Colon Cancer: Hispanic Negligence – Medical Science Assignment Help

Assignment Task

Pathophysiology

Colon cancer can begin in any part of the large intestine from the cecum to the rectum. Normally, these structures would contain a smooth lining which would allow for fecal material to move through the haustra at a consistent pace. However, colon cancer, also known as Colorectal Cancer, Oberleitner (2020) said “It is a disease characterized by the development of malignant cells in the lining or epithelium of the large intestine (p. 1256). This process begins with the formation of polyps There are two kinds but only adenomatous polyps, also known as adenomas, are considered as precancerous. When they become cancerous, they are then referred as adenocarcinomas. This means that they originate in glands that secrete mucous to lubricate the epithelium of the large intestine. Adenocarcinomas account for more than ninety-five percent of all colorectal cancer.

Orberleitner (2020) stated that these cancerous growths can either “partially or completely penetrate the entire wall of the large intestine as well as adjacent structures and organs” (p.1257). They metastasize to different locations by two systems, the vascular system via arterial and venous blood supply and the lymphatic system via the lymph fluid and lymph nodes. Lymph nodes are crucial when it comes to metastases because they contain high amounts of proteins that are critical in gene expression. When they spread they are classified as either regional or distant metastases. In regional metastases, this means the spread has occurred in nearby lymph nodes or in an adjacent area to where the tumor began. In distant metastases, the means the spread has occurred in distant areas . Possible areas that the cancer can spread to are the peritoneum, liver, lungs, and the brain. (American Cancer Society, 2020)

Causes and Risk Factors

So what causes the formation of these polyps? It is important understand that with colon cancer, the probability of developing it depends on several factors instead of one. As for one cause, it is genetic mutations. According to Howell and Jones (2021), for colon carcinogenesis to occur, there can be four mutations but not all mutations are necessary for the development of colon cancer at once (p.448). The rate of cellular division is controlled by mediating proteins that act as switches for by telling the genes controlled for growth what to do. When a mutation occurs and they become oncogenes, the proteins they create alter the cells growth rate to increase rapidly. Another type of genes are tumor suppressor genes which affects a cell’s ability to stop growing. Mutations to tumor suppressor genes the the cell continue to grow because it doesn’t know when to stop. Four possible mutations of these genes are Adenomatous Polyposis Coli, or APC, K-ras gene, DCC gene, and p53 gene. APC mutations can be inherited, from a condition called Familial Adenomatous Polyposis which is basically when someone has a very large amount of polys. Mutations to the APC gene can happen over time as well. If other mutations on top of the APC gene, the growth rate of the polyps will become progressively worse.

Besides they stated that besides having genetic mutations, there are other risk factors that cannot be control as well as some that can be controlled. (American Cancer Society,2020). As for risk factors an individual can not control, these include older age, specifically fifty years of age or older, and having Type two Diabetes. If an person has Chron’s Disease or Ulcerative Colitis, which are inflammatory bowel diseases, this can increase the risk as well. Being African American as well as having a background of Jewish or European Decent can put you at a higher Risk. As for factors that an individual can control, these include: physical inactivity, obesity, smoking, and alcohol. Diet is a factor one can also control. If an individual consumes higher amounts of red meat or processed meat, this can increase the chances of colon cancer. Other diet modifications that can influence colon cancer a low amount of fruit and vegetable intake, as well as Vitamin B levels.

In a study from the University of Osijek, they look at the importance of diet and lifestyle habits in a population that has a diet that is considered to by at a high risk for colorectal cancer. Specifically, this study focuses on the impact Vitamin B12 has on the population of Croatia, since its function is to help in DNA repair and replication, as well as gene [removed]Banjari and Kozic, 2018). Vitamin B12 comes from animal sources such as meat, poultry, fish, eggs, milk and dairy and is very permeable in entering the bloodstream. They stated that Vitamin B12 would normally be absorbed unless they have disturbances in the gastrointestinal system, like any acute or chronic inflammation such as Chron’s disease and Ulcerative Colitis. The main concerns in the diet of this region is the high intake of red meat, processed meat, and saturated fats. The demographic of this study was a total of two hundred Croatians between the ages 18 and 75, excluding omnivores and those with serious medical diagnosis, but including those who have no regular use of medications. They were given a questionnaire based on diet, and lifestyle while also being given a semi-quantitative food questionnaire that focused the frequency of foods with vitamin B12. The total score was out of one hundred and five. Scores less than seventy-four meant the person was of high risk, while scores above seventy-four meant the person was at low risk of colorectal cancer. The results of the scores were 52.2% of people were in high risk, while 47.8% were at low risk. The results showed that meat, milk and diary all showed the strongest correlation of Vitamin B12. For men, meat was the main contributing food for Vitamin B12 intake, while for women it was milk and dairy. Although meat was leading dietary source of Vitamin B12 and although there were similar intakes, meat had lower plasma concentrations of Vitamin B12 than that of milk and dairy. This means that if you one were to have specific levels of Vitamin B12 from milk and dairy, another person has to take in more meat to reach the same concentration levels. Not only did these people eat high amounts of red meat, they also ate few amounts fruits and vegetables. From the results, the Croatian women had better lifestyle and dietary habits than men.

