Case Study Analysis – Colorectal Cancer (CRC)

Case Study Analysis – Colorectal Cancer (CRC)

Cells provide structure and function for all living things (McCance & Huether, 2019). Cells house the biological functioning that makes proteins and chemicals inside our bodies. Furthermore, some of these same components influence genetics and diseases. Therefore, this knowledge will help better understand the pathophysiology and diseases (McCance & Huether, 2019). This paper will explain details about a patient from the assigned case study. The explanation of this case study will analyze why the patient presented the symptoms described, identify the genes that may be associated with the development of the disease, and explanation of immunosuppression and its effect on the body system.

Why the Patient Presented the Symptoms Described

Colorectal cancer (CRC) is the second most prevalent cause of cancer death in the United States (Siegel et al., 2020). CRC increases in individuals less than 50 years old and is associated with specific dietary factors and unhealthy and sedentary lifestyle choices that affect the digestive microbiota (Liu et al., 2018). Depending on the location of the CRC, its symptoms may vary. The patient presented with crampy left lower quadrant pain, and constipation is related to obstructions from the polyps or poor colonic propulsive activity.

When food enters the descending part of the colon, the stretch receptors of the anoderm perceive the stool (McCance & Huether, 2019). From here, a decision is made for compelling the mechanism hormones to expel the stool by relaxing the external anal sphincter, squatting, and increasing intra- abdominal pressure with the Valsalva maneuver. The second option is to postpone defecation by contracting the external anal sphincter and the gluteal muscle (McCance & Huether, 2019). However, if any polyps contribute to his constipation and pain, it narrows the colonic lumen of the passage of stool (Aran, 2017). Moreover, he may have had a positive response to bowel rest in the past because he may not have had as many polyps; or his adenocarcinoma of the colon may not have been in its stage presented in the pathology report (information not provided in this case study).

The patient’s low-grade fevers may be related to an infection, a paraneoplastic syndrome caused by malignancy itself (McCance & Huether, 2019). According to Siegel et al. (2020), malignancy can cause fevers, particularly associated with certain types of tumors. However, the association between malignancies induce fevers are not fully understood (Siegel et al., 2020). From a pathophysiological view, the release of pyrogenic cytokines either directly from tumor cells or from macrophages is likely to play a significant role (Soo, 2018). Chemically, interleukin-1, interleukin-6, and tumor necrosis factors are also factored in (McCance & Huether, 2019; Soo, 2018). As a result, cytokines induce prostaglandin E2, which acts on the hypothalamus (Soo, 2018), causing a standard body temperature change of 98.6 degrees Fahrenheit.

Identify the Genes that May be Associated With The Development of The Disease

Familial adenomatous polyposis and hereditary nonpolyposis colorectal cancers are two of the most common types of genes that are associated with CRC (Aran et al., 2017). The patient’s CRC may have progressed over 10 to 15 years with an associated genetic mutation in this case study. The most common genes that may be associated with this patient’s CRC are the following: APC (adenomatous polyposis coli), TP53 (tumour protein 53), BRAF (Kirsten rat sarcoma viral oncogene homolog), BRAF (B-Raf proto-oncogene serine/threonine kinase), COX-2 (cyclooxygenase-2), and Lynch Syndrome. Colorectal cancer results from the loss of gene mutation, molecular pathways, and genomic stability (book). Sometimes mutations occur because of chromosomal instability of an allele of tumor suppressor genes that prevent cancer absence (McCance & Huether, 2019). For example, the absence of the APC gene may lead to the creation of adenomatous polyps of the colon (Aran et al., 2017).

