NMS. Casos Clínicos

257

Chapter 8 ♦ Lower Gastrointestinal Disorders

Case Variation 8.22.3. Crampy abdominal pain ◆ ◆ Crampy abdominal pain also suggests intermittent obstruction. See Case Variation 8.22.2 for more information. Case Variation 8.22.4. Family history that is positive for colon cancer ◆ ◆ A family history of colon cancer carries a higher risk of development of cancer. Genetic syn- dromes known to be associated with colon cancer include Lynch syndrome and Gardner syndrome and familial adenomatous polyposis. Case Variation 8.22.5. Previous colonoscopy that demonstrated multiple polyps ◆ ◆ If the previous colonoscopy did not miss an additional lesion, it is unlikely that a new colon cancer has developed during the subsequent period. Epidemiologic data suggest that the progression from polyp to invasive cancer takes approximately 10 years. However, more recent data suggest another possibility: Cancer may arise from nonadenomatous tissue. The patient should still undergo repeat colonoscopy to establish a diagnosis. Case Variation 8.22.6. Scleral icterus ◆ ◆ Scleral icterus could be due to a number of reasons unrelated to the tumor, but the like- lihood that it is tumor related is high. Potential tumor-related causes include metastatic tumor replacement of the liver and a metastasis strategically located that blocks the bile duct. An ultrasound or CT scan of the liver would help assess these possibilities. Case Variation 8.22.7. A younger (22 years of age) instead of an older (55 years) adult ◆ ◆ In younger individuals, benign diagnoses such as inflammatory conditions are more likely. However, the scenario of colon cancer may still occur in young patients, and thus, a com- plete workup is necessary. Q: How do the following pathologic findings change the planned therapy? Case Variation 8.23.1. Penetration of the primary tumor into the nearby abdominal wall ◆ ◆ The portion of the abdominal wall is resected as part of a more radical procedure. Involve- ment of adjacent structures makes the T classification in the TNM system a T4 lesion and worsens the prognosis . Case Variation 8.23.2. Positive lymph nodes recognized at surgery ◆ ◆ The operation proceeds unchanged; however, the surgeon attempts to remove all involved nodes. Case Variation 8.23.3. Positive lymph nodes recognized by the pathologist 2 days later Case 8.23 Operative Findings in Colon Cancer You perform a colectomy for colon cancer in a 58-year-old patient. ◆ ◆ The hemicolectomy remains the procedure of choice, and no further operative procedures are necessary. The patient has stage III disease and is eligible for adjuvant chemotherapy. SAMPLE