Hematochezia : darah segar keluar dari anus, manifestasi tersering dari perdarahan

saluran cerna bawah

Tubular adenoma : An adenoma is a type of polyp, or a small cluster of cells that forms on
the lining of your colon.

CEA : A carcinoembryonic antigen (CEA) test is a blood test used to help diagnose and
manage certain types of cancers. The CEA test is used especially for cancers of the large
intestine and rectum.

Kolonoskopi : A colonoscopy is an outpatient procedure in which the inside of the large

intestine (colon and rectum) is examined. A colonoscopy is commonly used to evaluate
gastrointestinal symptoms, such as rectal and intestinal bleeding, or changes in bowel
habits.

Biopsi : Biopsi merupakan sebuah prosedur medis yang digunakan untuk mendeteksi
ketidaknormalan pada jaringan tubuh dengan menggunakan mikroskop.

Kolektomi : Kolektomi adalah operasi untuk mengangkat semua atau sebagian organ usus
besar. Pengangkatan juga dilakukan pada kelenjar getah bening terdekat.

Well differentiated adenocarcinoma : Well-differentiated cancer cells look more like normal
cells and tend to grow and spread more slowly than poorly differentiated or undifferentiated
cancer cells.
Metastasis adalah gerakan atau penyebaran sel kanker dari satu organ atau jaringan ke
organ atau jaringan lainnya.

Adjuvant chemotherapy is an approach to fighting cancer that combines different forms of

healing. Chemotherapy and radiation, or chemotherapy and surgery are used together.
Usually the chemotherapy will be used after all of the known and visible cancer has been
removed surgically or with radiation. Adjuvant chemotherapy aims to destroy hidden cancer
cells that remain but are undetectable.

1. Apakah usia dan jenis kelamin berpengaruh pada kasus tersebut?

Age-specific incidence rates were higher for men, for all life-time periods. However, the
magnitude of the male predominance was age-dependent. The RR and RD did not remain
constant over time: they increased gradually with age, peaked at 70–74 years, and declined
thereafter. The distribution of stage at diagnosis was similar between men and women, but
women seemed to have better survival, until the age of 64 years for colon cancer and 74
years for rectal cancer.

Estrogen has already been implicated in upper GIT cancers, such as esophageal and gastric
cancers, which, like CRC, are characterized by a higher incidence and mortality rates among
men, with a peak in male predominance at a certain age [17,18].Also in his research Wang
and friends demonstrated that people with high incidence of esophageal cancer have low
levels of estrogen compared to heathly subjects [19] This finding was supported by
experimental studies showing that estrogen regulates growth, cell differentiation, and cell
function in the GIT [20]. The possible protective role of estrogen in CRC has been suggested
in recent years by several lines of epidemiologic, clinical and experimental evidence [20,21].
For example, use of hormone replacement therapy was found to reduce the risk of CRC
[22,23]. Liang et al. [24] reported that the risk of second primary CRC was lower in
premenopausal women, but after age 55 years, incidence rates increased much more rapidly
in women than in men. The authors linked these findings to the corresponding decline in
estrogen levels with increasing age in women.

First, circulating levels of the main estrogenic compound, 17β-estradiol (E2), are largely
higher in women than in men, and they are age-dependent. During the child-bearing years,
from adolescence to the fifth decade, women are exposed to relatively high levels of
endogenous E2; however, after menopause, levels drop to close to those of men.

We hypothesize that in women, circulating levels of E2 may exert a cumulative protective

effect against the CRC carcinogenic process for up to 20–25 years after menopause. Such a
long period may represent the time needed for a normal mucosal cell to undergo
tumorigenic transformation and reach diagnostic size. As to the age-dependent survival
advantage of female patients, it is possible that CRC developing in high-E2 environments
may have a less aggressive biology, among other differences, than CRC developing in low-E2
environments.

2. mengapa pasien menderita hematocezia?

Hematochezia in colon cancer patients is not only an alert symptom, but is also correlated
with tumor location, tumor morphology, and circumferential involvement. However, it is not
a prognostic factor

for poor long-term outcome in non-metastatic colon cancer patients.

3. Mengapa 2 bulan?

4. mengapa pasien buang air besar berdarah tanpa disertai nyeri pada anus?

5. mengapa darah yang keluar bersama feses bewarna merah segar

6. bagaimana hub. keluhan pasien dengan kondisi pasien yang mudah lelah dan sering
berkunang-kunang?

7. apa sajakah kemungkinan penyebab pasien sering diare dan disertai nyeri perut

8. bagaimana hubungan keluhan dengan riwayat tubular adenoma di colon ascendens 10

tahun sebelumnya pada pasien
9. mengapa pasien mengalami penurunan berat badan hingga 10 kg?

