Colorectal Cancer

Patient Presentation:
D.H. is a 54 year old, female who initially presented to her primary care physician with complaints of abdominal pain, decreased appetite and weight loss over the past 3 months.  Additionally, the patient has experienced some changes in her bowel pattern and recently started having frequent episodes of blood in the stool.  D.H.’s hemoglobin and hematocrit were both low at 10.5 gm/dL and 32.9%, respectively.  Her past medical history includes hypertension and type 2 diabetes.

Differential List:
Diverticulosis/diverticulitis; inflammatory bowel disease (e.g. Crohn's disease or ulcerative colitis); colorectal cancer

Diagnosis/Prognosis:
A colonoscopy was performed and tissue samples of polyps were obtained and sent for biopsy.  Biopsy findings confirmed adenocarcinoma of the ascending colon and it was determined that D.H. would need to undergo surgery for resection of the tumor.

CRC is the third most common cancer in both men and women and incidence increases with age.  Since this trend is observed, CRC screening is recommended in adults over age 50.  CRC screening involves getting a colonoscopy completed every 10 years.  However, adults who have a family history of CRC should begin this screening at a younger age and should have a colonoscopy completed more frequently than every 10 years.  Surgery is the primary method of controlling CRC, and depending on the staging of the tumor, chemotherapy may or may not be recommended.

Treatment:
D.H. underwent a right hemicolectomy with anastamosis and was admitted to a surgical oncology floor for recovery.  Since her surgeon was able to reattach her colon, D.H. did not need a colostomy to be constructed.  The excised tumor was sent to pathology and revealed a grade I tumor.

Postoperatively, her pain was managed with a fentanyl PCA for pain control.  Patient was initially NPO except for medications when she returned from surgery and was on IV fluids and prophylactic antibiotics.  She was on PO Entereg® to rest and repair the bowel after surgery and was on IV Protonix® to prevent development of a stomach ulcer.  She was also on subcutaneous heparin to help prevent postoperative blood clots.

Over the course of the patient’s hospitalization, D.H.’s bowel function returned.  She was started on a clear liquid diet once she began passing gas and was advanced to a medium consistent carbohydrate diet once she had a bowel movement.  At this time, the Entereg® and fentanyl PCA were discontinued and D.H. was started on PO Percocet® for pain.  Any episodes of hyperglycemia were treated using low dose sliding scale insulin.

Outcome:
Patient was discharged home on a diabetic diet with instructions to follow up with her surgeon in 2 weeks.  She was given prescriptions for Percocet® and Colace®.  She was advised to avoid any heavy lifting and to continue with activity as tolerated.  Patient was also instructed to call her doctor if she began experiencing any signs or symptoms of infection (fever, chills, redness or cloudy drainage from incision).  Chemotherapy was not indicated at this time.