Medication for Colon Cancer Essay Assignment Paper

SO HERE IS THE SCENARIO:

R.T. is a 64-year-old man who comes to his primary care provider’s (PCP’s) offi ce for a yearly examination. He initially reports having no new health problems; however, on further questioning, he admits to having developed some fatigue, abdominal bloating, and intermittent constipation. His nurse practitioner completes the examination, which includes a normal rectal exam with a stool positive for guaiac. Diagnostic studies include a CBC with differential, chem 14, and carcinoembryonic antigen (CEA). R.T. has not had a recent colonoscopy and is referred to a gastroenterologist for this procedure.
A 5-cm mass found in the sigmoid colon confi rms a diagnosis of adenocarcinoma of the colon. A referral is made for surgery. The pathology report describes the tumor as a Dukes’ stage B, which means that the cancer has extended into the mucous layer of the colon. A metastatic work-up is negative.

HERE IS THE QUESTION:

Four weeks after surgery, R.T. is scheduled to begin chemotherapy. List three chemotherapy drugs used to treat adenocarcinoma of the colon.

INFORMATION THAT I GOT FROM MY BOOK:

Staging of Colorectal Cancer: Dukes’ Classification—Modified Staging System

Class A: Tumor limited to muscular mucosa and submucosa

Class B1: Tumor extends into mucosa

Class B2: Tumor extends through entire bowel wall into serosa or pericolic fat, no nodal involvement

Class C1: Positive nodes, tumor is limited to bowel wall

Class C2: Positive nodes, tumor extends through entire bowel wall

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Class D: Advanced and metastasis to liver, lung, or bone. Another staging system, the TNM (tumor, nodal involvement, metastasis) classification, may be used to describe the anatomic extent of the primary tumor, depending on:

• Size, invasion depth, and surface spread

• Extent of nodal involvement

• Presence or absence of metastasis

The higher the score in each category, the worse the disease and prognosis.

The patient with symptoms of intestinal obstruction is treated with IV fluids and nasogastric suction. If there has been significant bleeding, blood component therapy may be required.

Adjuvant Therapy

The standard adjuvant therapy administered to patients with Dukes’ class C or TNM (tumor, nodes, metastasis) system (T1–4, N1–2, M0) colon cancer is the 5-fluorouracil (5-FU [Adrucil]) plus leucovorin calcium (Wellcovorin) plus oxaliplatin (Eloxatin) approach (Aldoss & Iqbal, 2011) (see Chart 48-10 for Dukes’ classification and Chapter 15 for further discussion of TNM system). Other agents include irinotecan ( Camptosar) and capecitabine (Xeloda). Patients with Dukes’ class B or C rectal cancer are given 5-FU and high doses of pelvic irradiation. Molecular markers (i.e., fragments of deoxyribonucleic acid [DNA]) are being identified and used for prognostic value. In the future, chemotherapy will likely be individualized to target these markers (Aldoss & Iqbal, 2011). Radiation therapy is used before, during, and after surgery to shrink the tumor; to achieve better results from surgery; and to reduce the risk of recurrence. For inoperative or unresectable tumors, radiation is used to provide significant relief from symptoms. Intracavitary and implantable devices are used to deliver radiation to the site. The response to adjuvant therapy varies. Patients at risk for poor outcomes include those with higher Dukes’ or TNM stage (see Chapter 15), elevated CEA levels, insufficient lymph node sampling, and presentation with colonic perforation or obstruction

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