I.

INTRODUCTION

Colorectal cancer is a disease in which normal cells in the lining of the colon or rectum begin to change, start to grow uncontrollably, and no longer die. These changes usually take years to develop; however, in some cases of hereditary disease, changes can occur within months to years. Both genetic and environmental factors can cause the changes. Initially, the cell growth appears as a benign (noncancerous) polyp that can, over time, become a cancerous tumor. If not treated or removed, a polyp can become a potentially life-threatening cancer. Recognizing and removing precancerous polyps before they become cancer can prevent colorectal cancer. II. SIGNS AND SYMPTOMS General tiredness, unexplained weight loss, and lack of appetite Bleeding from the rectum or blood or mucus on the stools Anemia Pain when passing a bowel movement Nausea and vomiting A feeling that the bowel hasnt completely emptied following a bowel movement Ascending (Right) Colon Cancer y y y y y Occult blood in stool Anemia Anorexia and weight loss Abdominal pain above umbilicus Palpable mass

Distal Colon/Rectal Cancer y Rectal bleeding y Changed in bowel habits y Constipation or Diarrhea y Pencil or ribbon shaped stool y Tenesmus y Sensation of incomplete bowel emptying III. CAUSES The cause of most cases of colorectal cancer is the change in normally benign intestinal polyps to cancerous tumors. There are several different types of intestinal polyps, but only two carry a risk of developing into cancers. These two types can be removed during screening tests for colorectal cancer. The triggers that cause some polyps to become cancerous are not completely understood. IV. RISK FACTORS The lifetime risk of developing colon cancer in the United States is about 7%. Certain factors increase a person's risk of developing the disease.[5] These include:


Age: The risk of developing colorectal cancer increases with age. Most cases occur in the 60s and 70s, while cases before age 50 are uncommon unless a family history of early colon cancer is present. Polyps of the colon, particularly adenomatous polyps, are a risk factor for colon cancer. The removal of colon polyps at the time of colonoscopy reduces the subsequent risk of colon cancer. History of cancer. Individuals who have previously been diagnosed and treated for colon cancer are at risk for developing colon cancer in the future. Women who have had cancer of the ovary,uterus, or breast are at higher risk of developing colorectal cancer. Heredity:  Family history of colon cancer, especially in a close relative before the age of 55 or multiple relatives.  Familial adenomatous polyposis (FAP) carries a near 100% risk of developing colorectal cancer by the age of 40 if untreated  Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome  Gardner syndrome Smoking: Smokers are more likely to die of colorectal cancer than nonsmokers.

An American Cancer Society study found "Women who smoked were more than 40% more likely to die from colorectal cancer than women who never had smoked. Male smokers had more than a 30% increase in risk of dying from the disease compared to men who never had smoked.  Diet: Studies show that a diet high in red meat and low in fresh fruit, vegetables, poultry and fish increases the risk of colorectal cancer. In June 2005, a study by the European Prospective Investigation into Cancer and Nutrition suggested that diets high in red and processed meat, as well as those low in fiber, are associated with an increased risk of colorectal cancer. Individuals who frequently eat fish showed a decreased risk. However, other studies have cast doubt on the claim that diets high in fiber decrease the risk of colorectal cancer; rather, low-fiber diet was associated with other risk factors, leading to confounding. The nature of the relationship between dietary fiber and risk of colorectal cancer remains controversial.  Lithocholic acid: Lithocholic acid is a bile acid that acts as a detergent to solubilize fats for absorption. It is made from chenodeoxycholic acid by bacterial action in the colon. It has been implicated in human and experimental animal carcinogenesis. Carbonic acid typesurfactants easily combine with calcium ion and become detoxication products.  Physical inactivity: People who are physically active are at lower risk of developing colorectal cancer.  Viruses: Exposure to some viruses (such as particular strains of human papilloma virus) may be associated with colorectal cancer.  Primary sclerosing cholangitis offers a risk independent to ulcerative colitis.  Low levels of selenium  Inflammatory bowel disease: About one percent of colorectal cancer patients have a history of chronic ulcerative colitis. The risk of developing colorectal cancer varies inversely with the age of onset of the colitis and directly with the extent of colonic involvement and the duration of active disease. Patients with colorectal Crohn's disease have a more than average risk of colorectal cancer, but less than that of patients with ulcerative colitis.  Environmental factors: Industrialized countries are at a relatively increased risk compared to less developed countries that traditionally had high-fiber/low-fat diets. Studies of migrant populations have revealed a role for environmental factors, particularly dietary, in the etiology of colorectal cancers.  Exogenous hormones. The differences in the time trends in colorectal cancer in males and females could be explained by cohort effects in exposure to some gender-specific risk factor; one possibility that has been suggested is exposure to estrogens. There is, however, little evidence of an influence of endogenous hormones on the risk of colorectal cancer. In contrast,


