GOLDEN GATE COLLEGES

P. PRIETO ST., BATANGAS CITY

COLLEGE OF NURSING, SCHOOL OF MIDWIFERY AND CAREGIVING

CASE STUDY

RECTOSIGMOID ADENOCARCINOMA

RLE GROUP 3A2

Buhat, Fatima Mae R.

Buisan, Aniway F.
Cabatay, Sharnelle Nicolle A.
Clarin, John Michael F.
Cruz, L-Jay
De Castro, Maria Aliza Gwen D.
Galdiano, Paula Angela P.

Clinical Instructor

Mrs. Gypsyrose Arojado, RN

I. INTRODUCTION
 Colorectal cancer begins when healthy cells in the lining of the colon or rectum change and
grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A
cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A
benign tumor means the tumor can grow but will not spread. These changes usually take years
to develop. Both genetic and environmental factors can cause the changes. Colorectal cancer
can begin in either the colon or the rectum. Cancer that begins in the colon is called colon
cancer. Cancer that begins in the rectum is called rectal cancer. Most colon and rectal cancers
are a type of tumor called adenocarcinoma, which is cancer of the cells that line the inside
tissue of the colon and rectum.

Rectosigmoid is a portion of the large intestine in which the narrow sigmoid colon
undergoes enlargement before joining the rectum. The rectosigmoid serves as a storage area
where stool water is further recovered through absorption.The rectosigmoid region is a
common location for the development of both malignant and benign diseases of the large
bowel in adults. In immunocompetent individuals, these diseases predominantly include
colorectal adenocarcinoma, the second leading cause of cancer death, with cumulative time of
risk of 5% inflammatory disease, with combined incidence of ulcerative colitis; Crohn’s
disease. Symptomatology most preferable to the rectosigmoid region includes left tower
quadrant and perineal pain. Approximately 10% of colorectal cancers are located at the
rectosigmoid junction.There are substantial differences between treatment strategies for
sigmoid colon cancer and those for rectal cancer. The benefits of magnetic resonance imaging
(MRI)-directed multidisciplinary treatment including radiation, chemotherapy, or both, for rectal
cancer have been well established and standardized. Colorectal cancer is the third most
common cancer diagnosed in both men and women in the United States. The American
Cancer Society’s estimates for the number of colorectal cancers in the United States for 2023
are: 106,970 new cases of colon cancer, and 46,050 new cases of rectal cancer.

II. CLINICAL HISTORY

A. Patient’s Profile

a. Biographic Data

Name: Patient X

Age: 61 years old

Date of Birth: December 26, 1961

Sex: Male
Address: Purok 7, Sitio Tubigan, Conde Itaas, Batangas CIty Batangas

Religion: Roman Catholic

Nationality: Filipino

Civil Status: Married

Weight: 65 kg

Height: 5’7 m

b. Admission Data

Name of hospitals: Golden Gate Batangas Hospital Inc.

Case Number: 23-1653

Date of Admission: August 24, 2023

Time of Admission: 5:17 pm

c. Vital Signs Upon Admission

Temperature:

Heart Rate:

Respiratory Rate:

Blood Pressure:

02 Stat:

d. Chief Complaint
Rectal Bleeding

e. Source of Information
The main or primary source of information is the patient and patient’s relatives.

f. Final Diagnosis
Rectosigmoid Adenocarcinoma ST. IV
 T4NIMI (?) (Lung Metastasis)

B. Present Illness History

Two weeks ago prior to admission, patient X experienced a decrease of appetite, weight
loss, abdominal and rectal pain and occupational rectal bleeding. During assessment, the patient
expressed pain. Also, patient X experienced weakness and difficulty of breathing. This sought the
patient to seek medical advice at Golden Gate Batangas Hospital Inc.Patient X underwent
Exploratory laparotomy, anterior resection EN block Limited right Hemicolectomy. His family
accompanied him and answered questions during assessment.
Upon physical examinations, he was showing extremely abdominal pain. He had a blood
pressure of mmHg. His temperature is , pulse rate is and the respiratory rate is
beats/min. And his oxygen saturation was .

C. Post Medical History

Patient X has no significant history of past surgery. Patient X was a smoker for almost 10 years.
The patient's relatives told me that patient X can smoke 5 sticks per day. He also drank alcohol for
almost 10 years, and he also had an allergy but unknown. Patient X had a history of hypertension.

D.Family History

Patient X was a male and 61 years old. Him and his family lives in Purok 7, Sitio Tubigan, Conde
Itaas, Batangas CIty Batangas. Patient’s relatives revealed that they had a history of hypertension.

