COLORECTAL

CANCER
Group Conferences
January 16, 2013
MMS 301
 Overview
I. Colon Cancer Facts
II. Risk Factors
III. Pathophysiology
IV. Clinical Manifestations
V. Diagnostic Exams
VI. Management and Nursing Responsibilities
VII. Medical Treatment
VIII. Pre-Op Teaching
IX. Post-Op Care
X. Prevention of Colorectal CA
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 COLON CANCER FACTS
Malignancy of colon/rectum
If 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 stage
Colon 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 Factors
Age above 40, increasing age
Family hx of colon CA or polyps
Previous colon CA
Personal hx of ulcerative colitis, Crohn’s disease for more
than 10 years
Onset is 63-67 years old
Whites than African Americans
Incidence higher in industrialized western world
High fat diet, high intake of protein (beef ), low fiber diet
Excess alcohol intake
Genital CA or breast CA
 Pathophysiology
Arise 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 tissue
Lungs and liver metastasize
Complications: perforation, abscess formation,
peritonitis, sepsis, and shock
 Clinical Manifestations
Frequently asymptomatic and diagnosed incidentally
Symptoms 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 Exams
Fecal occult
Blood testing
Barium enema
Proctosigmoidoscopy, and with biopsy or cytology
smears
Colonoscopy
CEA (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
 Management &
Nursing Responsibilities
Digital rectal examination
Fecal occult blood tests
Sigmoidoscopy
Barium enema excellent in outlining large polyps
Colonoscopy – the gold standard for diagnosis
 Medical Treatment
Chemotherapy-pallative in nature
5 FU+ Leviamisole or leukovonin with 5 FU (To
stimulate immune system function and minimize
damage to healthy cells)
Radiation in rectal CA
Surgery
 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
 Pre-Operative Teaching
Parenteral nutrition: Abdominal status
Monitor electrolyte balance
Incisions, NGT, and wound drainage
Need for ostomy if applicable
 Post-Operative Care
Maintain F/E balance: NGT drainage-out, patency, IV
fluids, daily weight
Assess abdominal status and return of peristalsis
Assess stoma, avoid constipation
Check for rectal bleeding, H & H monitoring
Evaluate ability to apply and remove appliance
Promote optimal nutrition
Promote ventilation
 Preventive Measures
High Fiber, low fat diet
Avoid salt cured or nitrite cured foods
Avoid obesity
Annual occult exam above 50 years old (F/M)
Sigmoidoscopy every 5-10 years
Total colon exam every 5-10 yrs
 THANK YOU FOR
LISTENING! 
References:
 Black, J. & Hawks, H. (2005). Medical-surgical nursing (4 th 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.