GP with some uncomfortable symptoms

Betty has been recently diagnosed with Colorectal cancer. We meet Betty as she presents to her GP with some uncomfortable symptoms and follow her journey as she undergoes screening, diagnosis and treatment for bowel cancer. Follow Betty’s story as she deals with many issues associated with cancer including complications of treatment and cancer survivorship.

Betty’s story is the first scenario that you will engage with during your progress through the unit. Betty’s story is designed to prepare you for working with the person with a complex cancer diagnosis, and takes a focus on the pathophyisology of cancer, treatment options, assessment of symptoms associated with bowel cancer, prevention, public health and health promotion as well as the interprofessional management of the person with a complex disease.

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
Physical examination

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; auscultation- 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 splenomegaly; nil evidence of abdominal ascites.
  • Rectal examination- presence of formed stool in lower rectum, haemorrhoid visible on exterior peri-anal region.

Diagnostic tests

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.

Followup after diagnostic tests

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.

apply an understanding of cancer pathophysiology, diagnosis, aetiology and common treatment options;

Task

This task relates to the underlying physiology of the case study ‘Betty’. Pathological examination of biopsy from Betty’s colonoscopy and excision reveal moderately differentiated Adenocarcinoma of descending colon, stage 3A (Duke’s C).

Discuss the following in relation to this case study:

  • Succinctly discuss the pathophysiology of cancer tumours (Approx 250 words)
  • Discuss the pathophysiology of colorectal cancer disease in relation to a biopsy result of a moderately differentiated adenocarcinoma grade 3 (Approx 250 words)
  • Discuss ONE of the three pharmacological components of the FOLFOX treatment regime. Link your discussion to the relevant pathophysiology of bowel cancer (Approx 250 words)