INTRODUCTION Sigmoid Colon Cancer Cancers of the colon and rectum are the third most common cancer

among both men and women in the United States and the second leading cause of cancer death . INCIDENCE AND PREVALANCE Fifty-three percent of colorectal cancers occur in either the lower (sigmoid) colon or the rectum and should be easy to detect at an early stage. It is estimated that roughly 147,000 new cases are diagnosed each year, while the annual death rate from colorectal cancers hovers close to 50,000. It is expected to cause about 50,830 deaths during 2013. Sigmoid colon cancer is a malignancy of the sigmoid colon, the S-shaped portion of the large intestine that connects the descending colon to the rectum. The last part of the colon, which connects the descending colon to the rectum, is known as the sigmoid colon. All fecal matter is stored in this S-shaped part of the colon before it is expelled. When cancer cells are present in the lining of the sigmoid colon, it is termed as sigmoid colon cancer. Sigmoid colon cancer can be divided into three separate stages, depending on how far the cancer has spread.

Stage 1: Presence of small tumors (polyps) in the sigmoid colon that have not yet reached the mucosal layer of the colon. Stage 2: Cancer has spread to the mucosal layer. Stage 3: Cancer has spread beyond the mucosal layer and affected nearby lymph nodes as well. Risk Factors

Low fiber diet Are older than 60 Ulcerative colitis Crohns disease Presence of intestinal polyps Excessive drinking/smoking Family history of cancer

Symptoms and Diagnosis Similar to colon cancer in general, there are no specific signs and symptoms in the earlier stages. Some non-specific symptoms do begin to manifest toward the later stages. If you experience any of the following, you should consult your doctor and get tested.

Diarrhea Blood in your stool Smaller or narrower stool Abdominal pain or discomfort Anemia Sudden weight loss A sigmoidoscopy is the standard procedure with which a doctor will check the inside of the sigmoid colon and rectum. If polyps are found, the tissue will be sent for testing in order to confirm whether the polyps are benign or cancerous.

Treatment Treatment depends on many things, including stage of the cancer. Treatments may include:

Surgery (most often a colectomy) to remove cancer cells Chemotherapy to kill cancer cells Radiation therapy to destroy cancerous tissue

Surgery Stage 0 colon cancer may be treated by removing the cancer cells. This is done using colonoscopy. For stages I, II, and III cancer, more extensive surgery is needed to remove the part of the colon that is cancerous. This surgery is called colon resection. Chemotherapy Almost all patients with stage III colon cancer should receive chemotherapy after surgery for 6 8 months. This is called adjuvant chemotherapy. The drug 5-fluorouracil can increase the chance of a cure in certain patients.Chemotherapy is also used to improve symptoms and prolong survival in patients with stage IV colon cancer.

Irinotecan, oxaliplatin, capecitabine, and 5-fluorouracil are the three most commonly used drugs.

Monoclonal antibodies, including cetuximab (Erbitux), panitumumab (Vectibix), bevacizumab (Avastin), and other drugs have been used alone or in combination with chemotherapy.

You may receive just one type, or a combination of these drugs. There is some debate as to whether patients with stage II colon cancer should receive chemotherapy after surgery. You should discuss this with your oncologist. Radiation Radiation therapy is sometimes used in patients with colon cancer. It is usually used in combination with chemotherapy for patients with stage III rectal cancer.For patients with stage IV disease that has spread to the liver, treatments directed at the liver can be used. This may include:

Burning the cancer (ablation) Delivering chemotherapy or radiation directly into the liver Freezing the cancer (cryotherapy) Surgery

Prognosis Prognosis of sigmoid colon cancer will depend on the stage at which your cancer was when you were diagnosed. If detected in the earlier stages, chances of survival are high, and if the cancer does not return after five years, following treatment, the patient is said to have recovered completely. However, in most cases, the cancer is detected at later stages when the symptoms begin to manifest. The five year sigmoid colon cancer survival rate is 62%, albeit this will vary depending on the stage in which the cancer is diagnosed. Survival rates for stage 4 colon cancer are as low as 8%. Prevention The death rate for colon cancer has dropped in the last 15 years. This may be due to increased awareness and screening by colonoscopy. Colon cancer can almost always be caught by colonoscopy in its earliest and most curable stages. Almost all men and women age 50 and older should have a colon cancer screening. Patients at higher risk may need earlier screening.Colon cancer screening can often find polyps before they become cancerous. Removing these polyps may prevent colon cancer.Changing your diet and lifestyle is important. Medical research suggests that low-fat and high-fiber diets may reduce your risk of colon cancer.Some studies have reported that NSAIDs (aspirin, ibuprofen, naproxen, celecoxib) may help reduce the risk of colorectal cancer. But these medicines can increase your risk of bleeding and heart problems. Your health care provider can tell you more about the risks and benefits of the medicines and other ways that help prevent colorectal cancer.

