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RECTAL CANCER
Case Study
By:
To:
Patient is 58 years old, Filipino, female, married, Roman Catholic who was
diagnosed with Rectal Cancer Stage IV with metastasis on the liver, lung and bone.
According to the patient, she has been hypertensive and was taking Amlodepine
10 mg/tab once a day, as maintenance medication. Both of her parents died due to
stroke. Patient stressed that her mother has symptom such as difficulty in defecating. No
known familial history of cancer. However, some of her siblings have hypertension.
It was noted during the interview that she had difficulty in defecating and whenever
she’s constipated, she took Dulcolax 5mg 1 tab as needed at home.
Overview
Rectal cancer was usually associated with colon cancer, it was known as
Colorectal Cancer (CRC). It became the third most commonly diagnosed cancer in male
and second in female in the world. The American Cancer Society identified that there are
approximately 140,250 new diagnosed cases of large bowel cancer; 43, 030 new cases of
rectal cancer and the remaining were colon cancer. It is expected to cause death for
about 50,630 in the United States for as of this writing [1]. In the Philippines, colorectal
cancer became the number 1 gastrointestinal cancer surpassing liver cancer. Over 3,000
of new cases annually among Filipino were reported and over 2,000 of which die [2].
Figure 1: Human Anus Anatomy Rectum Anatomy and Rectum Function. Differentiate Anus Vs Rectum -
Anatomy Sciences. (2018). Retrieved from http://anatomysciences.com/human-anus-anatomy/human-
anus-anatomy-rectum-anatomy-and-rectum-function-differentiate-anus-vs-rectum/
The rectum is the concluding part of the large intestine, immediately following the
sigmoid colon, and ends the anus. The average length of the human rectum may range
between 10 and 15 cm. Its diameter can be linked to that of the sigmoid colon at its
beginning. Though, it becomes bigger near the anus, where it forms the rectal ampulla.
Rectal ampulla acts as a temporary storehouse of feces. The expansion of the rectal walls
causes the stretch receptors within the walls to stimulate the urge to defecate. When the
storage site becomes full, the intra-rectal pressure causes the anal canal walls to dilate
and expand. This results in the feces entering the canal.
Age is a major risk factor for sporadic CRC, more than 90% of the people
diagnosed with the disease are older than 50.
Approximately 20% to 25% of cases who have family history of the disease
suggesting a hereditary disposition. Actually, 85% of the CRCs coin from adenocarcinoma,
which accounts for adenomatous polyps [4]. Common variations of adenomatous
polyposis syndromes are familial adenomatous polyposis (FAP), MUTYH-associated
polyposis (MAP) and Lynch syndrome or Hereditary Non-Polyposis Colorectal Cancer.
Patients with continuing inflammatory bowel disease (IBD) have a higher possibility of
CRC. In fact, CRC accounts for 1/6th of ulcerative colitis (UC)-related deaths and 1/12th of all
deaths in patients with Crohn's disease [5].
Numerous studies shown that diabetes has a direct relationship between CRC
incidences. The increase of insulin concentration and insulin-like growth factor (IGF)-1
levels, increase of glucose (hyperglycemia), and prolonged exposure of the colorectal
mucosa to fecal bile acids (due to constipation) all play an important role in colorectal
carcinogenesis [6]. A meta-analysis study also exhibited that there is a higher possibility of
CRC in people who have DM in non-DM subjects by 35% [7,8].
According to the research, low socioeconomic plays a vital role as risk for having
CRC as there is an approximately 30 percent compared to people with high SES quintile.
Potentially variable behaviors such as physical inactivity, unhealthy diet, smoking, alcohol
and obesity are believed to account for a considerable proportion [9].
2. Nutritional-Metabolic Pattern
“Eats more vegetables and
a) Describe your typical daily food fish. 0-2 times a week red
“No raw foods”, as
intake? Do you consider yourself a meat, twice a week
healthy eaters? verbalized.
processed food for
breakfast”, as verbalized.
b) Describe your typical daily fluid “I am fond of drinking “Same as before”, as
intake? water”, as verbalized. verbalized.
8. Roles-Relationships Pattern
“With my family. My
a) Who do you live with? Alone,
siblings and I were close “With my family”, as
family, others? What was the
structure in which you grew up?
since we grew up verbalized.
together”, as verbalized.
