Colorectal cancer is the third most common cancer worldwide and the fourth most common cause of cancer death. Risk factors include age over 50, personal or family history of colon polyps or inflammatory bowel disease, diet low in fiber/high in fat/red meat, smoking, alcohol, and sedentary lifestyle. Symptoms include rectal bleeding, blood in stool, abdominal pain, and changes in bowel habits. Screening allows early detection through colonoscopy. Staging determines treatment which may include surgery, chemotherapy, and radiation therapy. Nursing care focuses on managing anxiety, fatigue, pain, and other side effects.

1. COLORECTAL CANCER
Dwi Kartika Rukmi

2. Morphology of Colon

3. CANCER
WORLWID
E

4. COLORECTAL CANCER
 Colorectal cancer (CRC) is a major cause of
morbidity and mortality throughout the
world. It accounts for over 9% of all cancer
incidence.
 CRC is the third most common cancer
worldwide and the fourth most common
cause of death
 In 2012, highest CRC incidence in both female
and male are in Japan (Miyagi Prefecture: ♀
37,2/100.000 and ♂ 62,4/100.000)
Arnold M, Sierra MS, Laversanne M, et al. Gut 2017;66:683–691

5. COLORECTAL CANCER RISK FACTOR
NON MODIFIABLE (20%)
 Age
 Personal History of Adenomatous Polyps
 Personal History of Inflammatory Bowel
Disease
 Family History of Colorectal Cancer or
Adenomatous Polyps
 Inherited Genetic Risk
MODIFIABLE (80%)
 A diet low in fibre, vegetables, and folate and
high in fat, red meat
 Heavy alcohol consumption
 A sedentary occupation
 Cigarette smoking
Hamza, Aglan, Ahmed,2017; Granados Romero JJ et al. 2017

6. Cont
 Age: increases progressively from age 40,
rising sharply after 50.
 Personal History of Adenomatous Polyps
: tubular or villous adenomas (life time
risk for adenomas is 19% and 95% CRC
develops from these adenomas)
Villous Adenoma
Tubular AdenomaHamza, Aglan, Ahmed,2017; Granados Romero JJ et al. 2017

7. Cont
 Personal History of Inflammatory Bowel
Disease :Ulcerative colitis and Crohn
disease usually described as inflammatory
bowel disease (IBD) . The relative risk of
CRC in patients with inflammatory bowel
disease has been estimated between 4-
to 20-fold
 Family History of Colorectal Cancer or
Adenomatous Polyps :People with a
history of CRC or adenomatous polyps in
one or more first-degree relatives are at
increased risk. CRC develop 100% in FAP
untreated by age 45
Ulcerative colitis
Familial
Adenomatous
Polyps (FAP)
Hamza, Aglan, Ahmed,2017

8. Cont
 Inherited Genetic Risk
 Approximately 5 to 10% of colorectal cancers are a
consequence of recognized hereditary conditions. The most
common inherited conditions are FAP and HNPCC, also
called Lynch syndrome
 HNPCC is associated with mutations in genes involved in the
DNA repair pathway
 FAP is caused by mutations in the tumor suppressor gene
APC
 The lifetime risk of CRC in people with the recognized
HNPCC-related mutations may be as high as 70 to 80%, and
the average age at diagnosis in their mid-40s
Hamza, Aglan, Ahmed,2017

9.  A diet low in fibre, vegetables, and
folate and high in fat, red meat
Hamza, Aglan, Ahmed,2017

10. Cont
 Alcohol comsumption
Rossi, M.,Anwar MJ.,Usman A.,et al. 2017

11. Cont
 A sedentary occupation
Hamza, Aglan, Ahmed,2017

12. Cont
 Cigarette Smoking
Liang, 2009

13. Pathophysiology of CRC (Nguyen, Duong, 2018)

14. LOCATION OF CRC
 Rectum (37%)
 Sigmoid (31%)
 Ascending colon (9%)
 Cecum (8%)
 Descending colon (5%)
 Transverse colon (4%)
 Hepatic angle (4%)
 Splenic Angle (2%)
Granados Romero JJ et al. 2017

15. SYMPTOM OF CRC
 Bleeding from the rectum
 Blood in the stool or in the toilet after having a bowel movement
 Dark or black stools
 A change in the shape of the stool (e.g., more narrow than usual)
 Cramping or discomfort in the lower abdomen
 An urge to have a bowel movement when the bowel is empty
 Constipation or diarrhea that lasts for few days
 Decreased appetite
 Unintentional weight loss
 Anemia from blood loss causes weakness and fatique
Hamza, Aglan, Ahmed,2017