PATIENTS PROFILE Name: CE B-day: June 22, 1948 Age: 65 Sex: Male Status: Married Address: San Jose City, Nueva Ecija Occupation: Farmer Attending Physcian: Dr. Jasmin Igama Date Admitted: July 22,2013 Time Admitted: 08:00 am Final Diagnosis: Sigmoid Colon Cancer, moderately differentiated S/P cycle I-day 1 Chemotherapy Initial Vital Signs: BP: 120/90 mm/Hg RR: PR: 22cpm 78bpm

Temperature: 36.5C

NURSING HISTORY PAST HEALTH HISTORY: The patient has no idea if he was given immunization. The patient suffered from illnesses like colds, cough and fever during his childhood. Ten years ago, the patient suffered nape pain which prompted him to a check-up. He was told that he had a Hypertension thus he was in maintenance for almost a year but failed to maintain taking up Losartan. FAMILY HEALTH HISTORY: Paternal Side (+) HPN Maternal Side (+)HPN He had a sister who died of Breast CA. No other known disease in the family.

PRESENT HEALTH HISTORY: January 2013- patient observed that his urination pattern was odd and painful at times. There is also a blood in his urine. He then went for check-up in a private hospital in the city and was diagnosed to have bladder infection. June 2013- the patient went for another consultation this time in Notre Dame Hospital since he still felt pain in urination with scant amount only. He then went for UTZ and diagnosed to have tumor in the sigmoid colon with bladder infiltration. Days after, he underwent ELAP to remove the tumor present in the sigmoid colon. The patient was advised then to undergo chemotherapy to prevent the growth of the tumor hence he was admitted in Notre Dame Hospital July 22, 2013.

PERSONS PSYCHOSOCIAL BEFORE: The patient is a 65 yr. old male, happily married and is gifted with a daughter and two sons. He only finished high school because according to him his parents cannot afford to send them to college. The patient always has fun time with his friends and shared that its his happiness to mingle with them and have few drinks of alcohol and share stories. The patient uses Ilocano as his dialect but he can understand Tagalog and a little of English. DURING: The patient is very positive on the outcome of the therapy and if asked if he was depressed upon knowing his condition the patient answered that God only knows what will happen so he just went day by day and is very hopeful. The wife of the patient is also very supportive and the pt. relates that he also get his strength from her and his family. The patient also openly communicates his feelings to his nurses. ELIMINATION BEFORE: Normally he urinates 6-10 times a day with an approximate amount of 250 mL per urination. But as stated above in the health history the pt. suddenly notices changes in his urination, he felt pain while urination and it is scanty as described by the patient. The patient has no problem in his defecation and said that he usually defecates everyday with the stool appearing dark brown, semi-formed and odorous. He doesnt have difficulty or pain in defecating. And due to drinking alcohol and too much pulutan he sometimes suffer diarrhea. But after the operation done to him dated June 2013 he observed blood in his stool but that was gone eventually. DURING: The patient defecated everyday in his two day stay in the hospital. He said that he doesnt have any pain while moving his bowel which is semi-formed and brown in color. He also has no difficulty in urination which he describes as light yellow in color. Output (whole shift) 7/22 7/23 1950 1690

REST AND SLEEP BEFORE: The patient sleeps at around 8-9 pm and wakes up at 4 am. He told that he needs to wake up early to go to his farm and there he usually takes nap for an hour. And went the clock hits 5 pm he go to the neighborhood and talk with them. He considers this his rest time after long hours in the farm. He stated that he can still do hard chores and believe that 6 hours of sleep is enough for him. DURING: The patient is confined to bed but can managed to move freely with the aid of IV stand for his IV contraptions. The first day the patient has no difficulty sleeping but during his chemotherapy he complained difficulty in sleeping and was prescribed with Xanor. SAFETY BEFORE: The patient has no known allergy. The patient started to use a reading eyeglass for the last three years. He His sense of smell, hearing and tasting are all intact. DURING: Patient still has difficulty seeing but his sense of hearing is still effective. He hears, understands and responds. The patient is safe by raising his side rails. His family supported him during his confinement. They visit and accompany him in the hospital. OXYGENATION BEFORE The patient has never complained of difficulty of problem that prompted him to visit a doctor. But he said that since his old now he sometimes feel out of breath when doing difficult task like lifting sack of rice as compared to before when he can still travel long distance with a sack of rice at hand.

