Colorectal Cancer New Insights for the Healthcare Professional

Question: Describe about the Colorectal Cancer of New Insights for the Healthcare Professional? Answer: 1: The stage IIA colorectal cancer invades the periphery of colon and rectum without affecting the distant organs and lymphatic channel. The tumour penetrates into muscularis propria and affects the perirectal tissues in entirety. The pathogenesis of colorectal cancer begins with the events of chromosomal instability in terms of hypermethylation of genes leading to CpG island methylator phenotype exhibiting microsatellite instability (MSI). Indeed, the mutations in mismatch repair genes results in sustained errors in replication leading to the development of stage IIA colorectal cancer (Wolff et al, 2007, p. 387). The AJCC cancer staging system categorises the stage IIA colorectal carcinoma in terms of T3N0M0 indicating absence of invasion and metastasis to the regional lymph nodes. Clinical literature reveals the patterns of enhanced expression of CD133+ and CD44 proteins in patients diagnosed with stage IIA colorectal cancer (Beauchemin Huot, 2010, p. 138). The clinical study cond ucted by Lam et al (2011) indicates the decreased appearance of JS-2 mRNA expression and increased JS-2 copy number during the early stages of colorectal cancers (including stage IIA condition). Indeed, these systematic epigenetic alterations result in transforming the normal colorectal epithelial cells to carcinomatous types leading to the progression of early stages of colonic adenocarcinoma. The spontaneous genetic mutations influence the structure of messenger RNAs and non-coding RNAs, thereby facilitating disruption in cellular morphology resulting in erroneous genetic expressions leading to stage IIA colorectal cancer. The molecular events in stage IIA colorectal cancer further include widespread aneuploidy and disfigurement of chromosomes 5q, 17p and 18q. Indeed, these chromosomal variations result in destabilizing the functions of genes including APC, TP53 and DCC/MADH2/MADH4 that adversely affect the DNA repair process resulting in somatic changes attributing to the develop ment of stage IIA colorectal cancer. The carcinomatous stage IIA cells indeed display the increased production of mucin under the influence of microsatellite instability, as evidenced by clinical studies. 2: The modifiable risk factors related to diet and lifestyle changes predispose humans in developing colorectal cancer condition. Indeed, lack of physical activity, inappropriate diet and obesity are some of the consistent and reversible factors attributing to colorectal cancer among the predisposed population (Giovannucci, 2002, pp. 925-43). The clinical studies reveal the influence of dietary components including red meat, carbohydrates and processed meat contributing to the risk of colorectal cancer. Acton (2013, pp. 14-15) describes the prevalence of modifiable risk factors among the US population aged between 20 69 years. Indeed, the modifiable risk factors including alcoholism and dietary insufficiency affect the expression of IGF-1 gene among the predisposed population resulting in the defects in somatomedin-C metabolism leading to the development of colorectal cancer. The modifiable risk factors including dietary fluctuations and obesity might have had influenced the intesti nal metabolism and genetic mutations leading to the development of colorectal carcinoma in Brians case. Indeed, the occult stool proved to be the preliminary indication in detecting stage IIA carcinomatous condition in Brians rectum. The non-modifiable risk factors attributing to the development of colorectal cancer include age advancement and personal history of adenomatous polyps (Haggar Boushey, 2009, pp. 191197). The clinical literature reveals the predisposition to colorectal cancer from the age of 40 years and onward among the patients with known history of intestinal abnormalities. Indeed, Brian predisposed do developing colorectal cancer due to his age of 50 years that proved to be the preliminary factor in developing this condition, as evidenced by the clinical literature. The genetic predisposition to developing colorectal malignancies among individuals with personal history of adenomatous conditions and inflammatory bowel disease warrants periodic screening of these cand idates to detect colorectal carcinomatous conditions at their early stages. The clinical literature reveals the occurrence of nocturnal abdominal pain in cases of IBS (Emmanuel Quigley, 2013). Indeed, Brians abdominal pain symptom might be the result of his personal history of IBS contributing to the development of colorectal cancer. 