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Cancer is the uncontrollable growth of abnormal cells in the human body. It is defined by a malfunction in cellular mechanisms that control cell growth. Cells evade checkpoint controls and begin growing uncontrollably which resulting in an increase in abnormal cells, cancer cells. These cancer cells form a mass tissue known as a tumor. In the United States of America, cancer has been determined to be among the leading causes of mortality rates after cardiovascular conditions, where one in every four deaths is caused by cancer. The most common types of cancer include prostate cancer, lung cancer, and breast cancer. Risk factors for cancer include excess smoking, radiation exposure, genetics, and environmental pollution. Colon cancer, or colorectal cancer, affects the distal third of the large intestine, the colon, as well as the rectum, chamber in which feces is stored for elimination. Colorectal cancer is the third leading cause of death in cancer-related issues in the United States in both males and females (Beadnell et al., 2018). This essay explores the physiology and pathophysiology of colon cancer.
Polyps are tissue growths that generally look like small, flat bumps and are generally less than half an inch wide. They are generally non-cancerous growths that can develop with age on the inner wall of the colon or rectum. There are several types of polyps, such as hyperplastic. They are common and have a low risk of turning cancerous. Hyperplastic polyps found in the colon will be removed and biopsied. Pseudo polyps also referred to as inflammatory polyps, usually occur in people suffering from inflammatory bowel disease and are unlike other polyps. This type of polyp occurs due to chronic inflammation as seen in Crohn’s disease and ulcerative colitis. However, a polyp cells which can turn out to be malignant. Villous adenoma or tubulovillous adenoma polyps carry a high risk of turning cancerous. They are sessile and develop flat on the tissue lining the organs. They might blend within the organ, making polyps not easily identifiable and difficult to locate for treatment. Adenomatous or tubular adenoma polyps have a high chance of being cancerous. When a polyp is found, it must be biopsied, and then will regular screenings and polyp removal will follow.
An adenocarcinoma is a cancer formed in a gland that lines an organ. This cancer impacts the epithelial cells, which are spread throughout the human body. Adenocarcinomas of the colon and rectum make up ninety-five percent of all colon cancers (Chang, 2020). Colon adenocarcinomas usually begin in the mucous lining the spread to different layers. Two subtypes of adenocarcinomas are mucinous adenocarcinoma and signet ring cells. Mucinous adenocarcinomas contain about sixty percent mucus which can cause cancer cells to spread faster and become more hostile than typical adenocarcinomas. Signet ring cell adenocarcinoma is responsible for less than one percent of all colon cancer. It is given this name because of how it appears under a microscope. These cells are aggressive and are more challenging to treat. The symptoms of colorectal adenocarcinoma are abdominal pain, blood in stool, constipation or diarrhea, and weight loss. The standard treatment for colorectal adenocarcinomas is chemotherapy, surgery, targeted therapy, and radiation.
Gastrointestinal carcinoid tumors are another type of cancer that affects the rectum. These cells grow in nerve cells known as neuroendocrine cells which help in regulating hormonal production. Carcinoid tumor cells grow slowly and can also develop in the lungs and other parts of the gastrointestinal tract. They cause about one percent of all colon cancers and half of cancer found in the small intestines. Symptoms are different depending on the growth location of the tumor (Falanga et al., 2019). A tumor in the appendix usually has no symptoms unless it starts to obstruct the path from the appendix to the intestines, causing appendicitis symptoms such as fever, vomiting, and nausea. Carcinoid tumors sometimes make hormones that might lead to a variety of symptoms that are dependent on produced hormones. Patients suffering from these tumors can experience flushing in the face, wheezing, quick heartbeats, and diarrhea. Tumors in the colon can cause weight loss, tiredness, stomach cramps, and pain. Gastrointestinal carcinoid tumor treatment options are similar to those of the aforementioned treatments.
Anorectal melanoma is a rare cancer that starts in the anus or rectum. This cancer can develop anywhere in the large intestines or rectum and spread aggressively. Melanomas are estimated to affect less than two percent of colon cancer. It rarely occurs; however, it is very aggressive and challenging to treat. This type of cancer can be easily missed during initial and follow-up diagnoses because it is rarely seen.
Familial adenomatous polyposis (FAP) accounts for almost one percent of all cancers in the rectum or colon. FAP is an inherited disorder distinguished from colon cancer, but some people can develop the abnormal gene that leads to this condition. People having this syndrome can create a lot of polyps in the colon as early as their teenage age. The patient’s colon has to be removed to stop the polyps from becoming cancerous. People with familial adenomatous polyposis keep increasing as they age because hundreds or thousands of polyps can grow in the colon as they age (Freidman et al., 2020). Patients with it may not have any symptoms at the early stages of the disease until it is in the advanced settings. The symptoms of familial adenomatous polyposis are abdominal cramps, unexpected weight loss, cysts of the skin, and lamps on the bones of the legs, arms, skull, and jaw. Treatment for this cancer can be the removal of the colon to curb the spread of the polyps which can cause cancer.
Pathophysiology of Colorectal Cancer
Pathophysiology is the combination of pathology and physiology. The study of the disordered physiological process associated with an injury or disease. Pathophysiology aims to explain the functional differences occurring within a person because of being sick. Colorectal Cancer or CRC can be sporadic, hereditary, or inflammatory bowel disease.