Symptoms

Once the body have the cancerous lesions, the tumors don’t always influence the presence of symptoms. According to Mayo Clinic (2021), “many patients may be asymptomatic, especially during the early stages of the disease”. That is because the polyps themselves don’t cause symptoms. It is when they turn into tumors, symptoms start to appear. This depends on the size, location, and the degree of obstruction these tumors grow. As for any noticeable changes to the body, an individual may experience changes in their bowel movements. That includes, and is not limited to, diarrhea, constipation, and changes in the stool’s consistency. The person may experience cramping in the anus. Following an obstruction, other symptoms can include an individual experiencing rectal bleeding or and become anemic. Because of this, Individuals may become fatigued and in the later stages, they may have severe weight loss due to the amount of obstruction or how much it has metastasized.

Diagnosis and Staging

When an individual shows symptoms or is asymptomatic with some risk factors, it is important for them to go undergo the screening process. In the article from Dragovich (Medscape), it was stated that there are two types of tests that are used for screening which focused on examining the stools and examining the colon and its structures (2021). There are three kinds of stool based test that primarily focus on the detection of cancer which are Annual Guaiac-Based Fecal Occult Blood test (gFOBT), annual Fecal Immunochemical Test (FIT), and stool DNA tests which are done every three years. Both gFOBT and FIT look for blood in stool. This is a result of the large and fragile blood vessels on polyps that get torn when stools pass by. This causes an individual to be anemic over time. As for the DNA stool test, it looks for polyp cells in a stool which are then used to find DNA mutations of genes. Structural exams focus on the detection of cancer and polyps. There are four exams that can be done. A colonoscopy, which is the most common, is done every ten years. A sigmoidoscopy, similar to a colonoscopy but doesn’t examine the entirety of the large intestine, a double-contrast barium enema, and a CT colonography are done every five years. Only in a Sigmoidoscopy and Colonoscopy can tissues be sampled for biopsy

In the article by Taylor (Medscape), the modalities Radiography, CT, MRI, Ultrasound, Nuclear imaging, and Angiography are all used in the evaluation and diagnosis of colon cancer. (2021). In radiography, abdominal radiographs are used to look for obstruction in the colon. As for a DCBE, although it’s been approved for screening, it has not been used as much as other screening tests because of the high false-positive rate. Regarding the classification of polyps in a DCBE, they are classified by their shape being labeled as either polypoid, annular, or flat lesions. Polypoid lesions can be any size and are irregular shaped. Annular lesions are a result circular masses that cause severe constriction. Flat lesions unilateral and broad. Although MRI is helps in staging and is used for determining liver metastases, CT if the primary choice for diagnosis, staging of colon cancer and treatment planning. The use of CT colonography, otherwise known as a virtual colonoscopy, is being implemented as the alternative for the standard colonoscopy which is more invasive. Unlike regular CT which takes images on two planes, CT colonography takes images from three planes to create a 3D image of colon.

When it comes to finding out what stage the cancer is in, there are three characteristics that are of interest: the size of the tumor (T), the spread to nearby lymph nodes (N), and metastases to distant lymph nodes or organs (M). The American Cancer Society (2020) stated that the staging is in accordance with the classification presented by the American Joint Commission on Cancer and there are variation in each of the five stages from 0 through IV. From stage 0 to stage II, there is no cancer spread to the lymph nodes or metastases occurring. Stage 0 has no growth beyond the mucosa. Stage I has two possible variations in which growth occurs through the muscularis mucosa into the submucosa (IT1) or into the muscularis propia. Stage II has two variations with IIAT3 and IIBT4a, with IIBT4a being the first stage in cancer passing through the wall of either the colon or rectum, but has not metastasized to other organs. Stage III has eight variations. In this stage, serious changes have occurred. Depending on the number of lymph nodes it has spread to, fat areas near lymph nodes, and if it has passed through the visceral peritoneum to either nearby tissues and organs or none at all, they would be classified as the higher the lettering or numbering, the more severe it would be. Stage IV has three variations key differences being in metastases: M1a, M1b, and M1c. All vary in the amount of distant organs the cancer has spread and if it has spread to distant parts of the peritoneum.

