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Adenocarcinoma of the Colon

Colon Adenocarcinoma


Presentation

  • We present 4 adolescents with an average age of 15 years who present with several month histories of significant weight loss and abdominal pain. All had an abdominal and pelvic computed tomography scan, which revealed an adenocarcinoma in the colon.[ncbi.nlm.nih.gov]
  • Colorectal cancer usually presents with alterations in the bowel habit. Less commonly, the presenting symptoms may be part of a paraneoplastic syndrome.[ncbi.nlm.nih.gov]
  • One year later, the patient presented with extensive intra-abdominal lymphadenopathy and peritoneal carcinomatosis, as well as a markedly elevated serum level of alpha-fetoprotein (AFP).[ncbi.nlm.nih.gov]
  • We conclude that any child presenting with unexplained persistent constipation, abdominal distension or bleeding per rectum, colon cancer should be suspected and investigated with endoscopy or barium enema.[ncbi.nlm.nih.gov]
  • Pulmonary hypertension, present in our patient, and cor pulmonale are well described in association with diffuse pulmonary tumor microemboli.[ncbi.nlm.nih.gov]
Weight Loss
  • On admission, symptoms were dominated by overall dysphagia, patient showing a weight loss of 10 kg for the last 30 days. Preoperative imaging tests did not revealed regional or distant metastatic disease.[ncbi.nlm.nih.gov]
  • We present 4 adolescents with an average age of 15 years who present with several month histories of significant weight loss and abdominal pain. All had an abdominal and pelvic computed tomography scan, which revealed an adenocarcinoma in the colon.[ncbi.nlm.nih.gov]
  • When the tumor is in the right colon, the patient may complain of vague cramping or aching abdominal pain and report symptoms of anorexia, nausea, vomiting, weight loss, and tarry-colored stools.[medical-dictionary.thefreedictionary.com]
  • February 2013 A 62-year old man presented to his primary care physician complaining of weight loss and bloody stool.[targetedonc.com]
  • Raptopoulos, M.D. 3 Citing Articles A 67-year-old woman presented with a three-month history of abdominal pain, weight loss, and rectal bleeding. She had never been screened for colon cancer.[nejm.org]
Anemia
  • Laboratory results showed anemia and elevated CA 125 levels. A pelvic computed tomographic scan revealed a huge multicystic mass on the right ovary and a well-enhancing intraluminal mass located at the rectosigmoid junction.[ncbi.nlm.nih.gov]
  • No other abnormal laboratory results were found except that 1 patient had anemia. Barium studies revealed the typical colon lesions in both patients, and colonoscopic pathologic examination disclosed mucinous adenocarcinoma.[ncbi.nlm.nih.gov]
  • Signs and symptoms include intestinal bleeding, anemia, and change in bowel habits. According to the degree of cellular differentiation, colonic adenocarcinomas are divided into well, moderately, and poorly differentiated.[ebi.ac.uk]
  • 80%) or microsatellite instability pathway (10% - 15%) Stage is most important prognostic factor Clinical features Increased carcinoma risk in patients with polyposis syndromes, Lynch syndrome and inflammatory bowel disease Right sided tumors cause anemia[pathologyoutlines.com]
  • Anemia in females may arise from gynecologic causes, but it is a clinical maxim that iron deficiency anemia in an older man means gastrointestinal cancer until proved otherwise 15.[slideshare.net]
Fatigue
  • […] microsatellite instability pathway (10% - 15%) Stage is most important prognostic factor Clinical features Increased carcinoma risk in patients with polyposis syndromes, Lynch syndrome and inflammatory bowel disease Right sided tumors cause anemia, weakness and fatigue[pathologyoutlines.com]
  • Symptoms that may require attention are fatigue from anaemia, visceral pain from liver metastases and, less commonly, somatic pain from bone metastases. If lung metastases are present there may be pleural effusions causing breathlessness.[myvmc.com]
  • Around 13 months after beginning therapy, the patient reported weight loss and fatigue. He underwent subsequent imaging, which found that he had progressive disease at that time.[targetedonc.com]
  • Common side effects include: hair loss nausea fatigue vomiting Combination therapies often mix multiple types of chemotherapy or combine chemotherapy with other treatments.[medicalnewstoday.com]
Fever
  • Our patient presented with 'B' symptoms (fever, drenching sweats, and more than 10% weight loss) and ascites.[jmedicalcasereports.biomedcentral.com]
  • Appendicitis is inflammation of the appendix that can cause abdominal pain or swelling, loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, or a low fever that begins after other symptoms.[cancer.net]
  • […] bleeding, hemorrhoids Constipation progressing to obstipation Abdominal, plevic, back or sacral pain Diarrhea with copious amounts of mucus Back pain that radiates down the legs Nausea and vomiting Changes in bowel patterns Weight loss Fatigue and dyspnea Fever[physio-pedia.com]
  • Clinics - Change bowel habits including constipation and diarrhea - Melena - Abdominal pain - Anemia due to chronic low-grade bleeding - Weight loss - Fever - Malaise.[atlasgeneticsoncology.org]
Pleural Effusion
  • If lung metastases are present there may be pleural effusions causing breathlessness. Effusions may require drainage. Colon Cancer (Adenocarcinoma of the Colon) References Braunwald E, Fauci AS, Kasper DL, et al.[myvmc.com]