Sporadic colorectal cancer develops from the colorectum without known contribution from germline causes. Different mutations occur, which lead to CRC. Sporadic CRC is a somatic cell mutation that is a natural developmental process in the immune system. A bodily genetic disease might be caused by the local colonic environment and a person’s background genetic makeup (Ju et al., 2019). Two-thirds of all colon cancers are this type and are primarily seen in clinical practice. In sporadic CRC, we have mutations such as microsatellite instability or mutator pathway dysfunction. Microsatellite instability or MSI is a hypermutable phenotype resulting from DNA mismatch repair activity loss. MSI is found in about fifteen percent of colon cancers. Twelve percent are associated with sporadic and the other three percent with Lynch syndrome. This instability is caused by germline mutations in mismatch repair or MMR genes. MMR system proofreads as DNA is formed when it identifies an abnormality in sequence repairs to the DNA are made. MMR gene dysfunction allows DNA to increase at high speed. These mutations confer a selective advantage on the cells, leading to the cancer spreading. CpG Island Methylator Phenotype or CIMP is another mutation that happens. CpG Island Methylator Phenotype is brought by DNA methyltransferases that support hypomethylation in promoter-associated CpG enough regions with tumor suppressor genes turned off. The switching off the CIMP pathway, abnormal cells can develop, and malignant cells develop, which leads to the spread of colon cancer in the body.
Hereditary is another war cancer is spread. It is an inherited disorder with a high chance of contracting some cancers. Changes or mutations bring about hereditary cancer symptoms in specific genes passed from parents to children. In this case, similar cancers might be seen in the same family members who are close such as a father, son, and brother having the same cancer and developing it from early stages. Hereditary cancer includes Lynch Syndrome or LS. LS is an inherited disorder that increases the chance of contracting particular colon cancer. Patients with Lynch syndrome have a high probability of having stomach, brain, and skin cancer. There is an attempt to repair defective cells in the body. They form mismatch repair genes as these genes continue to accumulate errors. As the abnormal cells increase, this can lead to abnormal growth of cells and possibly cancer. Familial Adenomatous Polyposis or FAP is also caused by Adenomatous Polyposis Coli or APC gene mutation. APC gene issues instructions for developing APC protein. These mutations cause the production of abnormally short non-function APC proteins. The fast APC protein cannot prevent the cellular overgrowth that causes the formation of polyps in the large intestines which can become cancerous. People who have inherited FAP have a lot of polyps in their colons, and all those with this genetic disorder will have colorectal cancer. The patients must undergo early examination because the number of polyps in their colons might increase, and they have a high chance of getting cancer.
Inflammatory Bowel Disease or IBD is a common term given to describe disorders that involve chronic inflammation of the digestive tract. Types of IDs include ulcerative colitis, inflammation, and sores or ulcers along the superficial lining of the large intestines. Crohn’s disease is identified by inflammation of the lining in the digestive tract, including the deeper layers of the digestive tract (Szekanecz et al., 2019). Chronic inflation is caused by cytokines and chemokines. These are secreted proteins with development and activation functions that control and decide the nature of immune response and control immune cell trafficking at the cellular arrangement of immune organs. Patients suffering from IDB have a high chance of contracting colon cancer if they have contracted an IBD liver complication known as primary sclerosing cholangitis. Before sclerosing cholangitis inflammation that causes scars within the bile ducts, the spots make the ducts hard and narrow, causing severe liver damage.
Providing Care to Patients in a Holistic Manner
The provision of care in a holistic manner means providing care to patients who are majored in a mutual understanding of their physical, psychological, emotional, and spiritual dimensions. Nursers are in charge of health promotion. Nurses working with colorectal cancer or CRC patients can promote health by mobilizing patients to take screening for colon cancer. Nurses should have a bond with patients, which will help them communicate about screening and its importance. The patients who connect with the nurses can also be taught ways to prevent them from getting CRC and symptoms of the disease. A nurse should be compassionate to patients, understand their problems, and be present. CRC can be contracted because of a patient’s background. You have to ask them about their background, what they eat, and their overall lifestyle (Verkhratsky & Nedergaard, 2018). CRCs can also be inherited through genes asking patients if any conditions exist in their families to help find if that is the problem. There are rapid changes in health care, allowing nurses to identify patients likely to have CRC. Advancements have shown that CRC appears when a person is aging. It will help nurses talk to patients encouraging them to take screening to check if they have CRC. A holistic manner can work well if a nurse creates a good rapport with the patients and communicates effectively.
Cancer is spreading and becoming a significant health issue in society. Awareness has to be raised on cancer and how it affects people, the patients, and those close to them. There are many causes of cancer, such as pollution or exposition to radiation. These issues have to be looked into to help in reducing the spread of cancer. Colon cancer can be inherited genetically to avoid further spread, screening has to be done, and those having it undergo treatment with their children. To ensure that someone can grow without being worried about contracting cancer. Screening of people over forty years old should be started as some of these colon cancers start turning into cancerous tumors. It will help control the number of people affected with cancer and help them to get treatment before their condition becomes worse. Nurses should also be able to communicate with patients with colon cancers and form a good rapport with them to help each other out. Nursers should also figure out a colon cancer patient’s background, diet, and activities to help diagnose the patient. Nurses play a vital role in helping patients who have colon cancer.
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