COLORECTAL CANCER

Group ConferencesJanuary 16, 2013

MMS 301

OverviewI. Colon Cancer FactsII. Risk FactorsIII. PathophysiologyIV. Clinical ManifestationsV. Diagnostic ExamsVI. Management and Nursing ResponsibilitiesVII.Medical TreatmentVIII. Pre-Op TeachingIX. Post-Op CareX. Prevention of Colorectal CA

3

1

2

4

5

6

7

COLON CANCER FACTSMalignancy of colon/rectumIf the disease is detected and treated at an early

stage, the 5 year survival rate is 90%.Only 34% of colorectal cancers are found at an

early stageColon polyps and early cancer can have no

symptoms. Therefore regular screening is important.Duke’s Classification of Colorectal CA

Stage A: confined to bowel mucosa

Stage B: invading muscle wall

Stage C: lymph node involvement

Stage D: metastases or locally unresectable tumor

Risk FactorsAge above 40, increasing ageFamily hx of colon CA or polypsPrevious colon CAPersonal hx of ulcerative colitis, Crohn’s disease for

more than 10 yearsOnset is 63-67 years oldWhites than African AmericansIncidence higher in industrialized western worldHigh fat diet, high intake of protein (beef), low fiber

dietExcess alcohol intakeGenital CA or breast CA

PathophysiologyArise from pre-existing benign adenomatous

colon polyps Transformation is slow = 1cm polyp take 7

years to progress to invasive carcinoma(Adenomastically round and polypoid)Lesions penetrate the colon wall and extend

into surrounding tissueLungs and liver metastasizeComplications: perforation, abscess

formation, peritonitis, sepsis, and shock

Clinical ManifestationsFrequently asymptomatic and diagnosed incidentallySymptoms commonly associated with right-sided lesions:

dull abdominal pain and melena (black tarry stools)Symptoms commonly associated with left-sided lesions:

caused by obstruction (abdominal pain and cramping, narrowing stools, constipation, and distention) bright red blood in the stool.

Symptoms of partial bowel obstruction: constipation or diarrhea, pencil or ribbon shaped stools, sensation of incomplete bowel emptying

Others: anemia, anorexia, weight loss with no known reason, fatigue, change in BM, stools that are norrower than usual, general abdominal discomforts(ei. Freq gas pains, bloating, fullness, and/or cramps).

Diagnostic ExamsFecal occultBlood testingBarium enemaProctosigmoidoscopy, and with biopsy or cytology

smearsColonoscopyCEA (carcinoembryonic antigens) levels –

reliable in predicting prognosis with complete excision of the tumor, the elevated

levels of CEA should return to normal within 48 hours elevations of CEA at a later date suggest recurrence

Digital rectal examinationFecal occult blood testsSigmoidoscopyBarium enema excellent in outlining large

polypsColonoscopy – the gold standard for

diagnosis

Management &Nursing Responsibilities

Chemotherapy-pallative in nature5 FU+ Leviamisole or leukovonin with 5 FU

(To stimulate immune system function and minimize damage to healthy cells)

Radiation in rectal CASurgery

Definitive treatment for colorectal CA Low anterior resection through an abdominal incision used

most extensively Temporary colostomy to allow for bowel rest and healing

(temp/permanent) Type of surgery depends on location and size tumor

Medical Treatment

Parenteral nutrition: Abdominal status Monitor electrolyte balanceIncisions, NGT, and wound drainageNeed for ostomy if applicable

Pre-Operative Teaching

Maintain F/E balance: NGT drainage-out, patency, IV fluids, daily weight

Assess abdominal status and return of peristalsis

Assess stoma, avoid constipationCheck for rectal bleeding, H & H monitoringEvaluate ability to apply and remove

appliancePromote optimal nutritionPromote ventilation

Post-Operative Care

High Fiber, low fat dietAvoid salt cured or nitrite cured foodsAvoid obesityAnnual occult exam above 50 years old (F/M)Sigmoidoscopy every 5-10 yearsTotal colon exam every 5-10 yrs

Preventive Measures

THANK YOU FOR LISTENING!

References: Black, J. & Hawks, H. (2005). Medical-surgical nursing (4th ed.)

Singapore: Elsevier Pte Ltd. Porth, C. & Heymann, G. (2004). Pathophysiology concepts of

altered health states. New York: Lippincott Williams & Wilkins, Inc. Smeltzer, S.C. & Bare, B. (2004). Brunner & Suddarth’s textbook of

medical-surgical nursing (10th ed). Philadelphia: Lippincott Williams & Wilkins.

Tortora, G. & Derrickson, B. (2009). Principles of anatomyand physiology (12th ed). Massachusetts: John Wiley and Sons Pte Ltd.