Question

R.T. is a 64-year-old man who went to his primary care provider's office for a yearly examination. He initially reported having no new health problems; however, on further questioning, he admitted to having
developed some fatigue, abdominal bloating, and intermittent constipation. His physical examination
findings were normal except for stool positive for occult blood. He had a complete blood count (CBC) with
differential, basic metabolic panel (BMP), and carcinoembryonic antigen (CEA) testing and was referred
to a gastroenterologist for a colonoscopy. Colonoscopy revealed a 5-cm mass in the sigmoid colon, which
was diagnosed as adenocarcinoma of the colon. A distant metastatic workup is negative, and R.T. is being
scheduled for a laparoscopic sigmoidectomy with anastomosis.

1. Identify six risk factors for colon cancer.

2. Outline the American Cancer Society's current evidence-based screening procedures for
colon cancer.

3. The preoperative chart includes detailed instructions for R.T. for a bowel preparation
regimen with polyethylene glycol and a prescription for neomycin (Mycifradin). What is the
purpose of the neomycin?

4. What are some suggestions you can make to help R.T. successfully complete the bowel
preparation?

5. Describe the rest of your preoperative teaching for R.T. and his family

6. Develop a teaching plan for R.T. focusing on the common effects of diarrhea, alopecia, and
nausea and vomiting.

Answer 1

1)

Six risk factors for colon cancer are :-

• Excessive alcohol consumption
• Age greater than 50 years
• Obesity
• Family history and genetic factors
• Tobacco or cigarette smoking
• History of inflammatory bowel disease, high risk adenomas, etc.

2)

Guidelines of the American Cancer Society's current evidence - based screening procedures are as follows :-

People at average risk of colorectal cancer should be started with regular screening at the age of 45.

Screening test options for colorectal cancer :-

a) Stool based tests :

• guaiac based fecal occult blood test (gFOBT)
• fecal immunochemical test (FIT)
• multi targeted stool DNA test (mt-sDNA)

​​​​​​​b) Visual examination of the colon and rectum :

• Colonoscopy
• Flexible sigmoidoscopy
• CT colonography

​​​​​​​3)

The purpose of the neomycin in the bowel preparation is to reduce the normal bacteria in the bowel prior to operative procedures.

4)

Some suggestions that should be given to R.T. for successful bowel preparation are:-

• Prescribed oral antibiotic should be taken.
• He should drink only clear liquids on the day before surgery.
• He should not drink or eat red, purple, or orange coloured drinks, gelatins or popsicles which may discolor the intestinal tissues.
• ​​​​​​Bowel should be cleaned before surgery.

5)

Other preoperative teaching for R.T. and his family are:-

• Eating and drinking should be prohibited for at least 8 hours before surgery.
• Skin preparation of the surgical area.
• Anxiety of the patient should be reduced.
• ​​​​​​​Patient should be physically and psychologically prepared for the surgery.

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