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38688220 a Case Study on Rectal Adenocarcinoma

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   A Case Study on Rectal Adenocarcinoma 1 I. INTRODUCTION Rectal cancer may be of the adenocarcinoma type and usually arise from the epithelium (the layer of cells) which lines the large intestine. The colon is part of the large bowel. The large bowel starts at the end of the small bowel (the ileum), at the caecum. The caecum has the appendix running off it. The start of the colon is the ascending colon and where this rises to meet the liver (the hepatic flexure) it becomes the transverse colon. The transverse colon goes across the upper abdomen until it becomes adjacent to the spleen (the splenic flexure) and at this point it becomes the descending colon. The large bowel at this point goes down the abdomen to the pelvis at which point it becomes the sigmoid colon (because it curves in an S shape, sigma being the Greek for S ). The sigmoid colon terminates at the rectum, which acts as a storage pouch for feces before it is evacuated through the anus. Overall, the function of the large bowel is to absorb water from stools. When the ileum enters its contents into the caecum, they are extremely liquid and gradually solidify as the contents progress around the large bowel. Rectal cancer is common but occurs very rarely in young adults. Rectal cancer becomes more common as age increases. People in their 50s, 60s and 70s are most at risk with sex incidence being slightly more common in females. Geographically, the rectal cancer tumor is found worldwide, but rectal cancer is most common in areas   A Case Study on Rectal Adenocarcinoma 2 which have low fiber diets. Areas of the world with high fat consumption and low fiber consumption such as Europe, USA and Australia. Furthermore, in the Philippines, 75% of all cancers occur after age 50 years, and only about 3% occur at age 14 years and below. If the current low cancer prevention consciousness persists, it is estimated that for every 1800 Filipinos, one will develop cancer annually. At present, most Filipino cancer patients seek medical advice only when symptomatic or at advanced stages: for every two new cancer cases diagnosed annually, one will die within the year. It is estimated that 30  – 50% of cancer patients in all stages of the disease will experience pain and 70  – 95% with advanced disease will have significant pain, but only a fraction of these patients receive adequate treatment. In a study on cancer pain among Filipino patients, 73% had pain related to their disease, 60% of which was persistent (43). Causative Factors:    Hereditary Conditions:  At particularly high risk of Rectal cancer are people with hereditary conditions such as Familial Adenomatous Polyposis or Hereditary Non Polyposis Colorectal Cancer. In these conditions, it can occur even in young adults, e.g. late teens and early 20s.    Family History of Rectal Cancer:  First degree relatives of patients with rectal cancer have an increased risk, particularly if the relative develops rectal cancer at a young age.    Polyps:  Certain types of polyps, notably villous adenomas have a potential to become malignant. Rectal cancer patients who have previously had a polyp in the large bowel should undergo regular  colonoscopy (ask your doctor how often).    Inflammatory Bowel Disease:  Patients who suffer from ulcerative colitis, have approximately a tenfold risk of developing the disease and should have a colonoscopy carried out regularly.    Diet:  A high fat, low fibre diet, especially if high in red meat, is the worst diet that predisposes people to rectal cancer. People who suffer from obesity are also at an increased risk. The rectal cancer tumor spreads by invading the bowel wall. Once it crosses through the muscle layer within the bowel wall, it enters the lymphatic vessels, spreading to local and then regional lymph nodes. Sometimes rectal cancer spread via the blood stream to the liver, which is the most common area of metastasis from this tumour. Other organs that may be affected by blood borne spread are the lungs, less often the bones, and even less often the brain. If a lot of tumor cells get through the bowel wall, they tend to float around as a small amount of fluid within the abdomen and can seed the covering of   A Case Study on Rectal Adenocarcinoma 3 the bowel (peritoneum). This type of seeding produces small nodules throughout the abdomen which irritates tissues and causes the production of large amounts of ascites (fluid). Direct spread from the rectum may attach the tumor to the bladder in males and cause fistulas. In females it may invade the vagina or adjacent pelvic organs. Virtually all adenocarcinomas develop from adenomas. In general, the bigger the adenoma, the more likely it is to become cancerous. For example, polyps larger than two centimeters (about the diameter of a nickel) have a 30-50 percent chance of being cancerous. You can learn more about polyp size and colon cancer risk by viewing the Polyp Size Gallery. By the time colorectal cancer is diagnosed, it has often been growing for several years, first as a non-cancerous polyp (adenoma) and later as cancer. Research indicates that by age 50, one in four people has polyps. General investigations into rectal cancer may show anaemia or an abnormal liver function test. The blood albumin level may be low (Albumin is produced mainly in the liver. It helps to keep the blood from leaking out of blood vessels. When albumin levels drop, fluid may collect in the ankles, lungs, or abdomen). If liver involvement is severe the clotting profile will be abnormal with a raised INR. The rectal cancer symptoms that may require attention are fatigue from anaemia and the feeling of tenesmus (wanting to open the bowels when there is no stool there can be particularly distressing, especially when it is painful). Rectal cancer patients may require treatment for visceral pain from liver metastases and less commonly for somatic pain from bone metastases. If lung metastases are present there may be pleural effusions causing breathlessness. Effusions may require drainage. The scope and limitation of this case study was only during the hospitalization of the patient right after his surgery, which was during our first week of duty on September 17-18, 2010. We then gather the necessary information for this case study possible. Furthermore, the group decided to choose this case to be presented in our clinical instructor for this is new and interesting problem, as far as we were exposed to the clinical area. In addition to that, our kind clinical instructor also suggests having this as our case.   A Case Study on Rectal Adenocarcinoma 4 II. GOALS AND OBJECTIVES General Objectives: To provide the students a guide line in caring for people with Rectal  Adenocarcinoma using the nursing process appropriately and effectively. To give information on the readers about the nature and the extent of well differentiated adenocarcinoma rectum disease. Lastly, to provide the general public of the new developments in nursing care in regards of treating the disease condition. Specific Objectives:  At the end of this study, we, the student nurses of this institution, will able to: 1. Define and identify the probable causative factors of adenocarcinoma rectum 2. Trace the anatomy and physiology. 3. Assess the nursing history of the patient. 4. Identify the signs and symptoms of the underlying disease. 5. Formulate the nursing care plan, to achieve the maximum wellness of the patients well as awareness on the part of the significant others. 6. To provide health teaching to the patient and significant others to improved the former condition and prevents complication.
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