Exposure to carcinogens rectal cancer Heredity Inflammatory Bowel Disease fiber) Affects normal cells Polyps

Family history of

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

Mutation in DNA mismatch repair genes

Proto-oncogens transforms to oncogenes Tumor suppressor genes is turned off inactivation of the adenomatous Polyposis coli gene Allows unchecked cellular replication

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

Increased cell division

Increases survival and proliferation of cancer cells causes further mutations Activation of the k-ras oncogene P53 mutations

Springs out from the colon

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 Activated oncogenes Mutation and inactivation of p53 gene crypt cells migrate from the base To the surface transformation takes place among the stem cell population at the crypt base transformed stem cell replicated monoclonal conversion produces the monocryptal adenoma undergoes differentiation and maturation loss of proliferation control abnormal cells spreads laterally and downward to form new crypts connects to pre-existing crypts and replaces them mucosa in the large intestine Regenerates

Forms epithelium composed of genetically altered cells located in the superficial portions of the mucosa

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 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 rectal exam was done enters the lymphatic vessels spreads to regional and biopsy was done revealing well – differentiated adenocarcinoma of the ano-rectalmass

vaginal bleeding Extends to the vaginal wall Foul smelling discharges

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

Changes in diet tumor tends to bleed or Due to ulcerating mass Anorexia Hematochezia nalbuphine was given

bowel obstruction

invades or compresses nerve trunks

back pain

pelvic pain

tramadol and

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 2 units of PRBC given

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

Anemia

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

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