DURING Night of July 23 the patient complained of difficulty of breathing and was given Alprozalam. But after given medication there were no further complains. NUTRITION BEFORE: He eats three times a day and if there are enough budgets he takes snack in the afternoon. Their meal was usually composed of rice, meat and vegetables. He likes to eat seafood. He is not allergic to any food. Every morning he drinks one cup of coffee before going to farm. He usually drinks 6-8 glasses of water a day. The patient also recalled that at the age of 15 he already started drinking alcohol with the like of gin and other brandy. And up until his 60s he still drinks alcohol with his friends with pulutan such as chicharon baboy, dinakdakan, mani and popular Filipino pulutan. He can tolerate 3-4 bottle of Red Horse but sometimes try to cross his limitations. DURING: The patient is in low purine diet. According to the patient he has good appetite. He has an IVF of D5W 1L for 12 hours and then later was hook with PNSS 1L for 4 hours for dehydration prior to chemotherapy. Intake 7/22 7/23 2900 2300

SPIRITUAL BEFORE: The patient is a Catholic and if he is not busy in the farm he attends mass with his wife. He is grateful to God for his family and believes that whatever problem he is facing he can surpass it with God. DURING: Patient has so much faith to God that he will survive this. He prays to God every day that he will be healthy.

ANATOMY AND PHYSIOLOGY The Gastrointestinal Tract Digestion takes place in the gastrointestinal (GI) tract, essentially a long tube that extends from the mouth to the anus. It is a complex organ system that first carries food from the mouth down the esophagus to the stomach. Food then travels through the small and large intestines before being excreted through the rectum and out the anus.

The esophagus, stomach, and large and small intestine -- aided by the liver, gallbladder, and pancreas -- convert the nutritive components of food into energy and break down the nonnutritive components into waste to be excreted. Esophagus The esophagus is a narrow muscular tube, about 9 1/2 inches long, that begins below the tongue and ends at the stomach. Stomach In the stomach, acids and stomach motion break food down into particles small enough so that the small intestine can absorb nutrients. Small Intestine The small intestine, despite its name, is the longest part of the gastrointestinal tract, extending for about 20 feet. Food passes from the stomach through its three parts: first the duodenum, then the jejunum, and finally the ileum. Most of the digestive process occurs in the small intestine.

Large Intestine Undigested material, such as plant fiber, is passed next to the large intestine, mostly in liquid form. The large intestine is wider than the small intestine but only about 6 feet long. It is the final portion of the digestive tract and includes thececum, the appendix, the colon, and the rectum, which extends to the anus. Cecum and Appendix. The cecum and the appendix are located in the lower-right quadrant of the abdomen. Colon. The colon absorbs excess water and salts into the blood. The remaining waste matter is converted to feces through bacterial action. The colon is divided into four major sections.

The first section, the ascending colon, extends upward from the cecum on the right side of the abdomen. The second section, the transverse colon, crosses the upper abdomen to the left side. The third section extends downward on the left side of the abdomen toward the pelvis and is called thedescending colon. The final section is the sigmoid colon.

Rectum and Anus. Feces are stored in the descending and sigmoid colon until they are passed through the rectum andanus. The rectum extends through the pelvis from the end of the sigmoid colon to the anus. Digestive System Physiology The digestive system is responsible for taking whole foods and turning them into energy and nutrients to allow the body to function, grow, and repair itself. The six primary processes of the digestive system include: 1. 2. 3. 4. 5. 6. Ingestion of food Secretion of fluids and digestive enzymes Mixing and movement of food and wastes through the body Digestion of food into smaller pieces Absorption of nutrients Excretion of wastes

LABORATORY EXAMS June 06, 2013 CT SCAN REPORT Clinical data: Bladder mass vs. Colonic mass Abdominal CT= Plain/IV contrast Findings: There is an annular enhancing wall thickening of the sigmoid colon measuring 80mm in length. This sigmoid mass invades the left supero-posterior aspect of the urinary bladder. Imaging wise: Sigmoid tumor with vesical infiltration and intravesical mass extensionwith suggestion of vesico-sigmoid fistula. Mild perisigmoid fatty tumor infiltration for tissue correlation. Chest X-ray: June 06, 2013 Impression: Atheromatous Aorta June 24, 2013 Pathology Consultation Dx: Segment of colon (sigmoid) Adenocarcinoma moderately differentiated, perforating thru bowel and bladder walls Hematolgy Report: July 22, 2013
Result WBC RBC Hemoglobin Hematocrit Platelet Count Neutrophils Lymphocytes Monocytes 6.6 x 10^3/uL 3.75 x 10^6/uL 122 grams/L 0.450L/L 373 x 10^3/uL .64 .31 .01 Reference Value 4.0-10.0 4.0-5.50 120-160 .400-.500 150.0-450.0 .40-.70 .20-.40 0.0-0.06 Analysis Normal Normal Normal Normal Normal Normal Normal Normal

DRUG STUDY

Pre-medication Generic name: Omeprazole 40 mg/tab Drug Classes: Antisecretory Drug, Proton pump inhibitor Action: generally used in combination with other medications to treat colon cancer or rectal cancer (cancer that begins in the large intestine) that has gotten worse or spread to other parts of the body. Indications: Contraindications: Adverse Reactions/Side effects: Nursing Considerations:

Drug name: 5-Fluorouracil Classifications: Action: generally used in combination with other medications to treat colon cancer or rectal cancer (cancer that begins in the large intestine) that has gotten worse or spread to other parts of the body. Indications: Contraindications: Adverse Reactions/Side effects: Nursing Considerations:

NURSING CARE PLAN

ASSESSMENT NURSING DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective akala ko normal lang namagtae siya, limang araw bago namin siya dinala sa ospital. As verbalized by the mother.

