COLORECTAL CANCER CECEP E.

KOSASIH

 The incidence increases with age (> 85 years

of age) and people with a family history of colon cancer or polyps.

The exact cause of colon and rectal cancer is

still unknown, but risk factors have been identified

The distribution of cancer sites

The incidence of cancer in the sigmoid and rectal areas has decreased, whereas the incidence of cancer in the cecum, ascending, and descending colon has increased

Pathophysiology
Ca colon and rectum is predominantly (95%)

adenocarcinoma. It may start as a benign polyp but may become malignant, invade and destroy normal tissues, and extend into surrounding structures.
Cancer cells may break away from the

primary tumor and spread to other parts of the body (most often to the liver).

Clinical Manifestations by the location The symptoms are determined

of the cancer, the stage of the disease, and the function of the intestinal segment.
change in bowel habits. blood in the stools Symptoms include unexplained anemia,

anorexia, weight loss, and fatigue.

dull abdominal pain and melena (ie, black,

tarry stools).
cramping, narrowing stools, constipation, and

distention
tenesmus (ie, ineffective, painful straining at

stool), rectal pain, the feeling of incomplete evacuation after a bowel movement, alternating constipation and diarrhea

Risk Factors for Colorectal Cancer Increasing age

Family history of colon cancer or polyps Previous colon cancer or adenomatous polyps History of inflammatory bowel disease High-fat, high-protein (beef), low-fiber diet Genital cancer or breast cancer (in women)

Staging of Colorectal Cancer: Dukes Class A: Tumor limited to muscular mucosa ClassificationModified Staging and Submucosa System
Class B1: Tumor extends into mucosa Class B2 : Tumor extends through entire

bowel wall into serosa or pericolic fat, no nodal involvement

Class C1: Positive nodes, tumor is limited to

bowel wall
Class C2 : Positive nodes, tumor extends

through entire bowel wall

Class D: Advanced and metastasis to liver,

Assessment and Diagnostic Findings fecal occult blood testing, barium enema,
proctosigmoidoscopy, and colonoscopy
sigmoidoscopy with biopsy or cytology

smears
Carcinoembryonic antigen (CEA) With complete excision of the tumor, the

elevated levels of CEA should return to normal within 48 hours. Elevations of CEA at a later date suggest recurrence

Complications
Partial or complete bowel obstruction. Hemorrhage. Perforation, Abscess formation, Peritonitis Sepsis Shock

Medical Management
Surgery to remove the tumor, Supportive therapy, and adjuvant therapy.
Chemotherapy Radiation therapy Immunotherapy, or multimodality therapy

ADJUVANT THERAPY
Colon cancer is the 5-fluorouracil plus

levamisole regimen
Rectal cancer are given 5-fluorouracil and

high doses of pelvic irradiation.

Mitomycin is also used. Radiation therapy is used before, during, and

after surgery to shrink the tumor, to achieve better results from surgery, and to reduce the risk of recurrence.

SURGICAL MANAGEMENT
Cancers limited to one site colonoscope. Laparoscopic colotomy with polypectomy. the neodymium/yttriumaluminum- garnet

(Nd:YAG) laser.
Bowel resection is indicated for most class A

lesions and all class B and C lesions.

Surgery is sometimes recommended for class

D colon cancer, goal is palliative; if the tumor has spread and involves surrounding vital structures, nonresectable

Surgical procedures
Segmental resection with anastomosis. Abdominoperineal resection with permanent

sigmoid colostomy
Temporary colostomy Permanent colostomy or ileostomy Construction of a coloanal reservoir.

NURSING PROCESS: THE PATIENT WITH Assessment COLORECTAL CANCER

Diagnosis Planning and Goals Intervention Evaluation

Assessment
health history about fatigue, abdominal or

rectal pain (eg, location, frequency, duration, association with eating or defecation), past and present elimination patterns, and characteristics of stool (eg, color, odor, consistency, presence of blood or mucus).
history of colorectal polyps, a family history of

colorectal disease, and current medication therapy.

identifies dietary habits, including fat and

fiber intake, as well as amounts of alcohol.

history of weight loss. includes auscultating for bowel sounds and

palpating for areas of tenderness, distention, and solid masses. Stool specimens are inspected for character and presence of blood.

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 impending surgery and the diagnosis of cancer Risk for ineffective therapeutic regimen management related to knowledge

deficit concerning the diagnosis, the surgical procedure, and self-care after discharge
Impaired skin integrity related to the surgical incisions (abdominal and

perianal), the formation of a stoma, and frequent fecal contamination of peristomal skin
Disturbed body image related to colostomy Ineffective sexuality patterns related to presence of ostomy and changes in

body image and self-concept

COLLABORATIVE PROBLEMS/ Intraperitoneal infection POTENTIAL obstruction Complete large bowel COMPLICATIONS GI bleeding
Bowel perforation Peritonitis, abscess, and sepsis

Planning and Goals

attainment of optimal level of nutrition; maintenance of fluid and electrolyte balance; reduction of anxiety; learning about the

diagnosis, surgical procedure, and self-care after discharge;

maintenance of optimal tissue healing; protection of peristomal skin; learning how to irrigate the colostomy and

change the appliance;

expressing feelings and concerns about the

colostomy and the impact on himself or herself;

PREPARING THE PATIENT FOR SURGERY PROVIDING EMOTIONAL SUPPORT PROVIDING POSTOPERATIVE CARE MAINTAINING OPTIMAL NUTRITION PROVIDING WOUND CARE MONITORING AND MANAGING

COMPLICATIONS
REMOVING AND APPLYING THE COLOSTOMY

APPLIANCE
IRRIGATING THE COLOSTOMY SUPPORTING A POSITIVE BODY IMAGE

THANK YOU