there is evidence that exogenous estrogens such as hormone replacement therapy (HRT), tamoxifen, or oral contraceptives might be associated with colorectal tumors.  Alcohol: Drinking, especially heavily, may be a risk factor.  Vitamin B6 intake lowers the risk of colorectal cancer. V. MEDICAL MANAGEMENT Digital rectal exam (DRE): The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. It only detects tumors large enough to be felt in the distal part of the rectum but is useful as an initial screening test.  Fecal occult blood test (FOBT): a test for blood in the stool. Two types of tests can be used for detecting occult blood in stools i.e. guaiac based (chemical test) and immunochemical. The sensitivity of immunochemical testing is superior to that of chemical testing without an unacceptable reduction in specifity.  Endoscopy:  Sigmoidoscopy: A lighted probe (sigmoidoscope) is inserted into the rectum and lower colon to check for polyps and other abnormalities.  Colonoscopy: A lighted probe called a colonoscope is inserted into the rectum and the entire colon to look for polyps and other abnormalities that may be caused by cancer. A colonoscopy has the advantage that if polyps are found during the procedure they can be removed immediately. Tissue can also be taken for biopsy.  Patient Procedure 1. Check the patients medical history for allergies, medications, and information pertinent to the current complaint. 2. Tell the patient to maintain a clear liquid diet for 24 to 48 hours before the test and to take nothing by mouth after midnight the night before. 3. Instruct the patient regarding the appropriate bowel preparation. 4. Inform the patient that hell receive an I.V. line and I.V. sedation before the procedure. 5. Tell the patient that the colonoscope is well lubricated to ease insertion and initially feels cool. 6. Explain that he may feel an urge to defecate when its inserted and advanced. 7. Inform him that air may be introduced through the colonoscope to distend the intestinal wall and to facilitate viewing the lining and advancing the instrument.  Colonoscopy Procedure 1. The patient is assisted onto his left side with knees flexed. 2. Cover the patient with drape. 3. Baseline vital signs are obtained. 4. Vital signs and electrocardiogram are monitored during the procedure.


Continuous or periodic pulse oximetry is advisable. The physician palpates the mucosa of the anus and rectum and inserts the lubricated colonoscope through the patients anus into the sigmoid colon under direct vision. 7. A small amount of air is insufflated to locate the bowel lumen and then advance the scope through the rectum. 8. Abdominal palpation or fluoroscopy may be used to help guide the colonoscope through the large intestine. 9. Suction may be used to remove blood and secretions that obscure vision. 10. Biopsy forceps or a cytology brush may be passes through the colonoscope to obtain specimens for histologic or cytologic examination; an electro-cautery snare may be used to remove polyps. 11. Tissue specimens are immediately placed in a specimen bottle containing 10% formalin and cytology smears in a Coplin jar containing 95% ethyl alcohol. 12. Specimens are sent to the laboratory immediately.  Nursing Interventions for Colonoscopy 1. The patient is observed closely for signs of bowel perforation. 2. Check the patients vital signs and document them accordingly. 3. Watch the patient closely for adverse effects of the sedative. 4. After recovery from the sedation, he may resume his usual diet unless the physician orders otherwise. 5. The patient may pass large amounts of flatus after insufflation. 6. After polyp removal, the stool may contain some blood. Report excessive bleeding immediately. 7. If a polyp is removed, but not retrieved, give enema and strain the stools to retrieve it.  Precautions 1. Although its usually a safe procedure, beware that colonoscopy can cause perforation of the large intestine, excessive bleeding, and retroperitoneal emphysema. 2. This procedure is contraindicated in pregnant woman near term, the patient who has had a recent acute myocardial infarction or abdominal surgery, and one with ischemic bowel disease, acute diverticulitis, peritonitis, fulminant granulomatous colitis, perforated viscus, or fulminant ulcerative colitis. For these cases of for screening purposes, a virtual colonoscopy may be an option to help visualize polyps early before they become concerns.
5. 6. 3.

