Bruce is a 47-year-old journalist, who decides

Bruce is a 47-year-old journalist, who decides to visit his doctor due to some gastrointestinal symptoms. At first, he experienced some minor abdominal pain and cramping, which was then followed by diarrhea, and therefore Bruce convinced himself that it was just a minor stomach bug. However, he had also been noticing that he’d been getting sick more often recently. Weeks went by, and the diarrhea just increased in frequency, and he also experienced periods of constipation in between the diarrhea periods, which he found rather odd. In addition, instead of feeling better, he started to feel really fatigued. This had been going on for 8 months before his wife finally convinced him to make an appointment with his family doctor, who then referred him to a gastroenterologist. A couple of months later, when he finally goes to his specialist appointment, Bruce admits after questioning that he has had blood in his stool, but he didn’t want to tell the doctor as he was embarrassed and didn’t want to get checked for hemorrhoids. The gastroenterologist also asks many questions about Bruce’s diet and his weight and discovers that Bruce has lost 15 kg in the past year despite eating a lot of hot chips and mashed potatoes – the only thing Bruce feels doesn’t make his diarrhea worse. The gastroenterologist then tells Bruce he will need to perform a colonoscopy to investigate further. After the colonoscopy, the surgeon tells Bruce that they found several polyps in his bowel, which is not necessarily a cause for concern as many polyps are benign, but they will have to wait on the results of the biopsies to make sure none of them were malignant. A week later the surgeon calls Bruce – the biopsy shows evidence that the growth is malignant and anaplastic, and that they can’t rule out metastatic growths. Bruce is called back in for follow-up tests, and they find that there is an abnormal growth in his liver. Bruce is now sent to an oncologist, who recommends that he has surgery to remove any remaining polyps, a portion of his bowel, and the abnormal growth from his liver. Based on the advice from his oncologist, Bruce also decides to undergo chemotherapy treatment. Whilst doing some routine checks after his treatment, Bruce is informed he has neutropenia. Question 1 Define and describe the terms malignant and anaplastic and discuss what this means for Bruce’s prognosis Question 2 Explain why Bruce has an increased risk of thrombocytopenia due to his condition and its treatment. Question 3 Explain the rationale for Bruce’s oncologist recommending chemotherapy in this instance and describe the mechanism of action of chemotherapeutic agents. Question 4 (3 marks) Name the gene family p53 belongs to and describe possible consequences of p53 gene mutation(s). CASE STUDY continued Bruce’s friend Greg has been trying to support him throughout his journey. Greg is a 42-year-old ITspecialist, who suffers from Type II diabetes mellitus, which has been under control using an oral anti-hyperglycaemic medication and a reasonably healthy diet. Rather disturbingly, however, Greg has been experiencing numbness and some awkward tingling in his left foot recently. Question 5 Assuming that Greg’s present symptoms are associated with his Type II diabetes mellitus, explain the link between: • Type II diabetes mellitus and Greg’s peripheral neuropathy, and • peripheral neuropathy and the potential for formation of leg ulcers Question 6 Although Greg takes an oral anti-hyperglycaemic medication, in the later stages of his condition, he may need to take insulin as well. Explain why insulin administration would be recommended in his case.

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