Explanation of Immunosuppression and The Effect It Has on The Body System

The immune system can be compromised by tumor cells. Tumor cells produce the transforming growth factor-beta (TGFβ) that alters the function of immune cells. CD4+ T-helper cells are the primary cells in the immune system (McCance & Huether, 2019). An abundance of such cells and cytokine production, such as interferon-gamma (IFNγ), strengthens anti-tumor immunity (Roelands et al., 2017). Prostaglandins (PGs) have a significant effect on the immune system as well because they can inhibit tumor necrosis factor (TNF) growth (Roelands et al., 2017). Immunotherapies are created to induce anti-tumoral immune responses (Roelands et al., 2017); they perform this by enhancing the host’s intrinsic anti-tumour immune response through cytokine treatment (Roelands et al., 2017; Soo, 2018). In comparison, passive approaches employ effector molecules or cells developed outside the patient’s body, including adoptive T-cell transfer and monoclonal antibodies targeting tumour-associated antigens (Roelands et al., 2017; Soo, 2018).

Conclusion

In sum, colon cancer is one of the most common types of cancer. If caught early, treatment has a high success rate (Aran et al., 2017). Promoting the importance of patient education, learning about family history related to medical and hereditary factors, performing routine health screening, and applying healthy modifiable lifestyle choices to reduce susceptibility (McCance & Huether, 2019). The more HCPs understand the pathophysiology of diseases, the better they can get a diagnosis, treat, and prevent diseases.

References

Aran, V., Victorino, A. P., Thuler, L. C., & Ferreira, C. G. (2017). Colorectal cancer: epidemiology, disease mechanisms and interventions to reduce onset and mortality. Clinical Colorectal Cancer, 15(3), 195–203. https://doi.org/10.1016/j.clcc.2016.02.008

Liu, L., Tabung, F. K., Zhang, X., Nowak, J. A., Qian, Z. R., Hamada, T., Nevo, D., Bullman, S., Mima, K., Kosumi, K., da Silva, A., Song, M., Cao, Y., Twombly, T. S., Shi, Y., Liu, H., Gu, M., Koh, H., Li, W., Giovannucci, E. L. (2018). Diets that promote colon inflammation associated with the risk of colorectal carcinomas that contain Fusobacterium nucleatum. Clinical Gastroenterology and Hepatology, 16(10), 1622–1631. https://doi.org/10.1016/j.cgh.2018.04.030

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby Elsevier.

Roelands, J., Kuppen, P. J., Vermeulen, L., Maccalli, C., Decock, J., Wang, E., Marincola, F. M., Bedognetti, D., & Hendrickx, W. (2017). Immunogenomic classification of colorectal cancer and therapeutic implications. International Journal of Molecular Sciences, 18(10), 2229. https://doi.org/10.3390/ijms18102229

Siegel, R. L., Miller, K. D., Goding Sauer, A., Fedewa, S. A., Butterly, L. F., Anderson, J. C., Cercek, A., Smith, R. A., & Jemal, A. (2020). Colorectal cancer statistics, 2020. CA: A Cancer Journal for Clinicians, 70(3), 145–164. https://doi.org/10.3322/caac.21601

Soo, P. ( 2018, July 28). Pathophysiology ch 10 alterations in immune function  YouTube. https://www.youtube.com/watch?v=Jz0wx1-jTds

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An understanding of cells and cell behaviour is a critically important component of disease diagnosis and treatment. However some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.

Effective disease analysis often requires an understanding that goes beyond isolated cell behaviour. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.

Case Study Analysis

An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factored in the diagnosis, and you explain the implications to patient health.

The Assignment

Develop a 1- to 2-page case study analysis in which you:

Explain why you think the patient presented the symptoms described.

Identify the genes that may be associated with the development of the disease.

Explain the process of immunosuppression and the effect it has on body systems.

Scenario: A 65-year-old obese African American male patient presents to his HCP with crampy left lower quadrant pain, constipation, and fevers to 101˚ F. He has had multiple episodes like this one over the past 15 years, and they always responded to bowel rest and oral antibiotics. He has refused to have the recommended colonoscopy even with his history of chronic inflammatory bowel disease (diverticulitis), sedentary lifestyle, and a diet lacking in fibre. His paternal grandfather died of colon cancer back in the 1950s as well. He finally underwent a colonoscopy after his acute diverticulitis resolved. A colonoscopy revealed multiple polyps that were retrieved, and the pathology was positive for adenocarcinoma of the colon.