Other screening methods



Double contrast barium enema (DCBE): First, an overnight preparation is taken to cleanse the colon. An enema containing barium sulfate is administered, then air is insufflated into the colon, distending it. The result is a thin layer of barium over the inner lining of the colon which is visible on X-ray films. A cancer or a precancerous polyp can be detected this way. This technique can miss the (less common) flat polyp.

Virtual colonoscopy replaces X-ray films in the double contrast barium enema (above) with a special computed tomography scan and requires special workstation software in order for the radiologist to interpret. This technique is approaching colonoscopy in sensitivity for polyps. However, any polyps found must still be removed by standard colonoscopy. Standard computed axial tomography is an x-ray method that can be used to determine the degree of spread of cancer, but is not sensitive enough to use for screening. Some cancers are found in CAT scans performed for other reasons. Blood tests: Measurement of the patient's blood for elevated levels of certain proteins can give an indication of tumor load. In particular, high levels of carcinoembryonic antigen (CEA) in the blood can indicate metastasis of adenocarcinoma. These tests are frequently false positive or false negative, and are not recommended for screening, it can be useful to assess disease recurrence. CA19-9 and CA 242 biomarkers can indicate e-selectin related metastatic risks, help follow therapeutic progress, and assess disease recurrence. Also the level of tissue inhibitor of metalloproteinases 1 (TIMP1) in the blood has been shown to correlate with the occurrence of colon cancer. ATIMP1 test can be helpful in an evaluation to assess the risk of having developed colorectal cancer. TIMP1 is particularly helpful as a marker for early identification of colorectal cancer, where it has been shown to have a high specificity and sensitivity. The research ofTIMP1, as a marker for early identification of colorectal cancer, is particularly focused in Denmark as a collaboration between theUniversity of Copenhagen, the Technical University of Denmark, Rigshospitalet and Cancer Marker A/S, which is a Danish medico-company. Cell free DNA - Blood: There is extensive literature describing DNA shed from tumors circulating as cell free DNA in the blood. Using highly sensitive assays, studies report the presence of DNA mutations and DNA methylation tumor markers such as SEPT9 in the plasma of colon cancer patients. In Europe, the SEPT9 methylation marker has been developed into the CE marked Epi proColon test (Epigenomics AG) and the ms9 test (Abbott Molecular). It is also the subject of a clinical trial in the US, and has been licensed for the development of LDT tests by Quest Diagnostics and ARUP Laboratories in the US, and Warnex Laboratories in Canada. Genetic counseling and genetic testing for families who may have a hereditary form of colon cancer, such as hereditary nonpolyposis colorectal cancer (HNPCC) or familial adenomatous polyposis (FAP).

Positron emission tomography (PET) is a 3-dimensional scanning technology where a radioactive sugar is injected into the patient, the sugar collects in tissues with high metabolic activity, and an image is formed by measuring the emission of radiation from the sugar. Because cancer cells often have very high metabolic rates, this can be used to differentiate benign and malignant tumors. PET is not used for screening and does not (yet) have a place in routine workup of colorectal cancer cases. Whole-body PET imaging is the most accurate diagnostic test for detection of recurrent colorectal cancer, and is a cost-effective way to differentiate resectable from nonresectable disease. A PET scan is indicated whenever a major management decision depends upon accurate evaluation of tumour presence and extent. Stool DNA testing is an emerging technology in screening for colorectal cancer. Premalignant adenomas and cancers shed DNA markers from their cells which are not degraded during the digestive process and remain stable in the stool. Capture, followed by PCR amplifies the DNA to detectable levels for assay. Clinical studies have shown a cancer detection sensitivity of 71% 91%. High C-Reactive Protein levels is risk marker. miRNA - profiling-based screening for detection of early-stage colorectal cancer: The life science and research company Exiqon A/S has developed a novel plasma miRNA screening assay for identifying early-stage colorectal cancer. Plasma miRNA has been shown to be a promising biomarker for many diseases including cancer. The goal of this technique is to select individuals for colonoscopy rather than to replace colonoscopy as the gold standard of colorectal cancer diagnosis. Blood plasma samples collected from patients with early, resectable (Stage II) colorectal cancer and sex-and age-matched healthy volunteers were profiled. So far potential biomarkers have shown promising specificity and sensitivity. The same technology can also be applied to patients who may be at higher risk of relapse and therefore in need for more aggressive adjuvant chemotherapy.

