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Review the following case and answer the questions that follow. Collaborate with other classmates. Be sure to ask them questions that will help to keep the conversation going. You may need to do some outside research, but put your answers in your own words.

Chief Complaint: 65-year-old woman with a loss of appetite, abdominal cramps, constipation, and blood in her stool.

History: Delores Murphy, a 65-year-old white female, was in good health until about 6 weeks ago, when she noted occasional cramps in the left lower quadrant of the abdomen associated with constipation. The episodes of cramping last about 30 minutes each and are most severe in the hour following her meals. She has taken laxatives which have partially relieved her symptoms, but she has had a decreased appetite and 12-pound weight loss over the past four weeks. In addition, she has become increasingly fatigued over this period. When questioned about her bowel habits, she reported bright red blood in her stools and a smaller caliber (i.e. diameter) of stool over the past two weeks.

Physical Examination: She appeared fatigued and distressed. Head and neck exams were normal, as was her thorax. Palpation of the abdomen revealed a 10 x 10 cm mass and tenderness in the left lower quadrant. Percussion over this area revealed a hollow, tympanic sound. Hepatomegaly was noted, and a hard and slightly tender liver edge was felt in the right upper quadrant. Bowel sounds were noticeably reduced. A stool sample was tested with Guaiac paper and was positive for blood.

After extensive testing, Delores is told that she has colon cancer and that the cancer has already metastasized. She is told that her best chance for a cure is via surgery, followed by chemotherapy.

  • What symptom do you think was the most alarming and why?
  • What does it mean that the cancer has metastasized?
  • Based on the exam, what other organs may be affected?

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