In summary, the gastrointestinal tract plays an important role in metabolizing essential

nutrients such

as carbohydrates, proteins, and fats. Dieting, exercise, stress, and loss of appetite cause
temporary alteration in the metabolism of nutrients and cause weight loss in healthy
individuals.

Patients with cancer-related weight loss often lose significant amounts of adipose tissue.
Researchers have found that the lipid-mobilizing factor produced either by the tumor or the
host tissue may induce lypolysis (Tisdale, 2000; Todorov et al., 1996). Evidence to date
suggests that the presence of tumor in the body alters healthy cell processes and increases
cytokine production, thus contributing to the continuation of malignancy process. In
addition, proinflammatory cytokines such as tumor necrosis factor, interleukin-1, and
interferon a contribute to alteration in healthy biologic responses, causing muscle wasting
and loss of adipose tissues (Trujillo & Nebeling, 2006) and subsequently resulting in cancer
cachexia. Research also indicates that cytokines can increase patients’ perception of pain
and cause depression, cognitive impairment, peripheral neuropathy, fatigue, and lethargy
(Myers, 2008; Seruga, Zhang, Bernstein, & Tannock, 2008).

The presence of cancer affects patients’ biochemical and metabolic functions. As a result,
hypoxia and metabolite deprivation are observed commonly in patients with solid tumors
such as those seen in CRC. Tumors are prone to consume more glucose than healthy tissues
because of hypoxia and increased activity of glycolytic enzymes (Gatenby & Gillies, 2004),
leading to an increased metabolic demand on the liver and a consequent increase in energy
expenditure. In addition, cytokines produced by healthy cells as a result of the inflammatory
process alter the signals that regulate satiety and affect gastric motility and emptying, which
leads to the feeling of fullness. The feeling of fullness restricts patients from consuming
adequate amounts of nutrients and, therefore, leads to malnutrition and progressive weight
loss followed by cancer cachexia (wasting syndrome characterized by weight loss, anorexia,
asthenia and anemia)

Acute stress often transforms into chronic stress during subsequent stages of the cancer
illness trajectory. Similar to the stress response in healthy individuals, cumulative stress
causes catecholamine and cortisol hyperactivity, resulting in weight loss

10. interpretasi hasil pemeriksaan colok dubur pada pasien

11. interpretasi pemeriksaan laboratorium pada pasien

12. mengapa pasi en melakukan pemeriksaan kolonoskopi? apa interpretasinya? (massa

yang rapuh dan mudah berdarah pada colon ascendent)

13. mengapa setelah itu dilakukan biopsi?

14. apa interpretasi pemeriksaan biopsi?

15. mengapa bisa terjadi adenokarsinoma pada pasien?

16. mengapa dilakukan kolektomi pada pasien?

17. bagaimana interpretasi hasil pemeriksaan histopatologi dengan diagnosis well

differentiated adenokarsinoma T3N2AM0 dan jelaskan apakah itu

18. mengapa pasien direncanakan diberikan kemoterapi ajuvan?

19. mengapa dilakukan pemeriksaan mutasi kars dan nras?

20. apakah pengaruh kebiasaan pasien yang suka makan daging kambing dan sapi tapi tidak
suka makan sayur dengan keluhan yang diderita pasien?

Although there is still a long road to cover the gaps in knowledge on nutritional
determinants and dietary pattern on the CRC risk, several dietary suggestions and goals
could be summarized. In brief, diets high in energy, consumption of red meat or processed
meat, rich in food with high glycemic index (carbohydrates, snack food, and frying fast food)
and rich in omega-6 PUFAs which causes the imbalance in omega-6 PUFAs to omega-3
PUFAs ratio has been linked to an increased CRC risk. In contrast, consumption of white
meat, as well as plant and fish oils rich in omega-3 PUFAs might even reduce the occurrence
of colorectal cancer. Higher intake of dietary fiber lowers the CRC risk up to 50%. Diet rich in
vitamin D, E, and C, selenium, and magnesium, adequate amounts of daily water intake,
healthy bowel motility, have been considered to reduce the CRC risk. However, in many
cases, the results are inconsistent and depend on multiple interdependent factors, i.e.,
ethnic, anthropometric, gender, hormonal, environmental, and lifestyle. In addition to
dietary habits, all these agents are suggested to modify the risk of CRC.
21. mengapa pasien sering konstipasi dan apa hubungannya dengan keluhan?

On the other hand, the present study suggested an increased risk of colorectal cancer
associated with self-reported constipation and functional constipation.

The present study showed that tumor size, T stage, and distant metastasis were associated
with constipation severity in rectal cancer, as well as female sex and lower BMI, as reported
in previous studies

A tumour that presses on the nerves in your spinal cord can slow down or stop the
movement of your bowel. This causes constipation.

Tumours in the tummy (abdomen) can squash, squeeze, or narrow the bowel and back
passage (rectum) making it difficult for you to have a bowel motion.

