Colorectal Cancer for Inflammatory Bowel Disease - myassignmenthelp

Question: Discuss about theColorectal Cancer for Inflammatory Bowel Disease. Answer: Colon and rectum tumors are mostly common; the colorectal area is now the third most common site of cancer cases and deaths globally (Bailey and You, 2014). Cancer of the colon and rectum develops from the epithelial lining of the intestine. It usually begins as a benign polyp which later becomes a malignant which penetrates and destroys the normal tissues. The frequency of occurrence is highest for individuals older than 85 years of age and is higher for individuals who have had a history of colon cancer in the family. The specific cause of colorectal cancer is still not known but the risk factors have been identified. The risk factors include breast cancer in women, high fat and beef intake, and medical record of inflammatory bowel disease and lastly family history of colon cancer (Ponteri-lewis, 2013). If this disease is detected early and treated, it could save three people out of four with colon cancer. This essay is going to talk about the drugs administered to Nelly their mech anism of action and lastly the technologies used to detect colorectal cancer. Drugs administered Colorectal cancer therapy depends on the stage of the disease and it usually done by removal of the tumor through surgery, adjuvant therapy and supportive therapy. Nellie had a stage IVA cancer and she was referred to a colonoscopy and it was discovered that nelly had polyps in the colon which were surgically removed. She later came for adjuvant therapy which included 5-Fluorouracil, Irinotecan and lastly Oxaliplatin. This kind of therapy was used to reduce the chances of the cancer coming back after surgery. Pain medication was initiated after targeted radiotherapy failed to shrink the tumor, the severe back pain was as a result of cancer that had spread to the spinal cord and was compressing the spinal cord. Pain medication included paracetamol and morphine. Spinal tumor increased each day which caused more pain and the dose of morphine was difficult to titrate due to severe side effects it caused. End of life pathway drugs were commenced which included levomepromazine and sublingu al clonazepam. Mechanism of action 5- Fluorouracil (5-FU) is an antimetabolite which exerts its action on cells undergoing cycling. It kills tumor cells which are in the cycling and resting phase of the cell cycle. In the cell fluorouracil is changed to 5- fluoro-2-deoxyuridine-5-monophosphate (5-FdUMP), which causes the suppression of thymidylate synthase which later leads to the death of thymineless of cells. DNA synthesis is inhibited by the penetration of FdUMP. RNA synthesis and function is inhibited by 5-fluorouradine-5-triphosphate (FUTP) which is a fluorouracil metabolite. In the tumor cell the mechanism of resistance include an increased thymidylate synthase activity, a reduced activation of 5-FU, and lastly a decreased drug sensitivity of this enzyme. As a result the cell is unable to divide and dies. Irinotecan is a plant derived cell cycle specific (CCS) drugs which is found in the camptothecins group. It is converted to an active form SN-38 which requires carboxyl esterase (Huangg, Wuerzberger-Davis and Seufzer, 2012). it inhibits topoisomerase 1 activity hence causing damage to the DNA. The DNA is damaged by an inhibiting enzyme that cuts and the single DNA strands during the normal DNA repair process (Maureen, Beidler and cheng, 2013). Oxaliplatin is a chemotherapeutic agent that contains 1, 2- diaminocyclohexane ligand. Like the other platinum based compounds it exerts its effect by damaging the DNA and also by inhibition of RNA synthesis. It induces three types of links which include DNA intra-strand link, DNA inter-strand crosslinks and DNA-protein crosslinks. Intra-strand links act by the induction of DNA lesions while the inter-strand link are said to bring about the cytotoxicity of cisplatin. The DNA protein crosslink causes arrest of DNA synthesis and inhibition of messenger RNA synthesis hence cell death. Paracetamol also known as acetaminophen is a weak inhibitor of cyclooxygenase-1 (COX-1) and COX-2 are inhibitors of prostaglandin (Boataud, Aronoff and Richardson, 2015). Prostaglandin is inhibited if there is a low level of arachidonic acid. Cox-2 is the main isoenzyme when the arachidonic acid is at low concentration (Aronoff, Boutard and Marnett, 2013). And for this reason paracetamol selectively prevents prostaglandin synthesis involving Cox-2 this is due to the lower flux in the pathway that produces decreased level of hydroperoxide. Opioids acts on the receptors found in neuronal cell membrane to produce effect. The major three types of receptors include kappa, delta, and mu. Morphine has been found to have a high affinity for m receptors. G-protein which is a guanine nucleotide protein is coupled to opioid receptors. The opioid has two sites where it acts upon, the postsynaptic neuron and the presynaptic nerve terminal. In the presynaptic nerve terminal the action of morphine is to prevent neurotransmitter release by reducing calcium entry and increasing potassium current. Morphine also acts on the pain pathways, opioid receptors are present in pain transmission regions of the nervous system. It acts by inhibition of neurotransmitter release from the primary afferent terminals found in the spinal cord and also the activation of the midbrain control that is the descending inhibitors. Levomepromazine is a neuroleptic agent. It has anti-histamine, anti-emetic and analgesic effect. It precise mechanism of action is not yet known. Clonazepam is a benzodiazepam. It is a strong anticonvulsant. Its main type of action is to make it easier for GABAergic transmission in the brain. This GABA receptors are located in dorsal raphe neurons which acts by inhibiting raphe cell lining. 