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PATIENT PRESENTATION

Chief Complaint

Increasing abdominal pain and bloating; constipation; continued fatigue

History of Present Illness

Patient was diagnosed with stage III left-sided colon cancer approximately 11.5 months ago after presenting to the clinic with generalized abdominal pain, bloating, loss of appetite, nausea, and irregular bowel movements. He presents to the clinic today and is found to have recurrent disease that is now metastatic.

Student Work-Up

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Missing Information?

Evaluate:

Patient Database

Drug Therapy Problems

Care Plan (by Problem)

TARGETED QUESTIONS

  1. What are the signs and symptoms this patient has for colon cancer at initial presentation?

    Hint: See Treatment in PPP

  2. What is the goal of treatment for this patient?

    Hint: See Treatment in PPP

  3. Was the initial chemotherapy selection appropriate at the time of diagnosis?

    Hint: See Treatment in PPP

  4. What is the recommended therapy for this patient?

    Hint: See Treatment in PPP

  5. What risk factors and adverse effects would you discuss with this patient?

    Hint: See Table 91-6 and Specific Agents Used in Colorectal Cancer in PPP

FOLLOW-UP

The patient calls clinic 18 days after his first treatment complaining of an acneiform like rash on his face and abdomen. What is most likely causing this problem? What actions, if any, would you take?

CASE SUMMARY

Global Perspective

Colon cancer is one of the most common cancers worldwide. The highest rate of colon cancer is in industrialized countries such as the United States as well as many countries in Europe. Industrialized countries tend to have diets high in fat, which partially explains the increased incidence, though other dietary and genetic factors play a role in its development. Early-stage colon cancer (stages I–III) is curable with either surgery alone or surgery in combination with chemotherapy. Most patients receive 6 months of adjuvant chemotherapy following surgical resection of the tumor. Metastatic disease (stage IV) is currently incurable though patients can live 2 or more years. The initial treatment for most patients with metastatic disease consists of a combination chemotherapy backbone with targeted agents added as appropriate. Some of the chemotherapy agents (e.g., 5-fluorouracil, irinotecan) have pharmacogenomic factors, while others have tumor mutations (e.g., cetuximab and panitumumab) that determine their efficacy and toxicity.

Key References

1. +
National Comprehensive Caner Network (NCCN). Colon Cancer (v 1.2022). Available online at: https://www.nccn.org/profile?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Issued 02/25/2022.

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