Knowledge deficient related to unfamiliarity of the condition and information misinterpretatio n.

After 8 hours of Nursing Intervention the patients parent/ watcher will: >Verbalize understanding of disease processes, possible complications

> Determine the mothers perception of disease process.

>Establishes knowledge base and provides some insight into individual learning needs >Accurate knowledge base provides opportunity for the mother to make informed decisions/choices about future and control of chronic disease. Although most others know about their own disease process, they may have outdated information or misconceptions.

> Review disease process, cause/effect relationship of factors that precipitate symptoms, and identify ways to reduce contributing factors. Encourage questions.

After 3 days of nursing intervention the goal was met. The patients watcher verbalized understanding of disease processes, and possible complications

Review medications, purpose, frequency, dosage, and possible side effects.

>

>Promotes

understanding and may enhance cooperation

with regimen Stress importance of good skin care, e.g., proper handwashing techniques and perineal skin care.
> > Reduces

spread of bacteria and risk of skin irritation/breakdown, infection.

Emphasize need for long-term > Patients with IBD are follow-up and periodic at risk for colon/rectal cancer, and regular reevaluation. diagnostic evaluations may be required
>

ASSESSMENT

NURSING DIAGNOSIS

PLANNING

INTERVENTION

RATIONALE

EVALUATION

OBSERVATION

(+) poor skin turgor (+)muscle wastin g (+) sunken fontan el Wt.= 1.8 kg(<2500 g) SGA

Nutrition, less than body requirements related to excessive fluid loss and malsabsorption as manifested by poor skin turgor, muscle wasting, sunken fontanel and Wt.= 1.8 kg(<2500 g) SGA

After 3 days of Nursing Intervention the patient will: isplay physical growth and Gain weigth appropriate for age and developmental stage.

> Measured height and weight everyday and compared it each day.

> for initial data base After 3 days of and to see gain or lose nursing in weight. intervention the goal was met. The patients watcher > Note status of fontanels, > Inadequate fluid verbalized production of mucus, and intake results in dehydration, understanding of number of wet diapers per day. skin turgor, and disease number of wet processes, and diapers per day. possible >Encourage continued use of complications formula for first 12 mo. of life. > Skim milk contains Discourage substitution of skim about half the number of or whole cows milk. calories in breast or > Determine color, frequency, consistency, and odor of stool.

commercial formulas;

> Altered elimination pattern may suggest problem with digestion and absorption.

> Instruct in addition to human milk fortifiers(HMF), as indicated, to milk supplemented

> FTT infants who are breastfed may

with extra calories breast milk, which is pumped and stored for feedings.

benefit from having the mother bottlefeed breast until the infant is gaining weight appropriately on a consistent basis. Note: The morning and evening feeding may be from the breast in order to support the maternal breastfeeding experience.

NON-MODIFIABLE FACTORS Age (65yrs old) Heredity Etiology: Unknown

MODIFIABLE FACTORS Diet (fats, fiber, Calcium Intake) Smoking (2packs/day) Alcohol Consumption (since 15 yearsold, at least 3x/wk)

Fats will enter the duodenum biliary secretion by the liver to emulsify the excess fats Colonic epithelial cells

Ingestion of carcinogens in the intestine (nitrosamines, polycyclic hydrocarbones, iso cyclic amines)

Inherited mutated genes

the ability to detoxify the carcinogens due to Ca + that binds to carbonic acid to etoxify the carcinogens Mutation of the normal cells Tumor suppressor genes are turned off cell growth and divided very quickly/ proliferation of mutated cell

Survival of the mutated cell

Hyperplasia of the mutated cells

Springs out from the epithelial cells of the colon (ADENOMA/POLYPS IN THE SIGMOID) A

A Invades the epithelial lining of the colon

Loss of proliferation control of the mutated cell ADENOCARCINOMA IN THE SIGMOID

Abnormal function of the colon absorption of water in the colon Continuous peristalsis Abdominal spasm Loss of appetite Weight loss

Causes obstruction

Hypo function goblet cell

Tumors become ulcerated due to continuous passage of stool

Tumors tend to bleed due to ulcerating mass BLOOD IN THE STOOL

ALTERATION IN BOWEL MOVEMENT (DIARRHEA/CONSTIPATION)