colorectal cancer, epidemiology, risk factors, sign and symptom, pathophysiology, complications, assessment and diagnostic findings, medical and nursing interventions

1. By
Mehwish Jamil

2. 
At the of this lecture students will be able to:
 Define colorectal cancer.
 Discuss the epidemiology of colorectal cancer.
 Explain risk factors of colorectal cancer.
 Describe pathophysiology of colorectal cancer.
 Enlist sign and symptoms of colorectal cancer.
 Discuss complications of colorectal cancer.
 Describe assessment and diagnostic findings.
 Explain medical and nursing interventions of
Colorectal cancer
Objectives

3. 
 Definition:
Colorectal cancer occurs when the cells
that line the colon or the rectum become abnormal and
grow out of control.
Cancer that begins in the colon is called a
colon cancer, while cancer in the rectum is known as a
rectal cancer. Cancers that affect either of these organs
may be called colorectal cancer.
Colorectal cancer

4. 
 the colorectal area (the colon and rectum combined)
is now the third most common site of new cancer
cases in the United States. Colorectal cancer is a
disease of Western cultures.
 Colorectal cancer is the second leading cause of
cancer death in both men and women. The lifetime
risk of developing colorectal cancer is 1 in 17 .
 Incidence increases with age (the incidence is highest
in people older than 85 years) and is higher in people
with a family history of colon cancer and those with
IBD or polyps.
Epidemiology

5. 
Risk factors

6. 
 Cancer of the colon and rectum is predominantly (95%)
adenocarcinoma (ie, arising from the epithelial lining of
the intestine).
start as a benign polyp but may become malignant
invade and destroy normal tissue
extend into surrounding structures
Cancer cells may migrate away from the
primary tumor and spread to other parts of
the body (most often to the liver, peritoneum,
and lungs)
Pathophysiology

7. 
 The most common presenting symptom is a change in bowel
habits.
 The passage of blood in or on the stools is the second most
common symptom.
 unexplained anemia
 anorexia
 weight loss
 Fatigue
 Symptoms associated with right-sided lesions are dull abdominal
pain and melena (i.e., black, tarry stools)
 Symptoms associated with left-sided lesions are those associated
with obstruction (i.e., abdominal pain and cramping, narrowing
stools, constipation, distention), as well as bright-red blood in the
stool.
Sign and symptom

8. 
Symptoms associated with rectal lesions are
tenesmus (i.e., ineffective, painful straining at
stool), rectal pain, the feeling of incomplete
evacuation after a bowel movement,
alternating constipation and diarrhea, and
bloody stool.
Conti…

9. 
 Tumor growth may cause partial or complete bowel
obstruction.
 Hemorrhage
 Perforation
 abscess formation
 peritonitis
 sepsis
 shock
Complications

10. 
 Along with an abdominal and rectal examination,
the most important diagnostic procedures for cancer
of the colon are
 fecal occult blood testing
 barium enema
 proctosigmoidoscopy
 colonoscopy .
 Carcinoembryonic antigen (CEA)
Assessment and Diagnostic
findings

12. 
 Treatment for colorectal cancer depends on the stage
of the disease and consists of surgery to remove the
tumor, supportive therapy, and adjuvant therapy.
 Adjunctive therapy:
 The standard adjuvant therapy administered to
patients with Dukes’ class C or non-metastasized
colon cancer is the 5-fluorouracil (5-FU; Adrucil) plus
leucovorin calcium.
Medical treatment

13. 
 Patients with Dukes’ class B or C rectal cancer are
given 5- FU and high doses of pelvic irradiation.
Mitomycin is also used.
 Radiation therapy:
therapy is used before, during, and after surgery to:
1. shrink the tumor
2. to achieve better results from surgery
3. and to reduce the risk of recurrence.
Conti…

14. 
 Cancers limited to one site can be removed through
the colonoscope.
 Laparoscopic colotomy with polypectomy minimizes
the extent of surgery needed in some cases.
 A laparoscope is used as a guide in making an
incision into the colon; the tumor mass is then
excised.
 Laparoscopic colectomy(beneficial)
 Use of the neodymium/yttriumaluminum-garnet
(Nd:YAG) laser
Surgical management

16. 
 Bowel resection
 Segmental resection with anastomosis
 Abdominoperineal resection with permanent
sigmoid colostomy
 Temporary colostomy followed by segmental
resection and anastomosis and subsequent
reanastomosis
 Permanent colostomy or ileostomy
 Construction of a coloanal reservoir called a colonic J
pouch
Conti…

22. 
 A nasogastric tube may be inserted to drain accumulated
fluids and prevent abdominal distention.
 The nurse monitors the abdomen for increasing
distention, loss of bowel sounds, and pain or rigidity,
which may indicate obstruction or perforation
 observes for signs of hypervolemia (eg, tachycardia,
hypotension, decreased pulse volume)
 assesses hydration status
 assesses the patient’s knowledge about the diagnosis,
prognosis, surgical procedure, and expected level of
functioning after surgery.
Preparation for
surgery(continue)

23. 
Nutritional support
 Teach all patients undergoing surgery for colorectal cancer
about the health benefits to be derived from consuming a
healthy diet.
 A complete nutritional assessment is important for the patient
with a colostomy.
 Advise on avoiding foods that cause excessive odor and gas,
including foods in the cabbage family, eggs, asparagus, fish,
beans, and high-cellulose products such as peanuts.
 nurse can help the patient identify any foods or fluids that
may be causing diarrhea, such as fruits, high-fiber foods,
soda, coffee, tea, or carbonated beverages.
 suggests fluid intake of at least 2 L per day.
Conti…

24. 
Supporting a Positive Body Image
 encouraged to verbalize feelings and concerns about
altered body image and to discuss the surgery and the
stoma (if one was created).
 If applicable, the patient must learn colostomy care and
begin to plan for incorporating stoma care into daily life.
 nurse helps 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.
Conti…

25. 
 Providing Wound Care
 Removing and Applying the Colostomy
Appliance
 Irrigating the Colostomy
 Discussing Sexuality Issues
Conti…