A case of Carcinoma colon improved by Homoeopathy treatment

case taking2Male  27 yrs / M
Arikode, Malappuram.
IP no: 165
GHMC Calicut

Presenting complaint
Colicky pain abd (1 month)
Pain < after food, night, touch  > vomiting and hard pr

History of presenting complaint
Started 2 yrs back as colicky pain lower abdomen with vomiting. Diagnosed as Appendicitis & Undergone Appendisectomy. Pain reappeared 1month back. Severe pain < after eating.
Distention & gurgling sound in abdomen during pain.
Complaints associated with constipation (once in 6 days). Pain ends in vomiting . Prostration after vomiting
With some > to pain. Progressive weight loss.

History of past illness

  • Small mass in rectum    4yrs    surgery
  • Jaundice                             4 months back
  • Haemorrhoids                   3yrs back

Family history

  • Elder sister     Hodgkins Lymphoma
  • Twin brother    Haemorrhoids
  • Grand father     Similar complaint.
  • Malappuram
  • 8th std
  • Islam
  • Married
  • Sibling 1
  • Non veg

Smoking, alcoholism – occasional

  • Appt – G
  • Thirst – G, prefers warm
  • Sleep – G
  • Bowels – Constipated
  • Urine – N
  • Sweat – generalised
  • Chilly pt
  • Desires veg food, sweets

Psychic features : Prefers company, courageous

Particulars : Extremities- aching pain in Rt thigh upto knee jt < raising the leg

  • Moderately built
  • Wasting
  • Pulse -82/min
  • Resp rate  : 20/min
  • Temp   : 37   o C
  • BP  : 130/ 80 mm Hg
  • Pallor present
  • No cyanosis , clubbing,Icteric,  lymphadenopathy.

Provisional diagnosis : Ca colon

Investigation

  • 16/6/08   Histopathology
  • Rt hemicolectomy- Adeno ca caecum. Well differentiated tumour ulceroproliferative 3.5 cm diameter serosa involved by tumour, restricted margin .
  • 05/02/09 USG abd  KUB   Rt hydroureteric nephrosis secondary  to mass lesion obstructing the dorsal ureter seems to be a tumour residue/ recurrence.
  • 16/04/10  CT – residual lesion Rt lumbar region with hydronephroureterosis

Final diagnosis : Ca colon with Rt hydroureteronephrosis

Totality of symptoms

  • Prefers company
  • Courageous
  • Desires sweets  veg
  • Chilly pt
  • Pain whole abd after eating
  • < night, after eating
  • > vomiting, hard pr
  • Constipation hard stool  once in 5days
  • Gurgling sound in abd
  • Aching pain in Rt thigh up to knee jt

ANALYSIS OF SYMPTOMS

  • Disease symptom
  • Pain whole abd after eating
  • < night, after eating
  • > vomiting, hard pr
  • Constipation hard stool  once in 5 days
  • Gurgling sound in abd

Patients symptom

  • Prefers company
  • Courageous
  • Desires sweets  veg
  • Chilly pt
  • Prefer warm drink

Evaluation of symptoms
Mental Generals

  • Prefers company
  • Courageous

Physical Generals

  • Desires sweets  veg
  • Chilly pt
  • Prefer warm drink

Particulars

  • < night, after eating
  • > vomiting, hard pr
  • Constipation hard stool  once in 5days
  • Gurgling sound in abdomen

Common Symptom : Pain whole abdomen after eating

Repertorial Totality

  • Prefers company
  • Courageous
  •  Desires sweets
  • Prefer warm drink
  • Constipation hard stools
  • Pain abd > vomiting, hard pr

20/5 /10  Calc carb 30 /1d

24/5/10   Lyco 30 /1d

16/ 7 / 10  Carbo veg  30/ 1d

COLORECTAL CARCINOMA
The incidence increases with age, the average age at diagnosis being 60-65 years.

Increased risk:

  • Diets are low in dietary fibre which increase faecal bulk and reduce transit time.
  • Fat and meat consumption correlates with risk of CRC.

Decreased risk: :

  • Fruit and vegetables consumption has a protective effect.
  • Increase fibre intake in the diet.
  • Exercise reduces the risk of CRC.
  • Aspirin and other NSAIDs reduce the risk
  • Hormone-replacement therapy

Aetiology

  • Both environmental and genetic factors are important in colorectal carcinogenesis:
  • ‘sporadic’ colorectal cancers: 80%
  • hereditary non-polyposis colon cancer (HNPCC): 10%
  • FAP: 1%
  • other family history: 10%
  • inflammatory bowel disease: 1%.

NON-DIETARY RISK FACTORS IN COLORECTAL CANCER

  • Medical  conditions
  • Colorectal adenomas
  • Long-standing extensive ulcerative colitis or Crohn’s colitis
  • Ureterosigmoidostomy
  • Acromegaly
  • Pelvic radiotherapy

 Others

  • Obesity and sedentary lifestyle-may be related to dietary factors
  • Smoking (relative risk 1.5-3.0)
  • Alcohol (weak association)
  • Regular aspirin use

Cancer families

  • Family history is, next to age, the most common risk factor for colon cancer.
  • FAP  is the best- recognized syndrome predisposing to colorectal Cancer.
  • Hereditary non-polyposis colorectal cancer (HNPCC) arises from germline mutations 

Pathology

  • Usually a polypoid mass with ulceration,
  • spreads by direct infiltration . It involves lymphatics and blood vessels with spread to the liver.
  • Histology is adenocarcinoma with moderately to well differentiated glandular epithelium with mucin production. ‘Signet ring’ cells in which mucin displaces the nucleus to the side of the cell are characteristic. 

Clinical features

  • Symptoms vary depending on the site of the carcinoma.
  • In tumours of the left colon, fresh rectal bleeding is common and obstruction occurs early.
  • Tumours of the right colon present with anaemia from occult bleeding, or altered bowel habit, but obstruction is a late feature.
  • Colicky lower abdominal pain
  • Rectal bleeding occurs in 50%.
  • Features of either obstruction or perforation, leading to peritonitis, localised abscess or fistula formation.
  • Carcinoma of the rectum causes early bleeding, mucus discharge or a feeling of incomplete emptying.
  • Iron deficiency anaemia or weight loss.
  • The alarm symptoms, suggestive of colorectal cancer, include change
  • In bowel habit, rectal bleeding, anorexia and weight loss, faecal incontinence, tenesmus and passing mucus per rectum.

On examination a mass may be palpable. Hepatomegaly may be found with liver metastases.

Digital examination of the rectum is essential and rigid sigmoidoscopy should be performed in all cases. Investigations

Rigid sigmoidoscopy

  • Colonoscopy is the investigation of choice because it is more sensitive and specific than barium enema.
  • Endoanal ultrasound or pelvic MRI stages rectal cancers  CT colography (‘virtual colonoscopy’)
  • carcinoembryonic antigen (CEA) concentrations follow-up and can help to detect early recurrence.
  • Faecal occult blood tests used for mass screening

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