3: Metronidazole administered as an adjuvant drug during the postoperative care of Brian following his abdomino-perineal resection. Bailey et al (2013, p. 407) reveal the pharmacokinetics of metronidazole in terms of controlling the episodes of diarrhea, ulcers and rectal bleeding in patients with reported colonic conditions. Brian administered with metronidazole for managing postoperative rectal hemorrhage, constipation, hemorrhoids and diarrhea following colonic surgical intervention. Morphine is the drug of choice for intravenous administration following colorectal surgeries to produce patient controlled analgesia (Tashjian Armstrong, 2012, p. 280). This drug administered to Brian following his abdomino-perineal resection to control the postoperative pain and stabilize the cardiopulmonary circulation. Mondal (2010, p. 260) discusses the efficacy of morphine in reducing episodes of postoperative pain following the surgical intervention. Furthermore, morphine potentially reduces the sympathetic overload resulting in reduced cardiac output and enhanced pulmonary ventilation. This further leads to restoration of pulmonary capacity in terms of stabilizing respiration and balancing cardiovascular functionality among the treated patients. 4: Nurses require assessing patients consciousness level, vitals and respiratory rate while administering morphine intravenously to Brian following his surgical intervention. Appropriate measures warranted by nurses in terms of inducing physical stimulation to prevent episodes of hypoventilation during morphine administration. Furthermore, nurses must consciously monitor the symptoms like drowsiness and reduced consciousness for subsequently adjusting the dose of morphine with the intent of avoiding potential complications during its administration. The nurses also require stringently adhering to the dosage guidelines in accordance with physicians prescription. The patterns of patients psychological and physical dependence on morphine require consistent tracking by nurses in case of its long-term administration to Brian. The bowel movements also warrant consistent monitoring by nurses in context to preventing episodes of constipation while administering IV morphine following the abdo mino-perineal resection. Indeed, the careful parallel administration of laxatives with the prescribed morphine regimen antagonizes its side effects in terms of reducing episodes of constipation in treated patients. Williams Hopper (2015, p. 650) discuss regarding the importance of dose adjustment of IV morphine by nurses in stabilizing cardiopulmonary and psychological condition of the patient. Indeed, the nurses require practicing caution while adjusting morphine dosages in context to the perspective of reciprocal variation of anxiety and peripheral circulation following IV morphine administration. The rationale of administering antagonistic therapy for treating pulmonary edema, respiratory depression and loss of consciousness following IV morphine intervention requires thorough understanding by the nursing professionals in context to handling cardiopulmonary emergencies (after initiation of morphine therapy) under postoperative period. References Acton, A. (2013). Colorectal Cancer: New Insights for the Healthcare Professional. Georgia: ScholarlyEditionsTM. Bailey, H., Billingham, R., Stamos, M., Snyder, M. (2013). Colorectal Surgery. Philadelphia: Elsevier. Beauchemin, N., Huot, J. (2010). Metastasis of Colorectal Cancer. Netherlands: Springer. Emmanuel, A., Quigley, E. (2013). Irritable Bowel Syndrome: Diagnosis and Clinical Management. UK: Wiley-Blackwell. Giovannucci, E. (2002). Modifiable risk factors for colon cancer. Gastroenterology clinics of North America. 31(4):925-43. Haggar, F., Boushey, R. (2009). Colorectal Cancer Epidemiology: Incidence, Mortality, Survival, and Risk Factors. Clinics in Colon and Rectal Surgery. 22(4): 191197. doi: 10.1055/s-0029-1242458. Lam, A., Gopalan, V., Nassiri, M., Kasim, K., Dissanayake, J., Tang, J., Smith, R. (2011). Altered JS-2 expression in colorectal cancers and its clinical pathological relevance. Molecular Oncology. doi:10.1016/j.molonc.2011.06.003. Mondal, S. (2010). Basic Undergraduate Pharmacology. Kolkata: Academic Publishers. Tashjian, A., Armstrong, E. (2012). Principles of Pharmacology: The Pathophysiologic Basis of Drug Therapy. Philadelphia: Lippincott Williams Wilkins. Williams, L., Hopper, P. (2011). Understanding Medical Surgical Nursing (5th edn.). Philadelphia: F. A. Davis. Wolff, B., Fleshman, J., Beck, D., Pemberton, J., Wexner, S. (2007). The ASCRS Textbook of Colon and Rectal Surgery. New York: Springer.