COLORECTAL CANCER

Submitted By: Bantilan, Rose Lyn Chu, Dean Dell Dionson, Keithlyn Kim Lauron, Maria Julie May Rubio, Ariane May Submitted To: Mr. Jerald Ugdoracion

COLORECTAL CANCER

less formally known as bowel cancer a cancer characterized by neoplasia in or vermiform appendix.

the colon, rectum,

ETIOLOGY: (unknown) Yet in spite of the high incidence of colon cancer, we still do not have a sound basis for delineating the causes and mechanism of colon carcinoma growth, nor do we have a means of curing the disease in every case. Almost all colon cancer starts in glands in the lining of the colon and rectum. There is no single cause of colon cancer. Nearly all colon cancers begin as noncancerous (benign) polyps, which slowly develop into cancer.

RISK FACTORS

Age. The risk of developing colorectal cancer increases as we age. The disease is more common in people over 50, and the chance of getting colorectal cancer increases with each decade. However, colorectal cancer has also been known to develop in younger people. Gender. The risk overall are equal, but women have a higher risk for colon cancer, while men are more likely to develop rectal cancer. Polyps. Polyps are non-cancerous growths on the inner wall of the colon or rectum. While they are fairly common in people over 50, one type of polyp, referred to as an adenoma, increases the risk of developing colorectal cancer. Adenomas are non-cancerous polyps that are considered precursors, or the first step toward colon and rectal cancer. Personal history. Research shows that women who have a history of ovarian, uterine, or breast cancer have a somewhat increased risk of developing colorectal cancer. Also, a person who already has had colorectal cancer may develop the disease a second time. In addition, people who have chronic inflammatory conditions of the colon, such as ulcerative colitis or Crohn's disease, also are at higher risk of developing colorectal cancer.

Family history. Parents, siblings, and children of a person who has had colorectal cancer are somewhat more likely to develop colorectal cancer themselves. A family history of familial polyposis, adenomatous polyps, or hereditary polyp syndrome also increases the risk as does a syndrome known as hereditary non-polyposis colon cancer, or HNPCC. This latter syndrome also increases the risk for other cancers as well.

Diet. A diet high in fat and calories and low in fiber may be linked to a greater risk of developing colorectal cancer. Lifestyle factors. You may be at increased risk for developing colorectal cancer if you drink alcohol, smoke, don't get enough exercise, and if you are overweight. Diabetes. People with diabetes have a 30-40% increased risk of developing colon cancer.

SYMPTOMS
*Many cases of colon cancer is asymptomatic, however, the following symptoms may indicate colon cancer:

Abdominal pain and tenderness in the lower abdomen Weight loss with no known reason Change in the frequency of bowel movements Diarrhea, constipation, or feeling that the bowel does not empty completely Bright red or very dark blood in the stool Stools that are narrower than usual General stomach discomfort like frequent gas pains, bloating, fullness and/or cramps Constant fatigue Vomiting

SCREENING TESTS
Barium Enema Sigmoidoscopy- visualization of the sigmoid colon and rectum
Colonoscopy best screening test for colon cancer If your doctor learns that you do have colorectal cancer, more tests will be done to see if the cancer has spread. CT or MRI scans of the abdomen, pelvic area, chest, or brain may be used to stage the cancer. Sometimes, PET scans are also used. Blood tests to detect tumor markers, including carcinoembryonic antigen (CEA) and CA 19-9, may help your physician follow you during and after treatment.

COLORECTAL CANCER STAGING

Stage Stage 0 Stage I TNM stage Tis N0 M0 T1 N0 M0 TNM stage criteria for colorectal cancer Tis: Tumor confined to mucosa; cancer-in-situ T1: Tumor invades

Stage I Stage II-A

T2 N0 M0 T3 N0 M0

Stage II-B

T4 N0 M0

Stage III-A Stage III-B Stage III-C Stage IV

T1-2 N1 M0 T3-4 N1 M0 any T, N2 M0 any T, any N, M1

submucosa T2: Tumor invades muscularis propria T3: Tumor invades subserosa or beyond (without other organs involved) T4: Tumor invades adjacent organs or perforates the visceral peritoneum N1: Metastasis to 1 to 3 regional lymph nodes. T1 or T2. N1: Metastasis to 1 to 3 regional lymph nodes. T3 or T4. N2: Metastasis to 4 or more regional lymph nodes. Any T. M1: Distant metastases present. Any T, any N.

POSSIBLE COMPLICATIONS

Blockage of the colon (Intestinal Obstruction): blockage in the intestine that does not allow food or stool to pass through the intestine. Gastrointestinal Bleeding Anemia : when the polyps bleed it can result in anemia, which is a lack of red blood cells and/or hemoglobin Cancer recurrence: when colon cancer comes back after it has gone into remission Cancer spreading to other organs or tissues (metastasis) this is when the colon cancer spreads to other parts of the body and organs, most often the liver, the lungs, bones and the brain Development of a second primary colorectal cancer

COLLABORATIVE MANAGEMENT
Treatment depends partly on the stage of the cancer. In general, 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, often during a colonoscopy. For stages I, II, and III cancer, more extensive surgery is needed to remove the part of the colon that is cancerous. Generally, large bowel resection is surgery to remove all or part of your large bowel. This surgery is also called colectomy. The large bowel is also called the large intestine or colon. Removal of the entire colon and the rectum is called a proctocolectomy. Removal of part or all of the colon but not the rectum is called subtotal colectomy. HERE ARE SOME OF THE SURGERIES: 1. Wide segmental bowel resection of tumor, including regional lymph nodes and blood vessels. 2. Transanal excision for small, localized, accessible tumors. 3. Low anterior resection for upper rectal tumors; possible temporary diversion loop colostomy while rectal anastomosis heals; 2nd procedure for takedown of colostomy. 4. Colonic J-pouch is a new technique that may be offered for rectal tumors. Laparoscopic procedures are controversial.

