Colorectal Cancer

COLORECTAL CANCER 1. CHIEF COMPLAINT •Colorectal cancer 2. HPI 3. ROS 4. SYMPTOMS •Fatigue •Weakness •Shortness of breath •Change in bowel habits •Narrow stools •Diarrhea •Constipation •Weight loss •Abdominal pain •Cramps •Bloating •Red or dark blood in stool 5. HISTORY •FAMILY HISTORY o Family history of colorectal cancer and polyps •SOCIAL HISTORY o High fat intake •PASTMEDICAL HISTORY o Colon polyps o Ulcerative colitis o FAP (familial adenomatous polyposis) o AFAP (attenuated familial adenomatous polyposis) o MYH polyposis syndrome •SURGICAL HISTORY •CHRONIC CONDITIONS 6. ALLERGIES

7. PHYSICAL EXAMINATION 8. SPECIFIC DATA LIKE GRADING ETC Dukes system •A - Tumour confined to the intestinal wall •B - Tumour invading through the intestinal wall •C - With lymph node(s) involvement •D - With distant metastasis TNM system •T - The degree of invasion of the intestinal wall •T0 - no evidence of tumor •Tis- cancer in situ (tumor present, but no invasion) •T1 - invasion through submucosa into lamina propria (basement membrane invaded) •T2 - invasion into the muscularis propria (i.e. proper muscle of the bowel wall) •T3 - invasion through the subserosa •T4 - invasion of surrounding structures (e.g. bladder) or with tumour cells on the free external surface of the bowel •N - the degree of lymphatic node involvement •N0 - no lymph nodes involved •N1 - one to three nodes involved •N2 - four or more nodes involved •M - the degree of metastasis •M0 - no metastasis •M1 - metastasis present AJCC stage groupings •Stage 0 -Tis, N0, M0 •Stage I -T1, N0, M0 -T2, N0, M0 •Stage IIA -T3, N0, M0 •Stage IIB -T4, N0, M0 •Stage IIIA -T1, N1, M0 -T2, N1, M0 •Stage IIIB -T3, N1, M0 -T4, N1, M0 •Stage IIIC -Any T, N2, M0 •Stage IV -Any T, Any N, M1 9. TESTS TO BE ORDERED

•CBP •Liver function tests •Barium enema x-ray •Colonoscopy •Flexible sigmoidoscopy •Stool occult blood testing •Biopsy •Chest x-rays •Ultrasonography •CAT scan of the lungs, liver, and abdomen •Blood test for CEA (carcinoembyonic antigen) 10.ASSESSMENT /PLAN •Radiotherapy •Chemotherapy •Surgical resection of the colon 11.EDUCATION •Reduce fat intake •Take more fiber diet 12.MEDICATION •5-flourauracil (5-FU) •Leucovorin •Oxaliplatin •Irinotecan •Bevacizumab •UFT •Leucovorin •Cetuximab •Panitumumab •Bortezomib •Oblimersen •Gefitinib •Erlotinib •Topotecan 13.FOLLOW-UP