 

VI. NURSING MANAGEMENT ASSESSMENT  Obtain health history about the presence of fatigue, abdominal or rectal pain (e.g. location, frequency, duration, association with eating or defecation), past and present elimination patterns, and characteristics of stool (e.g. color, odor, consistency, presence of blood or mucus).  Obtain history of IBD or colorectal polyps, a family history of colorectal disease, and current medication therapy  Assess dietary patterns, including fat and fiber intake, as well as amounts of alcohol consumed and history of smoking. Document a history of weight loss and feelings of weakness and fatigue  Auscultate the abdomen for bowel sounds and palpate the abdomen for areas of tenderness, distention, and solig masses  Stool specimen are inspected for character and presence of blood. NURSING DIAGNOSES  Imbalanced nutrition, less than body requirements related to nausea and anorexia  Risk for deficient fluid volume related to vomiting and dehydration  Anxiety related to impending surgery and the diagnosis of cancer  Risk for ineffective therapeutic regimen management related to knowledge deficit concerning the diagnosis of the surgical procedure, and self-care after discharge  Impaire skin integrity related to the surgical incisions (abdominal and pernianal), the formation of a stoma, and frequent fecal contamination of peristomal skin  Disturbed bodt image related to colostomy  Ineffective sexuality patterns related to presence of ostomy and changes in body image and self-concept PLANNING Major goals:  Attainment of optimal level of nutrition  Maintenance of fluid and electrolyte balance  Reduction of anxiety  Learning about the diagnosis, surgical procedure, and self-care after discharge  Maintenance of optimal tissue healing  Protection of peristomal skin  Learning how to irrigate colostomy (done only with sigmoid colostomies) and change the appliance  Expressing feelings and concerns about the colostomy and the impact on self  Avoidance of complications (e.g. intraperitoneal infection, complete large bowel obstruction, GI bleeding, bowel perforation, peritonitis, abscess and sepsis)

Preparing the client for surgery  Prepare the client physically for surgery by building the patients stamina in the days preceding surgery and cleansing and sterilizing the bowel the day before surgery.  If the patients condition permits, the nurse recommends a diet high in calories, protein, and carbohydrates and low in residue for several days before surgery to provide adequate nutrition and minimize cramping by decreasing excessive peristalsis.  A full liquid diet may be prescribed for 24-48 hours before surgery to decrease bulk.  If the patient is hospitalized in the days preceding surgery, parenteral nutrition may be required to replace depleted nutrients, vitamins, and minerals. Antibiotics such as kanamycin, neomycin and cephalexin are administered orally the day before surgery to reduce intestinal bacteria  The bowel is cleansed with laxatives and enemas, or colonic irrigations the evening before the morning of the surgery.  Measure and record intake output including vomitus for very ill and hospitalized patients to provide an accurate record of fluid balance. The patients intake of oral food and fluids may be restricted to prevent vomiting. Administer antiemetics as prescribed.  Full or clear liquids may be tolerated, or the patient may be allowed nothing by mouth. A nasogatric tube may be inserted to drain accumulated fluids and prevent abdominal distention.  Monitor abdomen for increasing distention, loss of bowel sounds, and pain or rigidity, which may indicate obstruction or perforation.  Monitoring IV fluids and electrolytes can detect hypokalemia and hyponatremia that occur with GI fluid loss.  Observe for signs of hypovolemia (e.g. tachycardia, hypotension, decreased pulse volume)  Assess hydration status and report decreased skin turgor, dry mucuous membreanes, and concentrated urine  Assess patients knowledge about the diagnosis, prognosis, surgical procedure, and expected level of functioning after surgery (include information about the physical preparation for surgery, the expected appearance and care of the wound, the technique of ostomy care, dietary restrictions, pain control, and medication management in teaching plan). Providing emotional support  Assess the patients anxiety level and coping mechanisms and suggest methods for reducing anxiety, such as deep breathing exercises and visualizing a successful recovery from surgery and cancer.  Arrange a meeting with a spiritual adviser if the patient desires or with the physician if the patient wishes to discuss the treatment or prognosis  Reduce fear from colostomy by presenting facts about the surgical procedure and the creation and management of ostomy. If the client is receptive, use diagrams, photographs, and appliances to explain and clarify.

