The development of cancer in the rectum or in colon which are parts of large intestine is known as colorectal cancer. Its main cause is due to the abrupt growth of cells that has ability to spread all over the body. The colorectal cancer is can be also called as rectal cancer, bowel cancer and colon cancer. TNM staging of colorectal cancer can be used to diagnose Brian’s cancer (McConnell and Yang, 2009).
The TNM stands for: the size of the preliminary tumors (T), whether there are cancer cells in lymph nodes (N) and whether the cancer cell has spread out all over the body (M). There are four stages of tumors in colorectal cancer:
T1 – the inner layer of the bowel has tumor.
T2 – the tumor has spread to the muscle layer of the bowel wall.
T3 – the tumor has spread to the outer lining of the bowel wall.
T4 – the tumor has spread from the outer lining of the bowel wall to other parts of bowel as well as its nearby organs.
Diagnosis from Brian’s Cancer from initial stage:
Stage 0 or carcinoma in situ (CIS) – The inner bowel lining has the cancer cells. In this stage there is very little risk of cancer to spread as the cancer cells are within the lining.
Stage 1 – In this stage the cancer cells have spread from the inner lining to the muscle wall of the bowel but it is restricted up to there.
Stage 2a – In this stage the cancer cells have spread out to the outer covering of the bowel wall. However, there absence of cancer cells in the lymph nodes (Wood, et al., 2010).
Modifiable risk factors – A large group of scientist believes that the reasons for colorectal cancer are abnormal dietary and harsh lifestyle. Physical inactiveness and excessive body weight are increasing the risk factors. In case of Brian overconsumption of energy, high alcohol consumption, processed meat and smoking with low diet in addition to micronutrients such as folate and methionine may have likely contributed to colon cancer.
Non-modifiable risk factors – The non-modifiable risk factors of colorectal cancer are older age, genetic disorder, diabetes, obesity, mutation and family history (Kato, et al., 2013).
These risk factors are briefly discussed below for Brian’s case:
Lifestyle – Many lifestyle factors causes the bowel cancer. It is connected with weight; diet and lack of physical exercise are the strongest risk factors for the colorectal cancer.
Diets – High consumption of red meats like beef, lamb, liver or pork and processed meat increases the risk of cancer. Cooking meats in very high temperature like frying and broiling and grilling gives out chemicals which may cause cancer.
Smoking – The cases of colorectal cancer is more in smokers than in non-smokers. Lungs cancer is mainly by smoking but it is also connected to colorectal cancer.
Age – As the age of Brian is 50, the age factor may also cause the cancer.
Personal history – If Brian has the history of adenomatous polyps, this increases the chances of colorectal cancer as even though it was previously cured it may occur in some other organ of the body. Inflammatory bowel disease (IBD) which involves ulcerative colitis and Crohn’s disease, in this cases colon get inflamed for a long period and then often develop Dysplasia. This condition generally leads to colon cancer.
Family history – The diagnosis of cancer within first degree of relative such as parents, children and siblings increases the risk of cancer. This is due to the fact that cancer runs in the family from inherited genes (Charkhpour et al., 2010).
Metronidazole is banned in European countries and in the United States of America due to its carcinogenic properties. If a combination a metronidazole and 5-fluorouacil (5-FU) is given to Brian for the treatment of bowel cancer, after four weeks it could be seen that prohibitive toxicity have occurred. This is due to the fact that 5-FU toxicity was increased by the addition of metronidazole as it decreases the therapeutic index of 5-FU in the treatment by impairing its clearance and results to toxicity without providing therapeutic efficiency (Hassanzadeh et al., 2010).
Morphine is the best drug to get relief from pain in cancer patients. In addition to its role in pain treatment, it is also vital for regulation of neoplastic tissue. In case of Brain, if morphine is administered to him it can cause secondary complications. As the role of morphine in growth-inhibiting and growth-promoting effects on cancer tumors have been seen. Therefore, morphine will create an adverse effect on Brian’s body (Charkhpour et al., 2010).
The nursing responsibilities while administering morphine to Brain is given below:
Indication – Severe pain in the abdominal area, moderate to severe chronic pain, pulmonary edema and myocardial infarction pain.
Action – The nurse must immediate contact the doctor and on his advice morphine should be administered. On administering morphine, it will bind to opiate receptors of the central nervous system (CNS) and response to pain stimuli will shift and a generalized central nervous system will be produced.
Side Effects – The side effects of morphine should be evaluated by the nurse like sedation, confusion, hallucinations, vomiting and nausea, headache, confusion, bradycardia, blurry vision, constipation, unusual dreams and etc.
Symptoms of over dosage – The symptoms of over dosage are like respiratory depression, pinpoint pupils, hypotension, deepening coma, circulatory failure and etc.
Management of dosage – The antidote of morphine should always be ready by the nurse. The antidote of morphine is Naloxone (Narcan).
The administration of morphine should be gradually stopped to prevent the symptoms after prolong usage. Fluid intake should be given to Brain to manage constipation (Shaffer and Aymong, 2014).
Charkhpour, M., Nayebi, A., Doustar, Y. and Hassanzadeh, K. (2010). 8-OH-DPAT Prevents Morphine-Induced Apoptosis in Rat Dorsal Raphe Nucleus. Anesthesia & Analgesia, 111(5), pp.1316-1321.
Hassanzadeh, K., Habibi-asl, B., Farajnia, S. and Roshangar, L. (2010). Minocycline Prevents Morphine-Induced Apoptosis in Rat Cerebral Cortex and Lumbar Spinal Cord: A Possible Mechanism for Attenuating Morphine Tolerance. Neurotox Res, 19(4), pp.649-659.
Kato, I., Startup, J. and Ram, J. (2013). Fecal Biomarkers for Research on Dietary and Lifestyle Risk Factors in Colorectal Cancer Etiology. Curr Colorectal Cancer Rep, 10(1), pp.114-131.
McConnell, B. and Yang, V. (2009). The role of inflammation in the pathogenesis of colorectal cancer. Curr colorectal cancer rep, 5(2), pp.69-74.
Shaffer, C. and Aymong, L. (2014). Administering vaccines. Nursing, 44(10), pp.46-50.
Wood, P., Yang, X. and Hrushesky, W. (2010). The Role of Circadian Rhythm in the Pathogenesis of Colorectal Cancer. Curr Colorectal Cancer Rep, 6(2), pp.74-82.
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