pathophysiology of adenocarcinoma, moderately differentiated

Exposure to carcinogens rectal cancer Heredity

Family history of Polyps

Inflammatory Bowel Disease fiber)

Pathophysiology of Moderately Differentiated Adenocarcinoma, Ano- Rectal Mass, Stage IV Diet (high fat, low

Affects normal cells

Mutation in DNA mismatch repair genes

Proto-oncogens transforms to oncogenes Tumor suppressor genes is turned off

Negatively affects the DNA repair at the crypt surface

Cells grow and divide very quickly

DNA repair genes is inactivated Inability to control proliferation of affected cells

inactivation of the adenomatous Polyposis coli gene Allows unchecked cellular replication

Increased cell division

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 altered cells located in the superficial portions of the mucosa

transformation takes place among the stem cell population at the crypt base

abnormal cells spreads laterally and downward to form new crypts

transformed stem cell replicated

connects to pre-existing crypts and replaces them

monoclonal conversion produces the monocryptal adenoma

undergoes differentiation and maturation loss of proliferation control

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 Endoscopy reveals circumferential Affects the rectum Ulcerating,friable mass measuring 9cm Length starting from the anal verge Affects adjacent structures local lymph nodes

rectal exam was done

Endoscopy was done showing extension of calcified Of tumor in the post vaginal wall right lower lobe Speculum exam was done revealing 1 cm Ulceration on post vaginal wall

vaginal bleeding

biopsy was done revealing well – differentiated adenocarcinoma of the ano-rectalmass

enters the lymphatic vessels

Extends to the vaginal wall

spreads to regional and

chest x-ray was done with impression pulmonary nodule in the

Foul smelling discharges

Changes in diet tumor tends to bleed or Due to ulcerating mass Anorexia

bowel obstruction

Hematochezia

invades or compresses nerve trunks

back pain

pelvic pain

tramadol and

nalbuphine was given

loss of weight

Body weakness

serum electrolytes was done

colostomy is performed

Loss of blood

Hemoglobin of 92 g/L And hematocrit of 0.27 g/L From CBC

Anemia

abdominal pain

Changes in bowel habits

CBC, typing, platelet count was done Loose bowel movement 2 units of PRBC given

Pallor

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Manifestations/signs and symptoms Procedures/ Diagnostic Tests Management / interventions Predisposing factors / causes

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Affectations of Ano – Rectal Mass