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Edgar Graham is 66 years old and has inflammatory bowel disease and hemorrhoids, both which were diagnosed 12 years ago. Several months ago he noticed blood in the toilet but was not concerned thinking it was hemorrhoids. Today, he noticed more blood, but was not associated with hemorrhoids, pain or a bowel movement. Because of continued gastrointestinal bleeding, he makes an appointment with his healthcare provider to be assessed for colon cancer. Edgar Graham reveals to his practitioner a significant family history of colorectal cancer. This, in combination with an inflammatory bowel disorder place him at high risk. He is given a colonoscopy and genetic testing which are both positive. Unfortunately, removal of the colon is the only method that can prevent further growth of the tumor. He is scheduled for colon removal with subsequent ileostomy. Before surgery, a significant amount of teaching and counseling is necessary to prepare Mr Graham for the dietary changes he will need to make and how he can maintain the stoma site. 1. What role may Mc Graham’s inflammatory bowel disease play in the development of cancer? 2. Besides bleeding, what other CAUTION signs and symptoms should Mc Graham report? 3. On the basis of Mc Graham’s family history of colon cancer, would he be more likely to have a germ line mutation or a somatic mutation? 4. Why is surgery the only option?
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