Colonic Jpouch

5. Abdominoperineal resection with permanent end colostomy for lower rectal tumors when adequate margins cannot be obtained or anal sphincters are involved. 6. Temporary loop colostomy to decompress bowel and divert fecal stream, followed by later bowel resection, anastomosis, and takedown of colostomy.

7. Diverting colostomy or ileostomy as palliation for obstructing, unresectable tumors. 8. Total proctocolectomy and possible ileal reservoir- anal anastomosis for patients with familial adenomatous polyposis and CUC before cancer is confirmed. 9. More extensive surgery involving removal of other organs if cancer has spread (bladder, uterus, small intestine)

Ileostomy
CHEMOTHERAPY Almost all patients with stage III colon cancer should receive chemotherapy after surgery for approximately 6 - 8 months. The chemotherapy drug 5-fluorouracil has been shown to 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. Chemotherapy may be used as adjuvant therapy to improve survival time. May be used for residual disease, recurrence of disease, unresectable tumors and metastatic disease. RADIATION Although radiation therapy is occasionally used in patients with colon cancer, it is usually used in combination with chemotherapy for patients with stage III rectal cancer.

Blood replacement or other treatments if severe anemia exists. For patients with stage IV disease that has spread to the liver, various treatments directed specifically at the liver can be used. This may include:

Other Therapeutic Interventions

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

NURSING MANAGEMENT
o o o o o o o o o o o o Prepare the patient for surgery, as indicated. Provide comfort measures and reassurance for patients undergoing radiation therapy. Prepare the patient for the adverse effects of chemotherapy and take steps to minimize this effects. Use strict aseptic technique when caring for I.V. catheters. Have the patient wash his hands before and after meals and after going to the bathroom. Listen to the patients fears and concerns, stay with him during periods of severe stress and anxiety. Encourage the patient to identify actions and care measures that will promote his comfort and relaxation. Monitor the patients bowel patterns. Monitors the patients diet modification, and assess the adequacy of his nutrition intake. Direct the patient to follow a high fiber diet. Caution him to take laxatives or an antidiarrheal medications only as prescribed by the doctor. Inform the patient about screening and early detection.

Management of patient that is for surgery:

Preoperative Management:

1. Preparing the client for surgery. Physical preparation building the patients stamina and cleansing the bowel prior to surgery Assess patients knowledge about the diagnosis, prognosis, surgical procedure, and expected level of functioning after surgery.

 Assess patients anxiety level and coping mechanisms and suggest methods for reducing anxiety such as deep breathing exercises. Intraoperative Management: 1. Maintenance of safety Maintains aseptic, controlled environment. 2. Effectively manages human resources, equipment, and supplies for individualized patient care. 3. Transfer patient to operating room table. 4. Position the patient, exposing the surgical site. 5. Applies grounding device to patient. 6. Ensure that the sponge, needle, and instrument counts are correct.

Postoperative Management:
1. Pain management during the immediate postoperative period, monitor for complications such as leakage from the site of anastomosis, prolapse of the stoma, perforation, stoma retraction, skin irritation, and pulmonary complications. 2. Maintaining optimal nutrition The patient avoids foods that cause excessive odor and gas, including foods in the cabbage family, eggs, fish, beans, and highcellulose products such as peanuts. Fluid intake of at least 2 L/day. 3. Providing wound care The nurse frequently examines the abdominal dressing during the first 24 hours after surgery to detect signs of hemorrhage. Splint the abdominal incision during coughing and deep breathing to lessen tension on the edges of the incision. Monitor vital signs to detect an infectious process. With colostomy stoma is examined for swelling (slight edema from surgical manipulation is normal), color (a healthy stoma is pink or red), discharge (small amount of oozing is normal), and bleeding (an ABNORMAL sign) 4. Monitoring and managing complications Frequently assess the abdomen, including decreasing or changing bowel sounds and increasing abdominal girth to detect bowel obstruction. Monitor hematocrit and haemoglobin levels and administer blood products as prescribed. For pulmonary complications frequent activity (turning to sides every 2 hours), deep breathing exercises, coughing, and early ambulation 5. Removing and applying the colostomy appliance The colostomy begins to function 3 to 6 days after surgery. Advise patient to protect the periostomal skin by washing the area gently with a moist soft cloth and a mild soap. 6. Irrigating the colostomy to empty the colon of gas, mucus, and feces

7. Supporting a positive image Help 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. Sources: http://www.health.am/cr/colorectal-cancer/ http://en.wikipedia.org/wiki/Colorectal_cancer http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001308/ http://www.lotsofessays.com/viewpaper/1688759.html http://www.webmd.com/colorectal-cancer/guide/risk-factors-colorectal-cancer

http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-forcolorectal-cancer.html http://www.medicinenet.com/colon_cancer/page4.htm