Abdominal Pain
  • The patient was referred for an evaluation of lower abdominal pain and distension. Laboratory results showed anemia and elevated CA 125 levels.[ncbi.nlm.nih.gov]
  • We report the case of a 42-year-old woman with an extensive cancer history who presented with right-sided abdominal pain and lower gastrointestinal (GI) bleeding, and was ultimately diagnosed with colon adenocarcinoma.[ncbi.nlm.nih.gov]
  • The authors report on 2 cases of colon cancer in children less than 17 years old, whose initial presentations were abdominal pain of unclear etiology and non-specific abdominal complaints.[ncbi.nlm.nih.gov]
  • We present 4 adolescents with an average age of 15 years who present with several month histories of significant weight loss and abdominal pain. All had an abdominal and pelvic computed tomography scan, which revealed an adenocarcinoma in the colon.[ncbi.nlm.nih.gov]
  • We report a case of a 75-year-old woman, presenting with abdominal pain and complaints of weakness and lost of appetite, who was found to have a mass on her right colon. She underwent right hemicolectomy for a pT3N2M0, stage IIIC colon cancer.[ncbi.nlm.nih.gov]
Diarrhea
  • Improvement in the secretory diarrhea by the somatostatin analog Sandostatin suggested that the diarrhea was related to a functional neuroendocrine tumor within the colonic tumor, the first case to be reported in the literature.[ncbi.nlm.nih.gov]
  • […] important prognostic factor Clinical features Increased carcinoma risk in patients with polyposis syndromes, Lynch syndrome and inflammatory bowel disease Right sided tumors cause anemia, weakness and fatigue Left sided tumors cause change in bowel habits (diarrhea[pathologyoutlines.com]
  • Complications from chemotherapy and biotherapy depend on the agents used, but may include nausea, vomiting, diarrhea, inability to fight infection and allergic reactions.[livestrong.com]
  • Treatment Options for Metastatic CRC Paul Helft, MD: The case today is a 62-year-old man who presented with bloody stools and diarrhea to his primary care physician. He also complained of weight loss.[targetedonc.com]
  • Appendicitis is inflammation of the appendix that can cause abdominal pain or swelling, loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, or a low fever that begins after other symptoms.[cancer.net]
Constipation
  • We conclude that any child presenting with unexplained persistent constipation, abdominal distension or bleeding per rectum, colon cancer should be suspected and investigated with endoscopy or barium enema.[ncbi.nlm.nih.gov]
  • ., a thirty-three-year-old railroad brakeman, was admitted to the hospital on May 22, 1934, complaining of pain in the left half of the abdomen, distention, and constipation.[cancerres.aacrjournals.org]
  • […] prognostic factor Clinical features Increased carcinoma risk in patients with polyposis syndromes, Lynch syndrome and inflammatory bowel disease Right sided tumors cause anemia, weakness and fatigue Left sided tumors cause change in bowel habits (diarrhea or constipation[pathologyoutlines.com]
  • Manifestations include progressive abdominal distension, pain, vomiting, constipation, cramps, and bright red blood on the stool's surface.[medical-dictionary.thefreedictionary.com]
  • Appendicitis is inflammation of the appendix that can cause abdominal pain or swelling, loss of appetite, nausea, vomiting, constipation or diarrhea, inability to pass gas, or a low fever that begins after other symptoms.[cancer.net]
Blood in Stool
  • Physical examination Rectal bleeding, blood stool, and changes in bowel habits are the most common symptoms. Inspect, auscultate, and palpate the abdomen.[medical-dictionary.thefreedictionary.com]
  • […] in stool Loss of appetite Change in bowel habits Location Rectum (15%), sigmoid (20%), descending colon (10%), transverse colon (12%), ascending colon (8%), cecum (8%) Location seems to be changing and moving back to cecum More common in right colon[learningradiology.com]
  • Some new stool tests look for genetic material from a cancer rather than for blood. Genetic stool tests are done every 3 years.[msdmanuals.com]
  • Other screening tests include: annual fecal occult blood tests stool DNA testing flexible sigmoidoscopy every 5 years CT colonography every 5 years These frequency recommendations depend on the individual's risk of colon cancer.[medicalnewstoday.com]
Abdominal Mass
  • […] bleed, less likely to obstruct due to wider lumen fecal occult blood leading to iron deficiency postprandial discomfort Left sided lesions more likely to obstruct, less likely to bleed due to narrower lumen change in bowel habits pencil thin stools abdominal[medbullets.com]
  • No other abdominal masses were seen. Cytoreductive abdominal surgery revealed a bulky copious mucinous gelatinous tumor filling the abdominal cavity making detailed examination and resection difficult.[jmedicalcasereports.biomedcentral.com]
  • An abdominal mass may be palpated when tumors of the ascending, transverse, and descending colon have become large. Note the size, location, shape, and tenderness related to any identified mass.[medical-dictionary.thefreedictionary.com]
Peripheral Neuropathy
  • Patients who received FOLFOXIRI had significantly more grade 3 and 4 toxicities, including neutropenia, stomatitis, and peripheral neuropathy. Cetuximab Cetuximab is a partially humanized monoclonal antibody against the EGFR.[cancer.gov]

