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COLORECTAL

CANCER
{ CANCER OF THE COLON AND RECTUM
 Colorectal cancer is the cancer affecting caecum,
conlon and rectum.

 Colorectal cancer is predominantly (95%)


adenocarcinoma

 It may start as a benign polyp but may become


malignant, invade and destroy normal tissues, and
extend into surrounding structures.

DEFINITION
 Increasing age  Obesity
 History of gastrectomy
 Family history of colon
 History of inflammatory
cancer or polyps
bowel disease
 Previous colon cancer
 High-fat, high-protein (with
or adenomatous polyps high intake of beef), low-
 High consumption of fiber diet
alcohol  Genital cancer (eg,
endometrial cancer, ovarian
 Cigarette smoking
cancer) or breast cancer (in
women)

RISK FACTORS
ADENOMATOUS POLYPOSIS
COLI GENE (APC GENE)

NORMALLY APC FORCES


APOPTOSIS

APC IS MUTATED

MUTATED BOWEL CELLS DON’T


DIE

UNCONTROLLED DIVISION

POLYP

MORE MUTATIONS

MALIGNANT TUMOR
 Changes in bowel habits (most common presenting
symptom), passage of blood in or on the stools
(second most common symptom).
 Unexplained anemia, anorexia, weight loss, and

fatigue.
 Right-sided lesions are possibly accompanied by
dull abdominal pain and melena (black tarry
stools).

CLINICAL
MANIFESTATIONS
 Left-sided lesions are associated with obstruction
(abdominal pain and cramping, narrowing stools,
constipation, and distention) and bright red blood
in stool.
 Rectal lesions are associated with tenesmus
(ineffective painful straining at stool), rectal pain,
and feeling of incomplete evacuation after a bowel
movement, alternating constipation and diarrhea,
and bloody stool.

CLINICAL MANIFESTATIONS
 Signs of complications: partial or complete bowel
obstruction, tumor extension and ulceration into
the surrounding blood vessels (perforation, abscess
formation, peritonitis, sepsis, or shock).

CLINICAL MANIFESTATIONS
 Abdominal and rectal
examination
 Fecal occult blood testing
 Barium enema

 Proctosigmoidoscopy and

colonoscopy
 Biopsy,

 Cytology smears.

ASSESSMENT AND DIAGNOSTIC


FINDINGS
Staging of Colorectal Cancer:
Dukes’ Classification–Modified Staging System
 Treatment of cancer depends on the stage of
disease and related complications.

MEDICAL MANAGEMENT
ADJUVANT  Patients with Dukes’ class B
{ THERAPHY { or C rectal cancer are given

 administered to patients 5- FU and high doses of


pelvic irradiation.
with Dukes’ class C or
non-metastasized colon
 Radiation therapy is used
cancer before, during, and after

 5-fluorouracil + surgery to shrink the tumor;


to achieve better results
leucovorin calcium
from surgery; and to reduce
(Wellcovorin). the risk of recurrence.
 Obstruction is treated with IV fluids and
nasogastric suction and with blood therapy if
bleeding is significant.

MEDICAL MANAGEMENT
 The type of surgery depends on the location and
size of tumor.

 Cancers limited to one site can be removed through


a colonoscope.

 Laparoscopic colotomy with polypectomy


minimizes the extent of surgery needed in some
cases.

SURGICAL MANAGEMENT
 Neodymium:yttrium-aluminum-garnet (Nd:YAG)
laser is effective with some lesions.

 Bowel resection with anastomosis and possible


temporary or permanent colostomy or ileostomy
(less than one third of patients) or coloanal
reservoir (colonic J pouch).

SURGICAL MANAGEMENT
 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 the colostomy
(sigmoid colostomies) and change the appliance

 Expressing feelings and concerns about the colostomy and the


impact on self; and avoidance of complications.

PLANNING & GOALS


NURSING
INTERVENTIONS
{
 Teach about the health benefits of a healthy diet; as
long as it is nutritionally sound and does not cause
diarrhea or constipation.

 Advise patient to avoid foods that cause excessive


odorand gas, including foods in the cabbage family,
eggs, asparagus, fish, beans, and high-cellulose
products such as peanuts;

 Suggest fluid intake of at least 2 L per day.

Maintaining Optimal Nutrition


 Administer antiemetics and restrict fluids and food
to prevent vomiting; monitor abdomen for
distention, loss of bowel sounds, or pain or rigidity
(signs of obstruction or perforation).

 Record intake and output, and restrict fluids and oral


food to prevent vomiting.

 Monitor serum electrolytes to detect hypokalemia


and hyponatremia.

Maintaining Fluid and Electrolyte


Balance
 Assess vital signs to detect signs of hypovolemia:
tachycardia, hypotension, and decreased pulse
volume.

 Assess hydration status and report decreased skin


turgor, dry mucous membranes, and concentrated
urine.
 Encourage patient to verbalize feelings and concerns.
 Provide a supportive environment and attitude to

promote adaptation to lifestyle changes related to


stoma care.
 Listen to the patient’s concerns about sexuality and

function (eg, mutilation, fear of impotence, leakage


during sex). Offer support and, if appropriate, refer
to an enterostomal therapist, sex counselor or
therapist, or advanced practice nurse.

Supporting a Positive Body Image


 Assess patient’s level of anxiety and coping
mechanisms and suggest methods for reducing
anxiety, such as deep breathing exercises. Arrange
meetings with a spiritual advisor, if desired.
 Provide meetings for patient and family with
physicians and nurses to discuss treatment and
prognosis; a meeting with an enterostomal therapist
may be useful.
 Help reduce fear by presenting facts about the

surgical procedure and the creation and


management of the ostomy.

Providing Emotional Support