Colorectal Cancer
Colorectal Cancer • Third most common cause of cancer
Colorectal Cancer
• 5-year survival rate:
– 90% for early, localized colorectal
cancer
– 64% for cancer that has spread to
adjacent organs and lymph nodes
death in the United States
• Most prevalent over the age of 50
• Estimated 75% of patients could be
cured if cancer was detected and
treated early
Risk Factors
• Causes: Unknown
– Genetic predisposition
– Age ( > 50 years)
– Familial polyposis
– Colorectal polyps
– Family history of colorectal cancer or adenoma
– Chronic inflammatory bowel disease
– History of ovarian or breast cancer
– High-calorie, high-fat, low-fiber diet
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 Nursing Assessment Nursing Assessment
• Past Health History * Change in bowel habits
* Previous breast or ovarian cancer * High calorie, high fat, low fiber
* Familial polyposis diet
* Adenomatous polyps * Medications
* Inflammatory bowel disease * Weakness or fatigue

Etiology and Pathophysiology Incidence of Cancer

• Adenocarcinoma is most common type

(95%)
• Most arise from adenomatous polyps
• Tumors spread through the walls of the
intestine and into the lymphatic system
• Tumors commonly spread to the liver
(venous blood flow from the tumor is
through the portal vein)

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 Nursing Implementation Nursing Implementation
• Health Promotion • Health Promotion
* Close attention to family history
* Physical examination with a digital *Epidemiological studies reported
rectal exam that the use of NSAID’s, or long term
* Fecal Occult Blood Test once per
year (avoid red meats and NSAID’s use of aspirin may decrease risk of
48 hrs prior to test to avoid false colorectal cancer
positive)
* Flexible sigmoidoscopy every 5 years
beginning at age 50

Clinical Manifestations Clinical Manifestations

• Clinical manifestations are nonspecific • Cancer on the right side gives rise to
and may not appear until the disease is manifestations that are different from
advanced those on the left side of the colon
• Manifestations determined by location,
stage, and functional segment of
involved intestine

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 Signs and Symptoms
Clinical Manifestations
• Right-sided lesions
– Usually asymptomatic
– Vague abdominal discomfort
– Iron deficiency anemia
– Occult bleeding
Clinical Manifestations
• Left-sided lesions
– Rectal bleeding
– Alternating constipation and diarrhea
– Narrow, ribbonlike stools
Diagnostic Studies
• Physical examination with digital rectal examination
• Fecal occult blood tests
• Colonoscopy
• Endorectal ultrasonography
• CT scan
• Barium enema
• CBC
• Liver Function studies
• Carcinoembryonic antigen (CEA) - most effective
for following progress after surgery
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 Collaborative Care
• Prognosis and treatment correlate with
pathologic staging of the disease
– Duke’s classification
– TNM system
Collaborative Care
• Chemotherapy and radiation therapy
– Recommended when a patient has
Dukes stage B or stage C at the time
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of surgery or has metastatic disease
Collaborative Care
• Endoscopic polypectomy
• Laser therapy
• Surgical therapy -The only curative
treatment
– Right hemicolectomy
– Left hemicolectomy
– Abdominal-perineal resection
– Colectomy
– Transanal approach
Collaborative Care
• Chemotherapy and radiation therapy
– Adjuvant therapy following colon
resection
– Primary treatment for nonresectable
colorectal cancer
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 Nursing Management Nursing Management
Nursing Diagnoses Planning

• Overall goals:
• Diarrhea or constipation
– Normal bowel elimination patterns
• Acute pain
– Quality of life appropriate to disease
• Fear
progression
• Ineffective coping
– Relief of pain
– Feelings of comfort and well-being

Nursing Management Nursing Management

Nursing Implementation Nursing Implementation

• Acute Intervention • Acute Intervention

– Preoperative care
• Ostomy care instruction
• Inform of the extent of the surgical
procedure and the amount of care
necessary to facilitate healing
– Postoperative care
• Management differs depending on the
type of wound
• Type of management is individualized

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 Nursing Management Nursing Management
Nursing Implementation Nursing Implementation

• Ambulatory and Home Care • Evaluation

– Psychologic support – Expected outcomes:
– Chemotherapy • Minimal alterations in bowel elimination
patterns
– Perineal wound may not be completely
• Relief of pain
healed before discharge
• Balanced nutritional intake

Nursing Management
Nursing Implementation Types of Ostomies

• Evaluation
– Expected outcomes:
• Quality of life appropriate to disease
progression
• Feelings of comfort and well-being

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 Loop Colostomy Sigmoid Colostomy

Nursing Management
Ostomy Appliances
Ostomy Care
• Characteristics of Stoma
• Colostomy Irrigations
• Ostomy Self-Care and Ileostomy Care
• Care of the Colostomy
• Nutritional Therapy
• Adaptation to an Ostomy