CASE6
WEIGHT LOSS
体重下降
History
A 66-year-old woman, a retired nurse, consults her general practitioner (GP)（国外的全科医生，一般是独立执业，不在医院工作的 ）with a 4-month history of tiredness, slight breathlessness on exertion and loss of weight from 71 to 65kg. Her appetite is unchanged and normal, she has no nausea or vomiting（恶心呕吐）, but over the last 2 months she has had an altered bowel habit with constipation（便秘） alternating with her usual and normal pattern. She has not seen any blood in her faeces（血便） and has had no abdominal pain. There is no relevant past or family history, and she is on no medication.
She has smoked 20 cigarettes daily for 48 years and drinks 20–28 units of alcohol a week.
Examination
She has slight pallor（苍白） but otherwise looks well. No lymphadenopathy（淋巴结节病） is detected, and her breasts, thyroid, heart, chest and abdomen, including rectal examination（直肠检查，通常指的是直肠指检）, are all normal.The blood pressure is 148/90mmHg.
investigation
| 项目 | 结果 | 参考范围 |
|---|---|---|
| Haemoglobin | 10.1g/dL | 11.7–15.7g/dL |
| Mean corpuscular volume (MCV) | 76fL | 80–99fL |
| White cell count | 4.9*109/L | 3.5–11.0*109/L |
| Platelets | 277*109/L | 150–440*109/L |
| Sodium | 142mmol/L | 135–145mmol/L |
| Potassium | 4.4mmol/L | 3.5–5.0mmol/L |
| Urea | 5.2mmol/L | 2.5–6.7mmol/L |
| Creatinine | 106mol/L | 70–120mol/L |
Urinalysis: no protein, no blood 尿液分析：无蛋白，无血
Blood film shows a microcytic hypochromic picture.
血涂片提示小细胞低色素图像
The microcytic（小细胞）, hypochromic（低色素） anaemia（贫血） and the altered bowel habit, the only symptom referable to the gastrointestinal tract, point to a carcinoma of the colon, which would also explain her weight loss. A barium enema（钡剂灌肠） revealed a neoplasm in the sigmoid colon（乙状结肠）, con-firmed by colonoscopy and biopsy（结肠镜和活检）. Chest X-ray and abdominal ultrasound showed no pulmonary metastases（肺转移） and no intra-abdominal lymphadenopathy（腹腔内淋巴结） or hepatic metastases（肝转移） respectively.
She proceeded to a sigmoid colectomy（乙状结肠切除术） and end-to-end anastamosis（断端造瘘）, and was regularly followed-up for any evidence of recurrence. Histology（组织学） showed a grade I tumour.
Carcinoma of the colon is increasing in frequency. If it presents at an early stage then the prospect for cure is good. Rectal bleeding, alteration in bowel habit for longer than 1 month at any age, or iron-deficient anaemia（缺铁性贫血） in men or postmenopausal women（绝经后妇女） are indications for investigation of the gastrointestinal tract.
Smoking is a risk factor for carcinoma of the colon.
网友评论