5-HT synthesis is not inhibited by clonazepam but it reduces the utilization of 5-HT in the brain. Technologies used to detect colorectal cancer Colonoscopy is a procedure in which one views the large intestine using a device known as a colonoscope (Zapka, Klabunde and Typlin, 2014). It is a thin flexible tube with a camera and a source of light. This device is inserted in the anus region and through the colon. This device captures images and videos for the doctor to see. If there is an abnormal growth the doctor will be able to see. It is also used to remove little amount of tissue for biopsy. DNA testing has been used to identify individual at risk of colorectal cancer. Through DNA testing doctors have been able to prevent the disease at an early stage. Clients identified at risk are genetically cancelled on the disease, so as to understand prevention and treatment measures (Leissic, 2012). Stool test has been used to check for the presence of blood. It is the most common method used for early cancer detection (Burch, Soares-Weiser and John, 2013). The basic examination of the stool includes checking for color and testing for occult blood. It also checks for the ion containing portion of the hemoglobin known as the heme which is changed during the movement in the intestines (Ouyang, Chen and Getzenberg, 2018). Lower gastrointestinal tract procedure has been used to detect the presence polyps and tumors in the colon. Barium enema is inserted in the rectum so as to visualize the presence polyps. This radioscope substance is inserted during fluoroscopy. Other visualizing colon studies include double contrast studies. In double contrast, it involves the insertion of thick barium solution followed by pumping of air. This process distinguishes barium coated mucosa and air filled lumen hence allowing easier detection of little lesions. Sigmoidoscopy, anoscopy and protoscopy are used to view the lower portion of the colon to check for rectal bleeding, tumor, polyps or other pathological processes. The anoscope is used to view the anus and the lower rectum. The sigmoidscopes and protoscopes are rigid scopes used to view the rectum and sigmoid (Elmunzer, Harvard and Schoenfeld, 2015). The flexible fiberoptic sigmoidoscope allows the colon to be viewed up to 40-50cm from the anus. During the procedure biopsy can be performed using a small biting forceps introduced through the endoscope. If the rectal polyps are viewed that can be removed with a wire snare used to grasp the pedicle. Magnetic resonance imaging is used in the checking of polyps in the colon (Forsberg, 2012). This is a non-invasive technique that uses radio waves and magnetic fields to produce an image of the area being studied. Oral contrasts agents are used to enhance images. The client lie in the machine having not eaten or drunk anything for the last 6-8 hours. The entire procedure takes up to thirty to ninety minutes. Scintigraphy is a radionuclide testing which uses the radioactive isotopes such as the indium and iodine. This agents are used to reveal or visualize changes in atomic structures, organ size and the presence of neoplasm or any other focal lesion. Abdominal ultrasonography is another method used to check polyps in the colon. This is done by production of high frequency sound waves in the internal body organs. This echoes are recorded on an olliscope as they pass through the tissues. This method is used to check the size of and the configuration of abdominal structures. Advantages of this method is that it needs no ionizing radiation hence they will be no side effects and it also not expensive. The only disadvantage that it has is that it cannot view structures behind a bone since the bone prevents ultrasonic echoes from passing to the deeper structures. References Aronoff, D., Boutard, O. and Marnett, J. (2013). Inhibition of prostaglandin H2 synthases by salicylate is dependent on the oxidative state of the enzymes.J. Pharmacol. Exp. Ther, 304, pp.589-594. Bailey, E. and You, N. (2014). Increasing disparities in the age related incidence of colon and rectal cancer in the United States. 150(1), pp.17-22. Boataud, O., Aronoff, D. and Richardson, J. (2015). Determinants of the cellular specificity of acetaminophen as an inhibitor of prostaglandin H2 synthases.Proc. Natl. Acad. Sci. USA, 99, pp.730-735. Burch, T., Soares-Weiser, K. and John, D. (2013). 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