colorectal cancer
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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
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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.
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