ANSWERS TO ACTIVITY 4

COLLABORATIVE MANAGEMENT

Treatment depends partly on the stage of the cancer. In general, treatments may include:
· Surgery (most often a colectomy) to remove cancer cells
· Chemotherapy to kill cancer cells
· Radiation therapy to destroy cancerous tissue

v SURGERY

Stage 0 colon cancer may be treated by removing the cancer cells, often during a colonoscopy. For stages I, II, and III cancer, more
extensive surgery is needed to remove the part of the colon that is cancerous.

Generally, large bowel resection is surgery to remove all or part of your large bowel. This surgery is also called colectomy. The
large bowel is also called the large intestine or colon.

Removal of the entire colon and the rectum is called a proctocolectomy.

Removal of part or all of the colon but not the rectum is called subtotal colectomy.

HERE ARE SOME OF THE SURGERIES:

1. Wide segmental bowel resection of tumor, including regional lymph nodes and blood vessels.

2. Transanal excision for small, localized, accessible tumors.

3. Low anterior resection for upper rectal tumors; possible temporary diversion loop colostomy while rectal anastomosis heals; 2 nd
procedure for takedown of colostomy.

4. Colonic J-pouch is a new technique that may be offered for rectal tumors. Laparoscopic procedures are controversial.

5. Abdominoperineal resection with permanent end colostomy for lower rectal tumors when adequate margins cannot be obtained
or anal sphincters are involved.

6. Temporary loop colostomy to decompress bowel and divert fecal stream, followed by later bowel resection, anastomosis, and
takedown of colostomy.

7. Diverting colostomy or ileostomy as palliation for obstructing, unresectable tumors.

8. Total proctocolectomy and possible ileal reservoir- anal anastomosis for patients with familial adenomatous polyposis and CUC
before cancer is confirmed.

9. More extensive surgery involving removal of other organs if cancer has spread (bladder, uterus, small intestine)

v CHEMOTHERAPY

Almost all patients with stage III colon cancer should receive chemotherapy after surgery for approximately 6 - 8 months. The
chemotherapy drug 5-fluorouracil has been shown to increase the chance of a cure in certain patients.

Chemotherapy is also used to improve symptoms and prolong survival in patients with stage IV colon cancer.
· Irinotecan, oxaliplatin, capecitabine, and 5-fluorouracil are the three most commonly used drugs.
· Monoclonal antibodies, including cetuximab (Erbitux), panitumumab (Vectibix), bevacizumab (Avastin), and other
drugs have been used alone or in combination with chemotherapy.
You may receive just one type, or a combination of these drugs. Chemotherapy may be used as adjuvant therapy to improve
survival time. May be used for residual disease, recurrence of disease, unresectable tumors and metastatic disease.

v RADIATION

Although radiation therapy is occasionally used in patients with colon cancer, it is usually used in combination with chemotherapy for
patients with stage III rectal cancer.

v Other Therapeutic Interventions

Blood replacement or other treatments if severe anemia exists.

For patients with stage IV disease that has spread to the liver, various treatments directed specifically at the liver can be used. This
may include:
· Burning the cancer (ablation)
· Delivering chemotherapy or radiation directly into the liver
· Freezing the cancer (cryotherapy)
· Surgery

NURSING INTERVENTION

o Prepare the patient for surgery, as indicated.

o Provide comfort measures and reassurance for patients undergoing radiation therapy.

o Prepare the patient for the adverse effects of chemotherapy and take steps to minimize this effects.

o Use strict aseptic technique when caring for I.V. catheters.

o Have the patient wash his hands before and after meals and after going to the bathroom.

o Listen to the patient’s fears and concerns, stay with him during periods of severe stress and anxiety.

o Encourage the patient to identify actions and care measures that will promote his comfort and relaxation.

o Monitor the patient’s bowel patterns.

o Monitors the patient’s diet modification, and assess the adequacy of his nutrition intake.

o Direct the patient to follow a high fiber diet.

o Caution him to take laxatives or an antidiarrheal medications only as prescribed by the doctor.

o Inform the patient about screening and early detection.

Management of patient that is for surgery:

v Preoperative Management:
 1. Preparing the client for surgery.
· Physical preparation – building the patient’s stamina and cleansing the bowel prior to surgery
· Assess patient’s knowledge about the diagnosis, prognosis, surgical procedure, and expected level of functioning after
surgery.
· Assess patient’s anxiety level and coping mechanisms and suggest methods for reducing anxiety such as deep
breathing exercises.

v Intraoperative Management:

1. Maintenance of safety
· Maintains aseptic, controlled environment.
2. Effectively manages human resources, equipment, and supplies for individualized patient care.
3. Transfer patient to operating room table.
4. Position the patient, exposing the surgical site.
5. Applies grounding device to patient.
6. Ensure that the sponge, needle, and instrument counts are correct.

v Postoperative Management:

1. Pain management during the immediate postoperative period, monitor for complications such as leakage from the site of
anastomosis, prolapse of the stoma, perforation, stoma retraction, skin irritation, and pulmonary complications.
2. Maintaining optimal nutrition – The patient avoids foods that cause excessive odor and gas, including foods in the
cabbage family, eggs, fish, beans, and high-cellulose products such as peanuts. Fluid intake of at least 2 L/day.
3. Providing wound care
· The nurse frequently examines the abdominal dressing during the first 24 hours after surgery to detect signs of
hemorrhage.
· Splint the abdominal incision during coughing and deep breathing to lessen tension on the edges of the incision.
· Monitor vital signs to detect an infectious process.
· With colostomy – stoma is examined for swelling (slight edema from surgical manipulation is normal), color (a healthy
stoma is pink or red), discharge (small amount of oozing is normal), and bleeding (an ABNORMAL sign)
4. Monitoring and managing complications
· Frequently assess the abdomen, including decreasing or changing bowel sounds and increasing abdominal girth to
detect bowel obstruction.
· Monitor hematocrit and haemoglobin levels and administer blood products as prescribed.
· For pulmonary complications – frequent activity (turning to sides every 2 hours), deep breathing exercises, coughing,
and early ambulation
5. Removing and applying the colostomy appliance – The colostomy begins to function 3 to 6 days after surgery.
· Advise patient to protect the periostomal skin by washing the area gently with a moist soft cloth and a mild soap.
6. Irrigating the colostomy – to empty the colon of gas, mucus, and feces
7. Supporting a positive image – Help the patient 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.

END…!!!!