Date post: | 11-Apr-2017 |
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Health & Medicine |
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CLINICAL PRESENTATION
ANGANA BHATTACHARJEE 10.03.2017
Malda Medical College
CLINICAL PRESENTATION Patients with COLON CANCER
present in three ways-
VAGUE ABDOMINAL SYMPTOMS AND PALLOR
ASYMPTOMATIC INDIVIDUALS DISCOVERED BY ROUTINE SCREENING
EMERGENCY CONDITION WITH INTESTINAL OBSTRUCTION,PERITONITIS OR RARELY ACUTE GI BLEDDING
CLINICAL PRESENTATION ACCORDING TO ANATOMICAL SITE
RIGHT SIDED COLONIC CANCER
FATIGUE ASSOCIATED WITH ANAEMIA
ALTERED BOWEL HABIT
ABDOMINAL PAIN IN ADVANCED TUMORS
MELENA-DARK TARRY STOOL
RIGHT SIDED ABDOMINAL
MASS
DESCENDING / SIGMOID COLON:
CONSTIPATION ALTERNATING WITH DIARRHOEA,ABDOMINAL
PAIN AND OBSTRUCTIVE SYMPTOMS,MELENA,
PERFORATION
TRANSVERSE: ALTERED BOWEL HABITS,BOWEL
OBSTRUCTION,MELENA
RECTAL:CHANGES IN BOWEL MOVEMENT,RECTAL
FULLNESS,URGENCY,BLEEDING,TENESMUS
ANAL:BLEEDING,DISCHARGE,MASS,
TENDERNESS ON PALPATION,PAIN ON DEFECATION
ADVANCED CANCER PAIN ABDOMEN-COLICKY AND RECURRENT DISTENSION,VOMITTING CONSTIPATION REDUCED BOWEL SOUNDS ON AUSCULTATION DEHYDRATION,TACHYCARDIA, HYPOTENSION PALPABLE LEFT SUPRACLAVICULAR LYMPH
NODES(VIRCHOW’S NODE) METASTATIC FEATURES
COMPLICATIONS STERCORAL ULCER OBSTRUCTION PERFORATION PERITONITIS PERICOLIC ABSCESS
MODE OF SPREAD
LOCAL SPREAD
HEMATOLOGICAL SPREAD
LYMPHATIC SPREAD
LOCAL SPREAD
INVADE THE BLADDER,OBSTRUCT
URETER CAUSING HYDRONEPHROSIS
PERFORATION CAUSING
PERITONITIS,PERICOLIC ABSCESS,FAECAL
FISTULA
ADHERENCE TO PSOAS MUSCLE
POSTERIORLY
INVADE UTERUS,OVARY
ABSCESS IN LATERAL
ABDOMINAL WALL
METASTASIS
LIVER METASTASIS• COMMONEST SITE-SPREADS VIA PORTAL VEINS• ENLARGED LIVER WITH HARD UMBILICATED
NODULES• JAUNDICE• DARK COLOURED URINE• LOSS OF APETITE,WEIGHTLOSS• NAUSEA VOMITTING• CONFUSION• ASCITES
LUNG METASTASIS• COUGH WITH OR WITHOUT
BLOOD • RECURRENT RESPIRATORY
INFECTIONS• HOARSENESS• WHEEZING• SHORTNESS OF BREATH
BONE METASTASIS• BONE PAIN• MUSCLE WEAKNESS AND NUMBNESS• WEAK BONES WITH INCREASED
SUSCEPTIBILITY TO FRACTURE• INCREASED SERUM CALCIUM LEVEL• BONE MARROW SUPPRESSION
MODIFIED DUKE’S CLASSIFICATION
A : GROWTH LIMITED TO BOWEL WALL B : INVADES INTO EXTRABOWEL TISSUES
BUT NO LYMPH NODES ARE INVOLVED B1 : INVADING MUSCULARIS PROPRIA B2 : INVADING INTO OR THROUGH
SEROSA C : LYMPH NODE SECONDARIES D : DISTANT SPREAD