Postoperative care  Pain management during immediate postoperative period.  Assess the abdomen for returning peristalsis and assess the initial stool characteristics.  Help patients out of bed on the first postoperative day and encourage them to begin participating in managing the colostomy Maintaining Optimal Nutrition  Teach the health benefits to be derived from consuming a healthy diet  A complete nutritional assessment is important. Avoid foods that cause excessive odor and gas, including foods in the cabbage family, eggs, asparagus, fish, beans, and highcellulose products such as peanuts.  Determine whether the elimination of specific foods is causing any nutritional deficiency.  Advise the patient to experiment with an irritating food several times before restricting it, because an initial sensitivity may decrease with time.  Help the client identify any foods or fluids that may be causing diarrhea such as fruits, high-fiber foods, soda, coffee, tea, or carbonated beverages.  Diphenoxylate with atropine may be prescribed as needed to control diarrhea. For constipation, prune or apple juice or a mild laxative is effective. The nurse suggests fluid intake of at least 2L per day. Wound Care  Frequently examine the abdominal dressing during the first 24 hours after surgery to detect signs of hemorrhage.  Help the patient splint the abdominal incision during coughing and deep breathing to lessen tension on the edges of the incision.  Monitor temperature, pulse, and respiratory rate for elevations that may indicate an infectious process.  If the client has a colostomy, the stoma is examined for swelling (slight edema from surgical manipulation is normal), color (a healthy stoma is pink or red), discharge (a small amount of oozing is normal), and bleeding (an abnormal sign if bright red or beyond trace amounts).  If the malignancy has been removed using the perineal route, the perineal wound is observed for signs of hemorrhage.  The wound may contain a drain or packing that is removed gradually. Bits of tissue may slough off for a week. This process is hastened by mechanical irrigation of the wound or with sitz baths performed 2 or 3 times each day initially. The condition of the perineal wound and any bleeding, infection, or necrosis is documented.

Monitoring and Managing Complications  Observe for signs and symptoms of complications  Frequently assess the abdomen, including bowel sounds and abdominal girth, to detect bowel obstruction.  Monitor vital signs for increased temperature, pulse, and respirations and for decreased blood pressure that may indicate an intra-abdominal infectious process.  Report rectal bleeding immediately because it indicates hemorrhage  Monitor hemoglobin and hematocrit levels and administer blood component therapy as prescribed.  Any abrupt change in abdominal pain is reported promptly  Elevated white blood cell counts and temperature or symptoms of shock are reported because they may indicate sepsis. Administer antibiotics as prescribed.  Frequent activity (e.g. turning the client from side to side every 2 hours), deep breathing, coughing and early ambulation can reduce the risk of pulmonary complications (pneumonia and atelectasis). Removing and Applying the Colostomy Appliance  Teach the client about colostomy care until the client can take over its management.  Teach skin care and how to apply, empty, and remove the drainage pouch.  If the client wants to bathe or shower before putting on a clean appliance, micropore tape applied to the sides of the pouch keeps it secure during bathing.  As soonas the patient has learned a routing for evacuation, pouches may be dispensed with, and a closed ostomy appliance or a stoma cap is used to cover the stoma. Except for gas and a slight amount of mucus, nothing escapes from the colostomy opening between irrigations Irrigating the Colostomy  Regulate the passage of fecal material by irrigating the colostomy or allowing the bowel to evacuate naturally without irrigations.  By irrigating the stoma at a regular time, there is less gas and retention of the irrigant. The time for irrigating the colostomy should be consistent with the schedule the person will follow after leaving the hospital  Colostomy irrigation is not recommended for persons with extensive pelvic irradiation because it carries a risk of perforation Supporting a Positive Body Image  Encourage client to verbalize feelings and concerns about altered body image and to discuss the surgery and stoma (if one was created).  If applicable, the client must learn colostomy care and begin to plan for incorporating stoma care into daily life.