9. Sexuality-Reproductive Pattern
a) How would you describe your No problem. She tried pills
sexual relationship? Satisfying? for a month when they No sexual activity/contact
Changes? Problems? were younger.
b) Describe menstruation cycle. Menarche – 12 years old
Problems? Last menstrual period? Menopause – 55 years old Menopause
Para? Gravida? G6P6
10. Coping-Stress Tolerance Pattern
Yes, adjusting to the
a) Any big changes in the past “Yes, when I knew about therapy. She shared that
year or two? my illness “, as claimed. she skipped a cycle due to
anxiety.
b) Who is most helpful in talking
“My husband and God”, as
things over? Are the frequently “My family”, as claimed.
available to you?
claimed.
Fecal Occult
Blood Test
Early stage Late Stage
Usually NO S/Sx Manifestations
Chemotherapy
Black streaked and
Rectal Pain Constipation narrowed stool
Loss of and rectal bleeding
Nausea
appetite
Dolcet 37.5
Dulcolax 5mg Hemostan
mg/325mg/tab
Collaborate Plasil 2 tabs OD 500mg/cap PO q8h
with 10mg/tab 1 tab PO TID
dietician PO TID
The nursing profession recognizes colon and rectal cancer as an altered life
process that affects the regulation, perception, and cognition of the client. Colon cancer
is categorized from stage I through stage IV, depending on how far the cancer
penetrates the mucosal layer and whether it spreads into surrounding organs. There are
a number of treatment options for colon cancer: surgery, chemotherapy, and radiation
therapy, all of which have unpleasant side effects. In line with the theory of unpleasant
symptoms which states that patients perceive illnesses and challenging treatments as
clusters of noxious symptoms that both individually and jointly impact their experience
of illness, their emotional distress, and their functional abilities, this patient’s case can be
related to this theory due to the number of symptoms the patient experiences between
the disease and the treatment options. There are a number of ways to aesthetically
describe the experience of colon cancer and how it affects her physically, emotionally,
spiritually and psychologically.
Worldwide, the majority of cancer patients are in advanced stages of cancer when
first seen by a medical professional. For them, the only realistic treatment option is pain
relief and palliative care. Effective approaches to palliative care are available to improve
the quality of life for cancer patients. Effective public health strategies, comprising of
community and home-based care are essential to provide pain relief and palliative care
for patients and their families in low-resource settings. There are great differences in
availability and development of palliative care around the world.
Palliative care focuses on improving the quality of patients’ lives by solving
problems caused by disease progression including addressing the physical complications
and symptoms it causes, pain relief, psychological support to patients and their families
and caregivers. It is carried out by a multidisciplinary team that includes physicians,
pharmacists, nurses, chaplains, social workers, psychologists, etc. Focus is instead on
relieving pain and other symptoms.
APPENDICES
a. Physical Examination and Health History Forms Used
3. Provided Decreases
quiet external
environment, stimuli, which
calm activities, may
and comfort aggravate
measures anxiety and
(e.g., dry/ cardiac strain
wrinkle—free and limit
linens, coping
backrub). abilities and
Approach the adjustment
patient calmly to current
and situation.
confidently
Helpful in
4. Assisted and decreasing
instructed in perception
relaxation of/ response
techniques, to pain.
e.g, deep/ slow Provides a
breathing, sense of
distraction having some
behaviors, control over
visualization, the situation,
guided increase in
imagery. positive
attitude.
Research
5. Evaluated shows that
the the most
effectiveness common
of the pain reason for
control unrelieved
measures pain is failure
through to routinely
ongoing assess pain
assessment. and pain
relief.
Dolcet is
6. As ordered, used for
Administered moderate to
Dolcet 1 tab severe pain.
PO Q8 PRN for It works by
pain works in the
brain to
change how
the body
feels and
responds to
pain,
increasing
the pain
threshold and
increases the
blood flow
across the
skin.
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
4. Avoiding
gas- Decreases
forming gastric
foods was distress and
recommend abdominal
er. distention.
5. Encouraged
To enhance
to eat high-
easy
fiber rich
defecation.
foods.
6. As ordered,
Dulcolax is a
administered
known
dulcolax tab
stimulant
PO as ordered
laxative. It
works by
increasing
the
movement of
the
intestines,
helping the
stool to come
out.
7. Consulted
Fiber resists
with dietitian
enzymatic
to provide
digestion and
well- balanced
absorbs liquid
diet high in
in its passage
fiber and bulk. along the
intestinal
tract and
thereby
produces
bulk, which
acts as a
stimulant to
defecation.
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
5. Weigh at Monitors
regular effectiveness
intervals and of dietary
document plan.
results.
6. Collaborate To have an
with dietitian accurate
and nutritional dietary
support team intake for
long term
needs.