Workup

  • Diagnostic workup is largely in line with the presenting features of the patients, and the diagnosis is usually made on the basis of colonoscopy and biopsy. However, when the presentation is unusual (as in our patient), diagnosis is difficult.[jmedicalcasereports.biomedcentral.com]
  • […] was negative in all mucinous and nonmucinous types of bronchioloalveolar carcinomas, thereby proving that CDX2 is a useful immunohistochemical marker for the differential diagnosis of primary versus metastatic adenocarcinomas in the lung and in the workup[ijpmonline.org]
Microcytic Anemia
  • anemia iron deficiency anemia in an elderly male is colon cancer until proven otherwise fecal occult blood test lacks sensitivity and specificity as it only tests for globin with a peroxidase false positive with high meat diet (myoglobin), radishes ([medbullets.com]
Pleural Effusion
  • If lung metastases are present there may be pleural effusions causing breathlessness. Effusions may require drainage. Colon Cancer (Adenocarcinoma of the Colon) References Braunwald E, Fauci AS, Kasper DL, et al.[myvmc.com]

Treatment

  • Treatment decisions are made based primarily on stage, and stage II patients are not routinely offered adjuvant therapy. Placing patients on a randomized clinical trial, until a standardized treatment is agreed upon, is one alternative.[ncbi.nlm.nih.gov]
  • BACKGROUND: The purpose of this study was to evaluate the 5-year survival of patients with colon adenocarcinoma that underwent elective or emergency curative surgical treatment.[ncbi.nlm.nih.gov]
  • Interestingly, sarcoidosis regressed after treatment of colon cancer. The literature is reviewed and possible mechanisms are explained.[ncbi.nlm.nih.gov]
  • The cytological evaluation may allow for prompt diagnosis and treatment.[ncbi.nlm.nih.gov]
  • Treatment involved excision of primary tumor and follow-up chemotherapy. The clinical, histological and immunohistochemical characteristics are discussed.[ncbi.nlm.nih.gov]

