prognosis (support your answer by research and listing a reference in APA style)?
The prognosis of colon cancer depends on various factors, including the stage of cancer, grade of cancer, patient’s age, gender, and overall health. In general, the earlier the diagnosis and treatment, the better the prognosis. However, in this case, the cancer has already metastasized, indicating an advanced stage of cancer. According to the American Cancer Society, the 5-year relative survival rate for patients with distant colon cancer (cancer that has spread to other parts of the body) is around 14% (American Cancer Society, 2021). Therefore, the possible prognosis for this patient may not be favorable, and aggressive treatment measures will be required.
Reference:
American Cancer Society. (2021). Survival rates for colorectal cancer. Retrieved from https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/survival-rates.html
