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Exposure to carcinogens Family history of

rectal cancer
Pathophysiology of Moderately Differentiated
Heredity Polyps
Adenocarcinoma, Ano- Rectal Mass, Stage IV
Inflammatory Bowel Disease Diet (high fat, low
fiber)

Affects normal cells

Mutation in DNA mismatch repair genes Proto-oncogens transforms to oncogenes

Tumor suppressor genes is turned off inactivation of the adenomatous


Polyposis coli gene

Negatively affects the DNA repair Cells grow and divide very quickly Allows unchecked cellular replication
at the crypt surface

DNA repair genes is inactivated Increased cell division

Inability to control proliferation of affected cells Increases survival and proliferation of cancer cells causes further mutations

Springs out from the colon Activation of the k-ras oncogene

P53 mutations
Prevent apoptosis

Prolong lifespan of affected cells

Continuous replication of affected cells

Increases number of malignant cells

Invades the epithelium of the bowel wall

Loss of methyl groups in DNA mucosa in the large intestine

Regenerates
Activated oncogenes

Mutation and inactivation of p53 gene crypt cells migrate from the base
To the surface

Forms epithelium composed of genetically transformation takes place undergoes differentiation


altered cells located in the superficial among the stem cell population and maturation
portions of the mucosa at the crypt base

loss of proliferation control


abnormal cells spreads laterally and transformed stem cell replicated
downward to form new crypts

connects to pre-existing crypts and monoclonal conversion produces


replaces them the monocryptal adenoma
expands early by crypt fission

extends to adjacent crypts

ADENOCARCINOMA performed exploratory laparotomy

Crosses the muscularis mucosa

Abdominal ultrasound was done considering rectal


mass
Extends to the terminal end of the colon

Anus
ANO-RECTAL MASS biopsy was done revealing well –
differentiated adenocarcinoma of the
ano-rectalmass
Endoscopy reveals circumferential Affects the rectum rectal exam was done
Ulcerating,friable mass measuring 9cm
Length starting from the anal verge
Affects adjacent structures enters the lymphatic vessels spreads to regional and
local lymph nodes

Endoscopy was done showing extension vaginal bleeding chest x-ray was done with impression
of calcified
Of tumor in the post vaginal wall Extends to the vaginal wall pulmonary nodule in the
right lower lobe
Speculum exam was done revealing 1 cm Foul smelling discharges
Ulceration on post vaginal wall
Changes in diet tumor tends to bleed or bowel obstruction invades or compresses nerve trunks
Due to ulcerating mass

Anorexia Hematochezia back pain pelvic pain tramadol and

nalbuphine was given

loss of weight serum


electrolytes
was done colostomy is performed abdominal pain Changes in bowel habits

Body weakness Loss of blood CBC, typing, platelet count was done
Loose bowel movement

Hemoglobin of 92 g/L Anemia 2 units of PRBC given


And hematocrit of 0.27 g/L
From CBC

Pallor
Legend:

- Manifestations/signs and
symptoms
- Procedures/ Diagnostic Tests
- Management / interventions
- Predisposing factors / causes
- Affectations of Ano – Rectal
Mass