16. DIAGNOSIS OF CRC (Granados Romero JJ et al. 2017)

17. Cont

18. Cont

19. STAGING OF CRC (Venook,2019; Hamza,Aglan ,Ahmed,2017)

20. STAGING
OF CRC
(AJCC,2010)

21. TREATMENT OF CRC (Granados Romero JJ et al. 2017)
 Stage 0 cancer can be treated by removing cancer cells by colonoscopy.
 Stage I, II and III Cancer, it is necessary to perform surgery using radical colectomy of the segment involved with margins > 5
cm, lymphadenectomy to the root of the nutrient vessel (minimum 12N), suspicious ganglion biopsy outside the resection
field It has been demonstrated that the laparoscopic approach is as safe as the traditional open approach for colorectal
cancer.
 Stage III: also treatment with radiotherapy combination with chemotherapy
 Chemotherapy (Fluorouracil and Leucovorin)  complementary chemotherapy for Stage III after surgery for 6-8 months for
improving symptom and prolong survival
 The 5 - Fluoracil continues to be the cytostatic mostly used in the treatment of colon cancer, those who make use of it or at
least approach the fulfilment of the therapeutic standard, achieve better percentages of survival.
 Anti angiogenesis therapy: Bevacizumab (lowering vascular endothelial growth factor (VEGF). Anti angiogenesis +
chemotherapy is better than chemotherapy only  improve global survival
 Stage IV with metastatic : various therapy approaches (ablation, chemotherapy, radiotherapy, cryotherapy or surgery)

22. Colonoscopy

23. SURGERY OF CRC

24. TOP TEN REPORT OF CRC PATIENTS
 Worry, anxiety or fear
 Information needs
 Fatigue
 Constipation or diarrhea
 Making plans
 Pain
 Sleep problems
 Tingling in hands and feet
 Work or education
 Other medical condition
NHS,2015

25. NURSING DIAGNOSIS
 Anxiety
 Deficient knowledge
 Fatigue
 Constipation
 Diarrhea
 Pain
 Disturbed Sleep Pattern
 Fear

26. NOC
Diagnosis NOC
Anxiety • Anxiety control
• Coping
Deficient knowledge • Diseases Process
• Health behavior
Fatigue • Energy conservation
• Nutritional status: energy
Constipation Bowel elimination
Diarrhea Bowel elimination
Pain • Pain Level
• Pain Control
Disturbed Sleep Pattern • Sleep
• Rest
Fear Fear control

27. NIC
Diagnosis NIC
Anxiety • Anxiety reduction
Deficient knowledge • Teaching: diseases process
• Teaching: individual
Fatigue • Energy management
Constipation Constipation/Impaction Management
Diarrhea Diarrhea management
Pain • Pain management
• Analgesic administration
Disturbed Sleep Pattern • Sleep enhancement
Fear Coping enhancement

28.  Arnold M, Sierra MS, Laversanne M, et al. Gut 2017;66:683–691 dalam https://gut.bmj.com/content/gutjnl/66/4/683.full.pdf
 Hamza AH,Aglan AH,Ahmed HH.2017. dalam http://www.avidscience.com/wp-content/uploads/2017/04/RAC0C-15-06.pdf
 Granados Romero JJ et al. 2017. Int J Res Med Sci. Nov 5(11):4667-4676 dalam https://www.researchgate.net/publication/320676335_Colorectal_cancer_a_review
 Rossi, M.,Anwar MJ.,Usman A.,et al. 2017 dalam https://pdfs.semanticscholar.org/a1ae/a03533995169bf2dc3ac66db6ffb6108bcdf.pdf
 Liang,P. 2009. Int. J. Cancer: 124, 2406–2415 dalam
https://www.researchgate.net/publication/23786425_Cigarette_smoking_and_colorectal_cancer_incidence_and_mortality_Systematic_review_and_meta-analysis
 Dulai,PS.,Sunborn,WJ.,Gupta,S.2016 dalam http://cancerpreventionresearch.aacrjournals.org/content/9/12/887
 Venook,AP.2019 dalam https://www.medscape.org/viewarticle/501381
 Nguyen,HT.,Duong,HQ.2018 dalam https://www.spandidos-publications.com/ol/16/1/9
 NHS.2015 dalam https://www.england.nhs.uk/wp-content/uploads/2015/03/colorectal-cancer-proms-report-140314.pdf