Help the client overcome aversion to the stoma or fear of self-injury by providing care and teaching in an open, accepting manner and by encouraging the patient to talk about his or her feelings about the stoma.

Discussing Sexuality Issues  Encourage the patient to discuss feelings about sexuality and sexual function.  Assess clients needs and attempt to identify specific concerns.  If the nurse is uncomfortable with this or if the patients concerns seem complex, the nurse may seek assistance from a sex counselor or therapist, or advanced practice nurse. EVALUATION Expected Patient Outcomes 1. Consumes a healthy diet y Avoids foods and fluids that cause diarrhea, constipation, and obstruction y Substitutes nonirritating foods and fluids for those that are restricted 2. Maintain fluid balance y Experiences no vomiting or diarrhea y Experiences no signs or symptoms of dehydration 3. Feels less anxious y Expresses concerns and fears freely y Uses coping measures to manage stress 4. Acquires information about diagnosis, surgical procedure, preoperative preparation, and self-care after discharge y Discusses the diagnosis, surgical procedure, and postoperative self-care y Demonstrates techniques of ostomy care 5. Maintains clean incision, stoma, and perineal wound 6. Expresses feelings and concerns about self y Gradually increases participation in stoma and peristomal skin care y Discusses feelings related to changed appearance 7. Discusses sexuality in relation to ostomy and to changes in body image 8. Recovers without complications y Is afebrile y Regains normal bowel activity y Exhibits no signs and symptoms of perforation or bleeding y Identifies signs and symptoms that should be reported to health care provider

VII. ANATOMY AND PHYSIOLOGY

The colon is made up of 6 parts all working collectively for a single purpose. Their purpose is ridding the body of toxins that have entered the body from food sources, environmental poisons, or toxins produced within the body. The colons role is to transfer nutrients into the bloodstream through the absorbent walls of the large intestine while pushing waste out of the body. In this process, digestive enzymes are released, water is absorbed by the stool, and a host of muscle groups and beneficial microorganisms work to maintain the digestive system. Overview of the Colons Anatomy The colon is approximately 4.5 feet long, 2.5 inches wide, and is a muscular tube composed of lymphatic tissue, blood vessels, connective tissue, and specialized muscles for carrying out the tasks of water absorption and waste removal. The tough outer covering of the colon protects the inner layer of the colon with circular muscles for propelling waste out of the body in an action called peristalsis. Under the outer muscular layer is a sub-mucous coat containing the lymphatic tissue, blood vessels, and connective tissue. The innermost lining is highly moist and sensitive, and contains the villi- or tiny structures providing blood to the colon. The colon is actually just another name for the large intestine. The shorter of the two intestinal groups, the large intestine, consists of parts with various responsibilities. The names of these

parts are: the transverse colon, ascending colon, appendix, descending colon, sigmoid colon, and the rectum and anus. Parts of the Colon: Transverse, Ascending, and Descending Colons The transverse, ascending, and descending colons are named for their physical locations within the digestive tract, and corresponding to the direction food takes as it encounters those sections. Within these parts of the colon, contractions from smooth muscle groups work food material back and forth to move waste through the colon and eventually, out of the body. The intestinal walls secrete alkaline mucus for lubricating the colon walls to ensure continued movement of the waste. The ascending colon travels up along the right side of the body. Due to waste being forced upwards, the muscular contractions working against gravity are essential to keep the system running smoothly. The next section of the colon is termed the transverse colon due to it running across the body horizontally. Then, the descending colon turns downward and becomes the sigmoid colon, followed by the rectum and anus. Ileocecal and Cecum Valves The ileocecal valve is located where the small and large intestines meet. This valve is an opening between the small intestine and large intestine allowing contents to be transferred to the colon. The cecum follows this valve and is an opening to the large intestine. The Rectum and the Anus The rectum is essentially a storage place for waste and is the final stop before elimination occurs. The tone of the muscles of the anal sphincter and a persons ability to control this skeletal-muscular system are vital for regulating bowel movement urges. When elastic receptors within the rectum are stimulated, these nerves signal that defecation needs to occur. In other words, these muscle and nerve groups convey when a bowel movement is necessary but allow a person to control when waste will actually be removed, as the final step in the digestive process. The anus is the last portion of the colon, and is a specialized opening bound with elastic membranes, sensitive tissues, and muscles and nerves allowing it to stretch for removing bowel movements of varying sizes. If, for example, you suffer from constipation, these tissues can become damaged and lose their ability to function normally if waste has to be forced out or remains in the body for prolonged periods. So its definitely good practice to keep things moving along at a regular pace. Ideally, you should have two bowel movements per day but at least once a day is pretty good; anything less than that could spell trouble for not only your digestive health but general health as well.

