For 2nd year B.Sc Nursing students

1. COLORECTAL
CANCER
Presented By:
Mr. Nandish. S
Asso. Professor
Mandya Institute of Nursing Sciences

3. Definition :
 It is a cancer of colon or rectum, which begin as non – cancerous
polyp.
 It is a growth of cells that form in lower end of digestive tract.
 It is a cancer that develops in the inner lining tissues of colon or
rectum.
 It is also known as Bowel / Colon / Rectal cancer.
 It is the 3rd leading cause of death in males after the age of 50 years.

5. Etiology :
• Idopathic
• Age : more than 50 years
• Chronic Inflammatory Bowel Disease (Ulcerative colitis , Crohn’s
disease)
• Genetics (First degree relatives : parent or sibling)
The most common of these are Hereditary Non - polyposis Colorectal
Cancer (HNPCC) is found in 3% cases. Other syndromes associated
with CRC are Gardner Syndrome and Familial Adenomatous
Polyposis.
(continued …)

6. • Previous history of Colorectal cancer
• History of ovarian or breast cancer (women)
• High fat & / or low fiber diet
• Smoking
• History of Type II Diabetes Mellitus
• Overweight or Obesity
• Racial background (African / American)

7. Clinical Manifestations :
They are determined by the location of & stage of tumor. They do not
appear until the disease is advanced. Common symptoms are
 Change in the bowel habits
 Passage of blood in the stool.
 Unexplained anemia
 Anorexia
 Weight loss
 Fatigue
Continued ..

8. Symptoms associated with right sided lesions are
- Dull abdominal pain
- Melena
- Black tarry stools
Symptoms associated with left sided lesions are
- Colicky Abdominal pain & cramping
- Narrowing , ribbonlike stools
- Constipation
- Distension
Continued ….

9. Symptoms associated with rectal lesions
 Tenesmus (It is the feeling of being unable to empty the bowel. It is
when person still feels the need to defecate, although there is no
more stool to remove)
 Rectal pain
 Feeling of incomplete evacuation
 Alternating constipation & diarrhea
 Bloody stool

11. Diagnostic Studies :
 History collection & physical examination
 Digital rectal examination
 Sigmoidoscopy
 Colonoscopy
 Barium enema
 CBC
 Liver Function Tests
 Stool examination for Occult blood
 Carcinoembryonic Antigen Test (CEA)
 CT Scan of abdomen
 Ultrasound

12. Dukes staging system for colorectal cancer :
Classification Description
A Negative nodes, limitation of lesion to mucosa
B 1 Negative nodes, extension of Lesion through mucosa,
but still within bowel wall
B 2 Negative nodes, extension through entire bowel wall
C 1 Positive nodes, limitation of lesion to bowel wall
C 2 Positive nodes, extension of Lesion through entire
bowel wall
D Presence of distant, unresectable metastases

13. Complications :
Partial or complete lumen obstruction
Perforation
Acute Hemorrhage
*all the complications need only surgical management.

14. Prevention :
- Cessation of smoking & tobacco use.
- Regular physical activities.
- Diet & weight reduction strategies.
- Tab. Aspirin (>75mg) is advised after 50 years every alternate day if
it is not contraindicated.

15. Management :
* Treatment depends on pathologic staging of tumor.
* Several non invasive procedures are performed through colonoscope
for stage 0 or A grade tumors.
 Endoscopic polypectomy is highly effective & safe procedure.
 Laser Therapy is used to ablate non – resectable tumors.

16. Surgical management :
 It is the most effective way of treating colorectal cancer.
 Location & extent of cancer determines the type of surgery
performed.
 Success of surgery depends on resection of tumor with adequate
margin of healthy bowel & resection of regional lymph nodes.

17. o Right Hemicolectomy – it includes removal of caecum, ascending
colon, hepatic flexure & transverse colon to the right from middle.
o Left Hemicolectomy – it involves resection of left transverse colon,
splenic flexure, descending colon & sigmoid colon with upper portion
of rectum.
o Segmental resection with anastomosis (removal of tumor & portion of
bowel on either side growth.)
o Abdomino-perineal resection with permanent sigmoid colostomy (miles
resection – removal of tumor, a portion of sigmoid colon, all of rectum
& anal sphincter).
o Temporary colostomy followed by segmental resection & anastomosis.
o Permanent colostomy or ileostomy.

19. Chemotherapy :
It is indicated in case of metastasis.
chemotherapy is used as both adjuvant therapy after surgery & primary
treatment for non resectable tumor.
Commonly used drugs are :
- 5 – fluorouracil (5-FU)
- Leucovorin
- Leucovorin – moodulated 5-FU - Irinotecan
- Capecitabine - Levamisole
- Oxaliplatin - Raltitrexed

20. Nursing Management :
- Imbalanced Nutrition, less than body requirement related to
anorexia.
- Diarrhea or constipation related to impaired bowel elimination
pattern.
- Pain, acute, abdomen related to difficulty in passing stools.
- Anxiety related to impending surgery.
- Impaired skin integrity related to surgical incision.
- Ineffective coping, related to diagnosis of cancer.