Or a tumour in the lining of the bowel can affect the nerve supply to the muscles and cause
constipation.

22. bagaimana pengaruh kebiasaan pasien yang jarang olahraga dengan keluhan?

In an epidemiological study, it was observed that those who exercised for ≥ 1 h per week
had a lower prevalence of colon polyps and adenoma than those who exercised for < 1 h[17].
In this study, exercise decreased the risk of polyp development throughout the entire colon,
regardless of a specific area of the colon. In another study, exercise was reported to
decrease the total number of intestinal polyps by 50% and the number of large polyps by
67%[18].

Although the association between exercise and prevention of CRC is definite, the molecular
mechanism underlying the protective effect of exercise is yet unknown. The association
between exercise and cancer is explained through several mechanisms. These mechanisms
include metabolic dysregulation [involving insulin, glucose and insulin-like growth factor
(IGF)], sex hormones, adiposity [changes in adipokines (leptin andadiponectin)], oxidative
stress and inflammation and impaired immune function[42,92] (Figure (Figure11).

Insulin pathway
Insulin influences DNA synthesis, cell survival, proliferation and differentiation using various
cellular signalling pathways via insulin growth factor receptor IGF1R[93]. Elevated systemic
IGF1 levels are associated with CRC risk. Physical activity decreases insulin resistance and the
insulin levels affecting the IGF pathway and indirectly decreases the risk of CRC, recurrence
and mortality.

Inflammation

Inflammation plays an important role in cancer development and progression[104].

Although the underlying mechanisms are yet unclear, the inflammatory process appears to
be an important pathway associated with the risk of CRC. Physical activity can decrease
systemic inflammation and improve immune function[105]. Proinflammatory cytokines such
as IL-6, C-reactive protein and tumour necrosis factor (TNF)-α are associated with an
increased risk of cancer. Various studies have demonstrated the effects of physical activity
on IL-6 in the colon cancer model. In a study conducted by Mehl et al[106], a decrease in
plasma IL-6 was observed in APCmin/+ male mice after treadmill running. This result has
been shown to be associated with fewer polyps.

New preclinical studies have shown that inflammation is associated with polyp formation
and progression and that the cyclooxygenase isoenzymes (COX-1 and -2) particularly play an
important role in intestinal tumour formation[103]. Administration of nonsteroidal
anti-inflammatory drugs that inhibit the COX enzyme is known to be associated with a
decreased risk of colon cancer (RR: 0.60, 95%CI: 0.40–0.89)[107,108]. Physical activity results
in a local anti-inflammatory effect by decreasing COX-2 and iNOS (inducible nitric oxide
synthase) expression in the colon mucosa. Adipocyte, energy balance, insulin, adipokines,
estrogen and other factors known to play a role in carcinogenesis have been shown to affect
the inflammatory response.

Myokines

Myokine secretion from the skeletal muscles may be involved in the protective effect of
exercise. Studies have shown that exercise-induced myokines include IL-6, IL-8, IL-15, brain
neurotrophic factor and leukaemia inhibitory factor released from the muscle fibres.
Exercise enhances the insulin sensitivity through these cytokines and decreases the
production of proinflammatory cytokines

Immunity

The mechanisms underlying the protective effect of exercise on the risk of colon cancer are
complex. The role of exercise in the immune system in cancer prevention is yet unclear.
Recently, macrophages and T cells have been the important factors in colon cancer
pathogenesis. Accumulation of intra-tumoral macrophages is associated with poor prognosis
in colon cancer. Exercise-induced changes in the immune system are a possible mechanism.
Exercise decreased the expression of macrophage and regulatory T-cell markers and
increased the number of cytotoxic T-cells. Exercise has been shown to increase natural killer
cell cytotoxicity, monocyte and macrophage number and function and the CD8 T-cell ratio.
Furthermore, it has been shown to decrease the increased antigen presentation,
inflammation and number of proinflammatory monocytes and prevent the accumulation of
aged T-cells.

Other mechanisms

n CRC, there are other suggested mechanisms (micro RNA, global DNA methylation,
intestinal microbiota, colon transit time and mitochondrial dysfunction) underlying the
effects of exercise on tumorigenesis. In recent years, it has been suggested that intestinal
microbiota is associated with CRC incidence and progression and may predict the response
to immunotherapy. Diet and lifestyle changes alter the intestinal microbiota

23. bagaimana hubungan body mass index pasien yang 30 dengan keluhan, dan interpretasi
angka 30

In conclusion, both obese and underweight patients with a diagnosis of CRC are at increased
risk of all-cause mortality, cancer-specific mortality and disease recurrence. The risk was
greatest for those who were underweight. Therefore, increased surveillance may be
necessary in these cohorts of patients. However, it is unclear whether strategies to reverse
abnormal BMI have any beneficial

effect on colorectal cancer prognosis.