STUDY PURPOSE

1. COLORECTAL CANCER
MINATI DAS
KINS,KIIT UNIVERSITY

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The colon and rectum

3. Risk Factors For Colorectal Cancer
• Increasing age (highest in people older than 85 years).
• Family history.
• Previous colon cancer.
• High consumption of alcohol.
• Cigarette smoking.
• Obesity and history of gastrectomy.
• History of inflammatory bowel disease.
• High fat, high protein, low fiber diet.
• Genital cancer or breast cancer.
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4. Clinical Manifestations
• Three factors greatly determine the signs and symptoms
experienced by a patient with colorectal cancer. These are:
▫ Location of tumor.
▫ Stage of disease.
▫ Function of the affected intestinal part.
• Most commonly, patients have change in bowel habits and
passage of stool with blood. Other clinical manifestations
include unexplained anemia, anorexia, weight loss, and
fatigue.
• Right-sided lesions are associated with:
▫ Abdominal pain and melena.
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5. Clinical Manifestations (Continued…)
• Left-sided lesions, causing obstruction, are associated with:
▫ Abdominal pain and cramping.
▫ Narrowing stools and constipation.
▫ Distention and bright red blood in stool.
• Rectal lesions are associated with:
▫ Ineffective, painful straining at stool.
▫ Rectal pain.
▫ A feeling of incomplete evacuation after a bowel movement.
▫ Alternating constipation and diarrhea.
▫ Bloody stools.
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6. Assessment and Diagnostic Findings
• Abdominal and rectal examination.
• Stool for occult blood.
• Barium enema.
• Proctosigmoidescopy. Most important
• Colonoscopy.
• Carcinoembryonic antigen may be useful
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7. Medical Management of a Patient With Colorectal Cancer
• If there is intestinal obstruction, patients are treated with IV fluids
and nasogastric suction. Blood transfusion if there is significant
blood loss.
• Treatment of this disease depends on its stage and consists of
surgical removal of tumor, supportive therapy, and adjuvant therapy.
By adjuvant therapy we mean chemotherapy, radiotherapy,
immunotherapy that a patient with non-metastasised colon cancer
would receive. The standard adjuvant therapy is 5-fluorouracil and
leucovorin calcium. Radiotherapy is used before, during, and after
surgery to shrink the tumor and to reduce recurrence.
• Radiotherapy is also used for unresectable tumors for symptoms
relief.
• Surgery is the primary treatment for most colorectal cancers.
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8. Medical Management of a Patient With Colorectal Cancer
(Continued…)
• Colostomy: This is a surgical creation of an opening into the colon.
It could be temporary or permanent.
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Permanent colostomy for rectal cancer

9. • Colostomy (Continued…):
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10. Nursing Management of a Patient With Colorectal
Cancer
Assessment
• Collect subjective data about:
▫ Presence of fatigue.
▫ Abdominal or rectal pain.
▫ Past and present elimination pattern.
▫ Characteristics of stool.
▫ Family history and fat and fiber intake.
▫ Alcohol intake and smoking.
▫ Weight loss.
• Auscultate the abdomen for bowel sounds.
• Palpate the abdomen for distention and solid masses.
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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Diagnoses
• Imbalanced nutrition, less than body requirements, related to
nausea and anorexia.
• Risk for deficient fluid volume related to vomiting and
dehydration.
• Anxiety related to cancer diagnosis and impending surgery.
• Impaired skin integrity related to surgical incisions.
• Disturbed body image related to colostomy.

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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Planning and goals
• Attainment of optimal nutrition.
• Maintenance of fluid and electrolyte balance.
• Reduction of anxiety.
• Attainment of optimal wound healing.
• Expressing feelings and concern about colostomy and the
impact on self.

13. 13
Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Interventions
• Patient Preparation for Surgery.
• Build the patient’s stamina days before surgery.
• Cleanse the bowel the day before surgery.
• If possible, provide a diet high in calories, protein, and
carbohydrate for several days before surgery.
• Provide full liquid diet if prescribed 24 to 48 hours before
surgery to reduce bulk.
• Clean the bowel with laxatives and/ or enemas the evening
before and the morning of surgery.
• Record intake and output to provide an accurate record of fluid
balance.

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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Interventions
• Patient Preparation for Surgery (Continued…).
• Insert nasogastric tube if ordered to drain accumulated fluids
and prevent abdominal distention.
• Monitor the patient for increasing abdominal distention, loss of
bowel sounds, and pain or rigidity, which may indicate intestinal
obstruction or perforation.
• Observe the patient for signs of hypovolemia (tachycardia,
hypotension, decreased pulse volume).
• Assess hydration status.

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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Interventions (Continued…)
• Providing Emotional Support.
• Assess the patient’s level of anxiety.
• Suggest methods for reducing anxiety such as deep breathing
exercises and visualising a patient who successfully recovered
from surgery and cancer.
• Provide factual information about the colostomy site to reduce
the patient’s fear that everybody will be aware of the ostomy.
• Providing Postoperative Care.
• Pain management.
• Abdominal assessment for bowel sounds.
• Mobilise the patient out of bed on the 1st day postop.

16. 16
Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Interventions (Continued…)
• Maintaining Optimal Nutrition.
• Teach patients undergoing surgery about the health benefits of
consuming healthy diet.
• Perform complete nutritional assessment to evaluate the
nutritional status of the patient.
• Advise the patient on avoiding foods that cause excessive odor
and gas such as foods in cabbage family, eggs, asparagus, fish,
and beans.
• Help the patient identify any foods or fluids that may cause
diarrhea including fruits, high fiber foods, soda, coffee, tea, or
carbonated drinks.
• Advise a fluid intake of at least 2 L/ day

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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Interventions (Continued…)
• Supporting a Positive body Image.
• Encourage the patient to verbalise feelings and concerns about
altered body image, and to discuss the surgery and the stoma if
one was created.
• If applicable, teach the patient about colostomy care in an open,
accepting manner and encourage him to talk about his feeling
about the stoma.

18. THANK YOU
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