Physiology of the Colon To summarize, approximately 500 ml (milliliters) of food pass through the colon daily. The various sections of the digestive tract absorb and remove water, propel waste throughout the long system of muscular tubes, work to keep the body alkalized, and accommodate the colonization of billions of beneficial microorganisms to aid us in breaking down waste matter. Regardless of the depth of your knowledge regarding the colons functions, please realize the importance of its functions for promoting overall health. Be good to your body on the inside as well as out by following a healthful diet, drinking ample of water, and keeping all your biological systems well maintained with stimulating exercise and by getting plenty of rest. The functions of the large intestine include  Mechanical digestion. Rhythmic contractions of the large intestine produce a form of segmentation called haustral contractions in which food residues are mixed and forced to move from one haustrum to the next. Peristaltic contractions produce mass movements of larger amounts of material.  Chemical digestion. Digestion occurs as a result of bacteria that colonize the large intestine. They break down indigestible material by fermentation, releasing various gases. Vitamin K and certain B vitamins are also produced by bacterial activity.  Absorption. Vitamins B and K, some electrolytes (Na+ and Cl), and most of the remaining water is absorbed by the large intestine.  Defecation. Mass movement of feces into the rectum stimulates a defecation reflex that opens the internal anal sphincter. Unless the external and sphincter is voluntarily closed, feces are evacuated through the anus.

VIII. PATHOPHYSIOLOGY

Risk Factors: Inherited Gene Mutations Aging High Fat diet Smoking Alcohol intake Low Selenium Asbestos Inhalation

Formation of benign polyp on the epithelial lining/mucosa of the intestine [STAGE 0]

Benign polyp begins replicating Tumor invades Submucosa and Muscularis Propria [STAGE I]

Tumor invades Subserosa and beyond (without other organs involved) [STAGE II A] Tumor invades adjacent organs or perforates the visceral peritoneum [STAGE II B] Metastasis to regional lymph nodes [STAGE III]

Signs and Symptoms: Rectal pain Bloody, black or pencil stools Cramping/Abdominal pain Diarrhea Constipation Fatigue

Malignant cells breaks off and metastasizes to other organs (liver, lungs, bones, and stomach)

Left Side

Right Side

Tend to be circumferential and can obstruct the bowel

Tumor grows outwards from one location in the bowel wall

IX. SOURCES
           

Brunner & Suddarths, Textbook of Medical-Surgical Nursing Volume I p.1098-1107 http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-colorectalcancer.html http://nursingcrib.com/nursing-care-plan/nursing-care-plan-colon-cancer-colorectal-cancer/ http://www.articlesbase.com/health-articles/anatomy-and-physiology-of-the-colon-107624.html http://www.joelertola.com/grfx/chrt_colonCancer.html http://cmapspublic.ihmc.us/rid=1204003153885_1438036982_17149/Colorectal%20Cancer%202.c map
http://nursingcrib.com/medical-laboratory-diagnostic-test/colonoscopy-procedure/ http://www.medicalcriteria.com/criteria/gas_colonoscopy.htm http://www.medicinenet.com/colonoscopy http://www.ncbi.nlm.nih.gov/books/NBK6945/ http://www.medterms.com/script/main/art.asp?articlekey=2792 http://www.emedicinehealth.com/colonoscopy/page2_em.htm

FAR EASTERN UNIVERSITY INSTITUTE OF NURSING S.Y. 2011 2012

COLORECTAL CANCER

SUBMITTED BY:
FAJARDO, DENNISON C. GROUP 14 BSN304

SUBMITTED TO:
Mrs. Amelita Miguel, RN, MAN