Treatment

Treatment for colon cancer depends heavily on what stage the cancer is in, there are five possible treatments (Oberleitner, 2020). Surgery is the most common treatment used for the majority of stages. If it was the primary therapy method, a Colectomy or Partial Colectomy may be performed. During this procedure, sections of the colon that contain the tumor and adjacent structures, such as blood supply and lymph nodes, are extracted to make sure the cancer is gone. The risks of having a Colectomy is improper healing from anastomosis, or the reattachment of structures, such as the two ends of the colon. If anastomosis cannot occur, the individual would have to have a colostomy bag. They would keep the bag until anastomosis is safe to perform but in most cases, this is permanent and irreversible so they would have to live with a colostomy bag for the rest of their lifetime. Often times, Radiation Therapy is used coincide with surgery is to terminate the probability of a recurrence. However, since the bowel is sensitive to radiation, precautions with dose limits must be considered since this organ does not react well with radiation. Chemotherapy is also used to prevent those with a very recurrence risk, such as stage II and III. For stage IV, chemotherapy can be used before and after surgery to try and eliminate the cancer cells and some normal cells that have the potential to for recurrence, such as cells that were nearby the tumor and its surrounding structures. Targeted therapies are like chemotherapy instead they focus on eliminating cancer cells by focusing on their proteins, due to the mutations. So for this, they may also be used in stage IV. Immunotherapy is another treatment that a can be used which focuses on the stimulation of the body’s immune system to aid shrinking tumors and controlling its rate of division. Since this is helpful for those with genetic mutations as well, this makes the treatment viable for those in Stage IV as well.

Prognosis

For the outlook of colon cancer, according to the American Cancer Society (2021), helps in determining the success of a treatment will be for those with same cancer and its stage, which is usually five years after an individual has been diagnosed. With that, SEER and the National Cancer Institute put out statistics regarding a five-year relative survival rate. However, SEER does not use stats regarding specific stage and instead categorizes the cancer based on its spread level. Statistics on Colon Cancer that were taken between 2010 and 2016 show that a person who’s cancer did not metastasize show a ninety-one percent chance of survival rate from the time of diagnosis. If the person had regional metastases, the survival rate dropped to seventy-two percent. Those with Distal metastases dropped even further to a fourteen percent survival rate. There are limitation on SEERS statistics. They only apply after its been diagnosed. They don’t look at overall health. The outlook will be better as years go by with the improvements of treatments.

Minority Inquiry and Conclusion

So how does this affect the Hispanic community with its mortality rate being on the progressive decline compared to other groups? In a Journal article by Wittich, there was a study that focused on the Hispanics and their perception on Colorectal cancer and its screening options. The results showed fifty-nine percent of Hispanics have never been screened. Overall, although many participants were not well informed about colon cancer, they were able to guess some risk factors. One concerning finding was when asked questions regarding the cancer, those who were less informed or with an education level that of at least secondary school, preferred not to know more about it or hold off getting tested. Other common thoughts were feelings of embarrassment and invasion of privacy. Some had struggles that involved having no insurance or needing to pay high deductible rates and stated that things may be different if it were otherwise.

An example of someone who was affected by Colon Cancer was a thirty nine year old Hispanic male. He was diagnosed with metastatic rectal cancer for his first time visit. He had a colonoscopy performed which showed a cancer lesion that was ten centimeters from the circumferential anal margin. He also had an Abdominal and Pelvic CT scan which showed a mass in the junction between the sigmoid colon and rectum and there were hepatic lesions that suggested distal metastases. For treatment, he had a partial colectomy that between the sigmoid colon and rectum. He went through six cycles of chemotherapy to then begin palliative care due do the systemic disease. After the progression of two years, he had a moderately differentiated adenocarcinoma in ninety percent of the perimeter of the colon wall. It was 5 x 4.2 x 2.4 cm which was located in the perimeter in 90% of the colon wall that was located 0.2 cm from the edge of the surgical incision and it infiltrated through the entirety of the nearby adipose tissue. The mass of three distal lymph nodes ruptured and invaded the nearby adipose tissue. His prognosis was a bad medium term. He showed fatigue and extreme weight loss.

As someone with a Mexican background, diet is an aspect that we should be very mindful when it comes to health as healthy habits can reduce being high risk to Colon Cancer since our diet for example isn’t on par as to being low risk. Just as Barzi stated, the mortality rate for Hispanics isn’t the same as other groups. With advancements in treatments and early detection, they should be going down the same for everyone. However, one aspect that could be studied more is the psychology aspect Hispanics and why they would tend to hold off on getting screened. My belief is that it machismo plays a part in that, but how can someone measure machismo behavior. Another is how can screening process become more affordable for those who would like to but don’t have the means to. How do different diets in the Hispanic community differ and where to they fall in terms of risk? From personal experience, although Mexicans eat a variety of fruits and vegetables, we do tend to eat high amounts of red meat. In terms of educating the Hispanic community, how can we bring forth information that would help, especially those in towns where they might not be well informed. Could the life of the patient who passed away been prevented if he knew the importance of getting screened and having available resources to him.

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