Introduction

A 55-year-old man arrived with a two-month history of fatigue that was exacerbated by exercise and was not improved by rest, as well as exertional palpitations, drowsiness, and occasional painless rectal bleeding following bowel movements. Physical examination revealed conjunctival pallor and tachycardia. The instance raised concers about several possible diagnoses, with colon cancer being the prime suspect.

Differential Diagnosis

Adenocarcinoma of the colon: The clinical presentation and risk variables support the primary diagnosis of colon cancer. Anemia, a typical consequence of colon cancer caused by continuous blood loss from the tumor, is suggested by the patient’s complaints of fatigue, tiredness, exertional palpitations, and rectal bleeding. Choosing colon adenocarcinoma as the primary diagnosis is strongly emphasized by the patient’s advanced age, conjunctival pallor, and tachycardia – all of which suggest a higher likelihood of anemia known to occur alongside advanced colon cancer according to the American Cancer Society’s latest statistics. Additionally, it is worth noting that the patient’s age falls within the recommended age for colorectal cancer screening as prioritized by the same authoritative organization – 45 years or older.

Iron Deficiency Anemia: Fatigue, lethargy, and conjunctival pallor may suggest iron-deficiency anemia as a potential diagnosis, but the patient’s clinical presentation brought up certain concerns about the root cause. While anemia can cause weakened energy and pale conjunctiva, iron deficiency is a typical reason behind it. However, the existence of rectal bleeding and palpitations, in this case, provides evidence for a more intricate etiology. As a result, while iron deficiency anemia is a probable diagnosis, the overall clinical picture must be considered.

Colon Polyps: Colon polyps can produce intermittent bleeding following bowel movements, making them a potential cause of rectal bleeding. However, because of the patient’s widespread and severe symptoms, they are less likely to represent the major diagnosis in this case. While colon polyps might cause localized problems such as rectal bleeding, they rarely induce systemic symptoms such as weariness, somnolence, or exertional palpitations (Benson et al., 2020). Symptoms that extend throughout the body can indicate illnesses like colon cancer-caused anemia. Therefore, it is crucial to investigate colonic polyps and, if needed, conduct a diagnostic workup with a colonoscopy to eliminate the chance of rectal bleeding originating from this source.

Diagnostics

Adenocarcinoma of the Colon: A CBC is performed to evaluate hemoglobin levels when suspected of colon cancer. As a result of colorectal cancer, chronic blood loss leads to anemia. Low hemoglobin levels can indicate this. A hemoccult or fecal immunochemical test is also indicated to look for occult blood in the stool (American Cancer Society, 2021). Blood in the stool can be caused by gastrointestinal bleeding, which is frequently associated with colon cancer, and these tests can help detect it. A positive result would raise the possibility of colon cancer, necessitating extra diagnostic steps.

A colonoscopy with biopsy is the gold standard for establishing the existence of adenocarcinoma in the colon. This method enables direct sight of the colon and the identification of any abnormal lesions or cancers (American Cancer Society, 2021). A biopsy might be collected during the colonoscopy to confirm the diagnosis through histological testing. This diagnostic method fully assesses the colon’s status and enables exact cancer localization and staging, which is critical for treatment planning.

Iron Deficiency Anemia: Several laboratory tests are required to identify iron deficiency anemia. Serum iron levels, ferritin levels, and total iron-binding capacity (TIBC) are all measured. Serum iron levels show the quantity of iron in the bloodstream, ferritin levels reflect iron storage in the body, and TIBC reflects transferrin’s ability to bind iron (Faruqi & Mukkamalla, 2020). A low blood iron level, a low ferritin level, and a high TIBC level all support the diagnosis of iron deficiency anemia. These tests confirm anemia and aid in determining the underlying cause, such as persistent blood loss caused by illnesses such as colon adenocarcinoma.

Colon Polyps: Colonoscopy is the primary diagnostic test for discovering and evaluating colon polyps. During a colonoscopy, a flexible tube with a camera at its tip is introduced into the colon. This enables a direct view of the colon lining; if any polyps are found, they may be removed during treatment (Benson et al., 2020). Colonoscopy is a highly successful technique for both diagnosis and therapy, offering a thorough examination of the colon and allowing for the removal of precancerous or cancerous polyps. It is regarded as the gold standard for evaluating and monitoring colon polyps.

Treatment

Excision of the tumor is the primary treatment for colon adenocarcinoma and is considered the most effective means of managing this ailment. This surgery aims to eliminate the malignant tumor in the colon, which is usually done alongside removing nearby lymph nodes to assess the extent to which cancer has spread (Recio-Boiles et al., 2019). Nevertheless, the specific surgical approach may differ depending on the size and location of the tumor.

Chemotherapy becomes critical when cancer progresses or metastasizes beyond the colon. Depending on the stage of cancer and the general health of the patient, a chemotherapy regimen such as FOLFOX (containing 5-fluorouracil, leucovorin, and oxaliplatin) or FOLFIRI (consisting of 5-fluorouracil, leucovorin, and irinotecan) may be prescribed (Chan & Chee, 2019). These chemotherapy treatments target cancer cells throughout the body and help prevent or treat disease symptoms. The medical team determines chemotherapy after a detailed assessment of the patient’s condition and stage of cancer.

Education

The patient is informed about colon cancer, its treatment choices, and the probable side effects of chemotherapy. The patient is also provided with emotional support, encouraging them to participate in joint decision-making over their treatment plan (Islind et al., 2020). The health education provided to the patient makes it easier to adhere to the treatment and ensures that other family members undergo early screening.

Follow-up

Close monitoring and follow-up by oncologists are required as part of treatment planning to assess patient response to treatment, manage possible side effects of chemotherapy, and determine the overall course of the disease (Taberna, 2020). Additionally, ongoing support and education for patients and their families is critical to ensuring they receive comprehensive care throughout their colorectal cancer treatment journey.

References