Commented [n1]: Tables are too compressed. Hard to read and
e. Drug Study understand.
DRUG DRUG ACTION INDICATI SIDE EFFECTS NURSING
NAME CLASS ON MANAGEMENT
RELATED TO
PT.’S DISEASE
5 FU Antineoplas Antimetabo Usually Common: Patient is
FLUOROUR tic; lites are cell- used for - Diarrhe diagnosed
ACIL 500mg Cytotoxic specific. The the a having Rectal
IV and Chemothera basic work treatmen - Nausea Cancer Stage III.
1000mg IV py drug; of this drug t of - Vomitin She was
in D5 W 1L x Antimetabo is to tumors g administered
22H lites damage the and - Mouth with
RNA and different sores Fluorouracil as a
DNA that kinds of - Poor chemotherapy
tells the cell cancer appetit drug currently
how to such as e on her 2nd
copy itself Colon - Metallic session.
in the and taste Management
division Rectal - Vein are as follows:
phase. It is cancer discolor - Instructe
classified as which is ation d the
pyrimidine specifical on IV patient
analog due ly site to
to its diagnose - Low increase
interference d in the blood fluid
with the patient. counts intake as
DNA and Delayed the drug
RNA effects: may
synthesis - Hair cause
done by thinnin dehydrat
mimicking g ion due
the building - Nail to
blocks discolor diarrhea,
necessary ation nausea
for - Hand- and
synthesis. foot vomiting
syndro .
me - Advised
- Skin the
reactio patient
ns to
(peelin consume
g, ice chips
rashes, prior IV
dry, treatme
crackin nt to
g) prevent
mouth
sores
and after
to
prevent
nausea
and
vomiting
.
- Instructe
d patient
to get
plenty of
rest,
maintain
good
nutrition
as
prescrib
ed by
the
dietician
and try
to do
simple
exercise
s to
boost
the
energy
and
immune
system.
- Instructe
d patient
to limit
crowded
areas to
prevent
accumul
ation of
infection
.
DRUG DRUG ACTION INDICATION SIDE EFFECTS NURSING
NAME CLASS MANAGEMENT
RELATED TO PT.’S
DISEASE
LEUCOVOR Reduced It is a folic -It is used in Its side effects Patient is
IN 300mg folic acid with combination are oftentimes diagnosed having
in D5 W x acid; added with attributable to Rectal Cancer
2H Chemo- vitamin Fluoruracil that of Stage III. She was
protecta which to treat Fluorouracil or administered with
nt enhances cancers any other Leucovorin
the such as; chemo drug combined with
binding of colon and when used in Fluorouracil as a
Fluoroura rectal combination. chemotherapy.
cil to an cancer. Common: Management are
enzyme -As an - Allergic as follows:
inside of antidote to reaction - Instructed
the effects of s the patient
cancer certain (rashes, to increase
cells. As a chemothera itchines fluid intake
result py drugs s, facial as the
fluoroura such as flushing drug may
cil may Methotrexa ) cause
stay in the te. - Nausea dehydratio
cancer -Treatment and n due to
cell of vomitin diarrhea,
longer megaloblast g nausea
and exert ic anemia and
its when folic vomiting.
anticance acid - Instructed
r effect deficiency is patient to
on the present. get plenty
cells. of rest,
maintain
good
nutrition
as
prescribed
by the
dietician
and try to
do simple
exercises
to boost
the energy
and
immune
system.
3. Rectum Anatomy, Diagram & Function | Body Maps. (2018). Retrieved from
https://www.healthline.com/human-body-maps/rectum#1
4. Dove-Edwin, I., Sasieni, P., Adams, J., & Thomas, H. (2005). Prevention of
colorectal cancer by colonoscopic surveillance in individuals with a family history
of colorectal cancer: 16 year, prospective, follow-up study. BMJ, 331(7524), 1047.
doi: 10.1136/bmj.38606.794560.eb
5. Jess, T., Rungoe, C., & Peyrin–Biroulet, L. (2012). Risk of Colorectal Cancer in
Patients With Ulcerative Colitis: A Meta-analysis of Population-Based Cohort
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10.1016/j.cgh.2012.01.010
6. Luo, S., Li, J., Zhao, L., Yu, T., Zhong, W., & Xia, Z. et al. (2016). Diabetes mellitus
increases the risk of colorectal neoplasia: An updated meta-analysis. Clinics And
Research In Hepatology And Gastroenterology, 40(1), 110-123. doi:
10.1016/j.clinre.2015.05.021
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10.1038/sj.bjc.6604917
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https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-
staging/survival-rates.html