Cancer and its treatment can causediscomfort and affect how you can lead a life on your own. However, a medicalfocus in a specialized area called palliative care is the prevention, managementand alleviation of the symptoms and treatment of cancer and any side effects.
It also provides full support for cancer patients and their families. Anyone,regardless of age, type and stage of cancer, can receive palliative carebefore, during, and after treatment. Palliative care is a way of preventing andalleviating suffering through early identification and impeccable assessmentand treatment of pain and other problems, thus improving the quality of life,the mentality and the spirit of life of patients and their dependents livingwith life-threatening diseases (WHO, 2012). I want to present a patient mind changefrom newly diagnosis of Caecal Tumor.
Mr. Chan TW is 65 years old. He admittedfor abdominal distension since September of 2017. He complained with mildabdominal pain for 7/10 point and gastric reflex with no nausea or vomiting.And mild shortness of breathing noted. Vital signstable and SaO2 92% in room air when he warded. 0.5L/min O2via nasal cannula given to patient.
SaO2 increase to 97%. Hehas hypertension, gouty, high cholestenone follow up Hospital AuthorityGovernment Clinic on medication of Norvasc, Losartan and Simvastatin. And hehad stroke before with good recovery over 13 years. The last Oesophago Gastro Duodenoscopydone over 20 years ago. No regular checkup for Gastrointestinal Endoscopy.
Hehas 2 sons. One of his son live with him and the other one work and live in TheUnited States of America. He lives in a private estate with his younger son andhis wife. He retired from the job of taxi driver. Dr. Tsang is his main careprovider.
He is the specialist of Gastroenterology. Abdomen X Ray and Blood taking done in thefirst day of Mr. CHAN TW admission. Gamma glutamyl transferase (GGT) blood testis high 1.59µkat/L. Abdomen X Ray shown There is no abnormal dilated bowel loopidentified.
No significant air fluid level identified. No free gas is seenunder diaphragm. The abdomen appears distended. Both renal outlines areobscured by bowel shadow. There is no definite radiopaque calculus seen aroundboth renal regions. No definite bony erosion is seen.
Bilateral lung bases mildatelectatic changes are noted. There is no special finding from the report ofAbdomen X Ray. And we can exclude the problem of Intestinal Obstruction. Therefore,further investigation needed.Dr. Tsang prescribed CT low dose lung andCT Whole abdomen (Plain + Contrast) in next day.In the report of CT low dose lung, severalsmall lung nodules are noted in both lungs with the more sizeable one is seenin the left upper lobe and measures about 0.
34cm. These are too small to bewell characterized. Bilateral lung basal atelectatic changes are noted. Milddegrees of bilateral pleural effusions are noted. Right apical mild pleuralthickening noted. Small right lung cyst is noted. Central airway is patent.
Bilateral proximal airways are mildly prominent. We can be identified thereason of mild shortness of breathing, as the pleural effusions in bilaterallung. We need to reduce the shortness of breathing problem which may also causethe anxiety.In the report of CT Whole abdomen (Plain +Contrast), Moderate amount of ascites is noted. There is peritoneal wallthickening.
Streakiness and nodularity is noted in the mesenteric fat. Several hypo-enhancingnodules are noted in the left lobe of the liver with sizes measures about2.77cm x 2.94cm.
There is dilatation of the intrahepatic duct in the lateralsegment of the left lobe of liver likely due to compression by the masses.These are suggestive of tumor which can be primary tumor such ascholangiocarcinoma or due to metastases. Hepatocellular carcinoma is consideredless likely. Small cyst is noted in the right lobe of the liver. CBD and theright intrahepatic duct are not dilated. Hepatic and portal veins appearpatent.
There is a 3.42cm x 2.37cm x 2.35cm irregular enhancing mass lesionseen near the appendix and the caecum. Feature is suggestive of tumor and canbe due to carcinoma or metastasis. The serosal outline is irregular.
rightsided mesenteric lymph nodes are noted with sizes measure about 0.54cm. Small0.74cm left para-aortic lymph node is noted. These are nonspecific andpossibility of early nodal metastasis cannot be excluded Follow up will behelpful.
Spleen and pancreas are unremarkable. Bilateral renal cortical cystsare noted. Both renal sizes and perfusion are satisfactory. No hydronephrosisor renal calculus. There is no focal adrenal mass. Bladder is not distended andshows no gross mass lesion. The prostate is mildly prominent in size.
The bowelloops are not dilated. Hiatus hernia is noted. Moderate amount of ascites isthe main cause abdominal distention and the reason of abdominal pain. Featureis compatible with peritoneal metastasis. Correlation with analysis of theascitic fluid will be helpful for confirmation.And the colonoscopy with polypectomy donein next day.
And diagnosed there are multiple caecal diverticulum and there isa caecal tumor. To release the pressure of the abdominal distension and thepain, ultrasound guided ascites drainage done in the same day and ascitic fluidsent for the cytology exam. Atypical cells present in the specimen, suspiciousof malignancy. After the ascites drainage inserted, Mr. Chan TW verbally saidfeel much more comfortable with decrease of abdominal pain and decrease shortof breath symptom.
And second blood taking for CA19.9 42.7IU/mL is noted. In Physical problem, Mr. Chan TW complaintwith a server pain over abdominal area with 7/10 pain score on and off of distendingpain. He may experience unnecessary fatigue, depression, anger, fear or stress.We try to find a solution will help him stay active, sleep better and improve hisappetite.
It will also help him enjoy activities and time spent with family andfriends. Oxycodone was given for better pain control. Sometimes, care andgetting support can also relieve some of the physical and emotional stress thatoften make pain worse.Mr. CHAN TW loss his appetite. He may eatless than usual, and not feel hungry at all, or easily full after eating only alittle.
Ascites may produce a feeling of fullness. Loss of appetite can lead toserious complications. He will be losing weight and not getting nutrition fromthe foods for the body needs, and loss the muscle mass and strength. And we talkwith him to find the cause and what supplement or nutrition he need.Mr. Chan TW complaint nausea and vomiting.
it can be prevented with appropriate medications. Zofran was prescribed for nauseaand vomiting.