Prognosis

  • MSI is associated with a favorable prognosis, but poorly differentiated adenocarcinomas (PDAs) have a poor prognosis. In this study, we aimed to investigate this inconsistency by analyzing the heterogeneity of PDAs.[ncbi.nlm.nih.gov]
  • CONCLUSION: The prognosis of SCC is poorer than that of MC and NMC. SCC patients had more locally advanced and almost no early-detected tumors, less hematogenic spread, and very poor surgical outcomes.[ncbi.nlm.nih.gov]
  • Colorectal carcinoma rarely affects children and has a dismal prognosis with 5-year survival rates as low as 2.5%-7% despite apparently radical surgery.[ncbi.nlm.nih.gov]
  • Survival obviously depends on the extent of the disease at diagnosis; the earlier the diagnosis is, the better the prognosis will be. Clinical characteristics, diagnosis, and treatment of colon cancer in pediatric patients are discussed.[ncbi.nlm.nih.gov]
  • The lack of any clinical benefit despite an aggressive and multimodal therapeutic strategy, raises a question about what should be targeted when we face this rare disease associated with a very poor prognosis.[ncbi.nlm.nih.gov]

Etiology

  • The syndrome may be associated with multiple etiologic agents or diseases. Malignancy, usually lymphoreticular, has been present in rare patients (less than 1%).[ncbi.nlm.nih.gov]
  • The authors report on 2 cases of colon cancer in children less than 17 years old, whose initial presentations were abdominal pain of unclear etiology and non-specific abdominal complaints.[ncbi.nlm.nih.gov]
  • Etiology According to the WHO Classification of Tumors of the Digestive System the following factors may play an etiological role in the development of CRC: - Diet (high caloric food, meat consumption) - Obesity - Sedentary lifestyle - Smoking - Alcohol[atlasgeneticsoncology.org]
  • View Article PubMed Google Scholar Lovett E: Familial factors in the etiology of carcinoma of the large bowel. Proc R Soc Med. 1974, 67: 751-752. PubMed PubMed Central Google Scholar Lynch H, Lynch J: Genetics of colonic cancer.[jmedicalcasereports.biomedcentral.com]
  • Etiology • I. Genetic influences: – preexisting ulcerative colitis or polyposis syndrome – hereditary nonpolyposis colorectal cancer syndrome (HNPCC, Lynch syndrome) germ-line mutations of DNA mismatch repair genes II.[slideshare.net]

Epidemiology

  • Epidemiology 139,000 new cases, 53,000 deaths (2006, US). Clinical findings Rectal bleeding, occult blood in stools and, if advanced, bowel obstruction and weight loss.[medical-dictionary.thefreedictionary.com]
  • J Natl Cancer Inst 100: 1184-7 31 Pera M, Manterola C, Vidal O, Grande L (2005) Epidemiology of esophageal adenocarcinoma. J Surg Oncol 92: 151-9 .[codes.iarc.fr]
  • Cancer epidemiology 38, 448–454, 10.1016/j.canep.2014.04.004 (2014). 18. Mitry, E. et al. Epidemiology, management and prognosis of colorectal cancer with lung metastases: a 30-year population-based study.[nature.com]
  • To provide a clearer estimate of the incidence and risk factors, Neugut and colleagues examined data from the Surveillance, Epidemiology, and End Results (SEER) and Medicare databases for patients 65 and older diagnosed with stage IV adenocarcinoma of[medpagetoday.com]
  • . • EpidEmiology Old age: peak incidence: 60 to 70 years of age, 20% cases before age of 50 • Adenomas – presumed precursor lesions for most tumors • males affected slightly more (20% )often than females • • • incidence rates in developed countries-US[slideshare.net]
Sex distribution
Age distribution

Pathophysiology

  • What is the best pathophysiology of colorectal cancer. The pathophysiology just has to be brief and concise. It also has to include nursing considerations for the patient.[medical-dictionary.thefreedictionary.com]
  • Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126. National Cancer Institute website.[medlineplus.gov]

Prevention

  • The mucin, in turn, creates a barrier that may, in fact, prevent chemotherapy medications from effectively penetrating cancer cells. In short, the chemo may not be able to get where it needs to be.[verywell.com]
  • Therefore, we recommend that the patients with the diagnosis of NETs should undergo further screening for the associated primary malignancies to prevent late-stage diagnosis of synchronous malignancies.[ncbi.nlm.nih.gov]
  • Postoperatively, direct nursing care toward providing comfort, preventing complications from major abdominal surgery, and promoting the return of bowel function.[medical-dictionary.thefreedictionary.com]
  • The procedure takes 15 - 30 minutes during which time the patient is sedated to prevent discomfort.[coloncancerfoundation.org]

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