III. PHYSICAL ASSESSMENT

CATEGORY NORMAL or IF ABNORMAL,

ABNORMAL DESCRIBE BELOW
Head and Scalp Normal
Eyes Not normal Eyes are dry, poor eyesight
Ears Not normal Dry skin, hearing loss
Nose Not normal Patient showed nasal flaring
Mouth/lips/tongue Not normal Patient mouth is dry,
wrinkled,and “nakaikom”,
also, the mouth is open
during assessment due to
dyspnea, Difficulty of
speaking

Neck Normal
Chest/Breast Not normal Positive of dsypnea,
tachycardia, and wheezing
sound
Arms/hand/nails Not normal Dry, yellowish colored, flaky
skin, nails are clubbing
Abdomen Not normal Dry skin, distended
abdomen, patient non-
verbalized pain in the
abdomen
Legs/feet Not normal Positive in edema, dry skin,
flaky

IV. ANATOMY AND PHYSIOLOGY

The rectum is the end part of the large intestine that connects the colon to the anus. It is
the area where a person holds stool before excreting it from the body. The sigmoid colon is
part of the hindgut. It is the last part of the colon before the rectum.
 The main function of the sigmoid colon is to transport fecal matter from the descending
colon to the rectum and anus. This function is carried out with peristaltic waves that move the
content of the sigmoid colon. Feces form in the descending and sigmoid colon and accumulate
in the rectum before defecation. In addition, another function of the sigmoid colon is to absorb
water, vitamins and other nutrients from the feces, before they are moved to the rectum.

V. PATHOPHYSIOLOGY

VI. LABORATORY TEST AND DIAGNOSTIC EXAMINATION

● Clinical Chemistry

TEST REFERENCE RESULT

Creatinine 58 - 110 umol/L 523

Na+ Sodium 135 - 148 mmol/L 155

K+ Potassium 3.50 - 5.30 mmol/L 5.00

Calcium 2.10 - 2.55 mmol/L 1.92

 Magnesium 0.70 - 1.00 mmol/L 1.20

Albumin 35 - 50 g/L 25

● Hematology

TEST REFERENCE RESULT

Red Blood Cell 4-6 x 10^12/L 4.30

WBC 5-10x10^9/L 27.13

Hematocrit 0.37 - 0.35 0.36

Hemoglobin 140 - 170 g/dL 115

MCV 86 - 110 fL 82.3

MCH 26 - 38 pg 26.7

MCHC 310 - 370 g/L 324

TEST REFERENCE RESULT

Segmenters 38.3 – 73.7% 94

Lymphocytes 18.0 – 48.3% 3

Bands/Stabs 0 – 0.07%

Eosinophils 0.80 – 7.30%

Monocytes 4.40 – 12.7% 3

Basophils 0.00 – 1.70

Platelet Count 150 – 450 x 10^9/L 380

● Arterial Blood Gas

PARAMETERS REFERENCE RESULT

PH 7.35 - 7.45 7.299

PC02 35 - 45 mmHg 14.9 mmHg

P02 80 - 105 mmHg 71 mmHg

TC02 23 - 27 mmol/L 8 mmol/L

HC03 22 - 26 mmol/L 7.3 mmol/L

BEecf (-2) - (+3) mmol/L (-19) mmol/L

S02 95 - 98% 93%

PROGNOSIS

The most common site of metastases for colorectal cancer, which includes
colon cancer or rectal cancer is the liver. Colorectal cancer cells may also spread to the
lungs, bones, brain or spinal cord. If a patient has been treated for colorectal cancer and
cancer cells have been found in these areas, it may be a sign that the original colorectal
cancer has spread. Metastatic colorectal cancer is different from recurrent colorectal
cancer. Recurrent colorectal cancer is cancer that returns to the same part of the colon
or rectum after treatment, rather than spreading to other parts of the body.

Colorectal cancer is the second leading cause of malignancy and has a favorable
outcome if identified early. Along with regular screening, a better understanding of
commonly presenting symptom patterns would aid in earlier detection. This report
intends to acquaint clinical awareness with the patient’s history and presenting
symptoms.

When found early, colorectal cancer treatment is highly successful. The overall
5-year survival rate for rectal cancer is 67%, but this is affected significantly by various
factors, most notably the stage of cancer. If the cancer is diagnosed when it is in the
localized stage, the survival rate jumps to 89%. The 5-year survival rate is 71% if cancer
has metastasized to surrounding tissues or organs and or the regional lymph nodes.
However, with metastatic spread to distant areas of the body, the 5-year survival rate
drops to 15%.

DISCHARGE PLANNING

● Get up and move often. Use your pain medicine so you feel good enough to
move.
● Slowly increase your activity over time. Start by taking short walks on a level
surface.
● Do not lift or push anything heavier than 5 pounds.
● Ask your healthcare provider when you can go back to work. It depends on the
kind of work you do.
● If you have a stoma (colostomy or ileostomy), take care of it as directed.
● Wash your cut (incision) site gently with soap and water. Pat dry. Don't rub.
● Check your incision every day. Look for redness, fluid leaking, swelling, or edges
of the skin pulling apart.
● Take your medicines exactly as directed.
● Do not take any other medicine, vitamins, supplements, or herbs without the
approval of your healthcare provider.
● Follow any diet and fluid intake tips given and as directed by your attending
physician.
● Make a follow-up appointment as directed by our staff.