In: Nursing
Bruce is a 47-year-old man, who decides he needs to visit his doctor due to some gastrointestinal symptoms. At first it just started out as a bit of abdominal pain and cramping, followed by diarrhea so at first Bruce just thought he had a stomach bug. But weeks went by and the diarrhea just increased in frequency, and instead of feeling better, he started to feel really fatigued. This has been going on for 8 months before his wife finally convinced him to make an appointment with a doctor, who then referred him to a gastroenterologist. A couple of months later when he finally goes to his specialist appointment, Bruce admits after questioning that he has had bleeding with his stool but he didn’t want to tell the doctor as he was embarrassed and didn’t want to get checked for hemorrhoids. The gastroenterologist also asks many questions about Bruce’s diet and his weight and discovers that Bruce has lost 15 kg in the past year despite eating a lot of hot chips and mashed potatoes – the only thing Bruce feels doesn’t make his diarrhea worse. The gastroenterologist then tells Bruce he would like to perform a colonoscopy to investigate further. After the colonoscopy, the surgeon tells Bruce that they found a number of polyps in his bowel which is not necessarily a cause for concern as many polyps are benign, but they will have to wait on the results of the biopsies to make sure none of them were malignant. A week later the surgeon calls Bruce, unfortunately it is bad news – the biopsy shows evidence that the growth is malignant and anaplastic and that they can’t rule out metastatic growths. Bruce is called back in for follow-up tests, and they find that there is an abnormal growth in his liver also.
Bruce is now sent to an oncologist, who recommends that he has surgery to remove any remaining polyps, a small portion of his bowel, and the abnormal growth from his liver. Based on the advice from his oncologist, Bruce also decides to undergo chemotherapy treatment. Whilst doing some routine checks after his treatment, Bruce is informed he has neutropenia.
Question 1
Bruce doesn’t understand what the surgeon and oncologist are saying after the results because he doesn’t understand the terminology being used. Explain in terms a patient could understand what is meant by malignant, anaplastic and metastatic tumour, and what does this then mean for his prognosis. In order to help explain these terms, compare Bruce’s growth with a benign, differentiated and localised growth.
An abnormal growth of cells and tissues in an organ is called a tumor/ neoplasm.
Neoplasm are of two types: benign and malignant. Slow growing and localized tumors are said to be benign. Benign tumors won't spread. It can be removed by surgery and have a good prognosis unless it interfere with any vital function. Cells are well differentiated in a benign tumor which means the cells appears as normal and mature cells under microscopic examination and grows and spreads slowly compared to poorly differentiated cells.
Malignant tumors proliferate (grows) rapidly and can spread to the adjacent structures as well as distant sites (known as metastasis) and can even be fatal. Cells are poorly differentiated in malignant neoplasm which means the cells appear to be disorganized and abnormal under microscopic examination and also grows and spreads at a rapid rate compared to the well differentiated cells in benign neoplasm. Mostly the term cancer is used to indicate a malignant tumor.
In Bruce's case the biopsy reports showed a malignant and anaplastic growth and no metastatic growths were ruled out initially. During follow up tests an abnormal growth in his liver was identified. His oncologist recommended removal of his bowel polyps, a small portion of his bowel and the mass in the liver and chemotherapy treatment too. After the treatment his routine tests revealed neutropenia.
Explanation to the patient : Bruce could be informed that several small growths or lumps were seen in the inner linings of his bowel during the colonoscopy (visualization of his large intestine and rectum) and a sample is been sent for biopsy to identify whether the growth is of major concern or not. Though bowel polyps are localized and will not spread to other sites (benign) the risk of malignancy can be excluded only after the biopsy reports. Malignant tumors may spread to the adjacent sites of the primary tumor location as well as to distant sites. Benign tumors can be removed and completely cured by surgery whereas malignant tumors need long term management including surgical excision, radiation and chemotherapy and the prognosis is not expected to be good always.
Once the reports are ready explain to Mr. Bruce that his bowel growths are malignant and anaplastic that means the cells are poorly differentiated (anaplasia) and are growing (proliferating) rapidly than as the normal cells do. So far no spread to other tissues (metastasis) are identified but there is chances of spread of tumor in malignancy. During the follow up test explain to Mr. Bruce that a lump is found in his liver too that may be due to tumor metastasis.
Explain to Mr. Bruce about the available treatment options in his case which are to remove the polyps as well as the affected portion of his bowel and to remove the growth in his liver too. Also explain about chemotherapy that helps to destroy the rapidly proliferating cancer cells.in his body. Before the treatment he should be explained about the side effects of chemotherapy like fatigue, nausea, vomiting, loss of hair, constipation, loss of appetite, anemia due to reduced RBC count and chances of getting secondary infections as a result of weakened immune system.
The test result showing neutropenia can be explained as : Chemotherapy destroys the cancer cells as well as the normal blood cells including the WBCs too. Reduction in neutrophil a component of our White Blood Cells is common after chemotherapy and it may cause susceptibility to infections. Advice Mr. Bruce to avoid contracting infections by following infection control measures.