Group Conferences January 16, 2013 MMS 301

Overview
I. Colon Cancer Facts II. Risk Factors III. Pathophysiology IV. Clinical Manifestations V. Diagnostic Exams VI. Management and Nursing Responsibilities VII. Medical Treatment VIII. Pre-Op Teaching IX. Post-Op Care X. Prevention of Colorectal CA

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COLON CANCER FACTS

Malignancy of colon/rectum If the disease is detected and treated at an early stage, the 5

year survival rate is 90%. Only 34% of colorectal cancers are found at an early stage Colon polyps and early cancer can have no symptoms. Therefore regular screening is important. Dukes Classification of Colorectal CA
Stage A: Stage B: Stage C: Stage D: confined to bowel mucosa invading muscle wall lymph node involvement metastases or locally unresectable tumor

Risk Factors

Age above 40, increasing age Family hx of colon CA or polyps Previous colon CA Personal hx of ulcerative colitis, Crohns disease for more than 10 years Onset is 63-67 years old Whites than African Americans Incidence higher in industrialized western world High fat diet, high intake of protein (beef), low fiber diet Excess alcohol intake Genital CA or breast CA

Pathophysiology
Arise from pre-existing benign adenomatous colon

polyps Transformation is slow = 1cm polyp take 7 years to progress to invasive carcinoma (Adenomastically round and polypoid) Lesions penetrate the colon wall and extend into surrounding tissue Lungs and liver metastasize Complications: perforation, abscess formation, peritonitis, sepsis, and shock

Clinical Manifestations
Frequently asymptomatic and diagnosed incidentally Symptoms commonly associated with right-sided lesions:

dull abdominal pain and melena (black tarry stools) Symptoms commonly associated with left-sided lesions: caused by obstruction (abdominal pain and cramping, narrowing stools, constipation, and distention) bright red blood in the stool. Symptoms of partial bowel obstruction: constipation or diarrhea, pencil or ribbon shaped stools, sensation of incomplete bowel emptying Others: anemia, anorexia, weight loss with no known reason, fatigue, change in BM, stools that are norrower than usual, general abdominal discomforts(ei. Freq gas pains, bloating, fullness, and/or cramps).

Diagnostic Exams

Fecal occult Blood testing Barium enema Proctosigmoidoscopy, and with biopsy or cytology smears Colonoscopy CEA (carcinoembryonic antigens) levels reliable in predicting prognosis
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

Management & Nursing Responsibilities

Digital rectal examination
Fecal occult blood tests Sigmoidoscopy

Barium enema excellent in outlining large polyps

Colonoscopy the gold standard for diagnosis

Medical Treatment
Chemotherapy-pallative in nature 5 FU+ Leviamisole or leukovonin with 5 FU (To

stimulate immune system function and minimize damage to healthy cells) Radiation in rectal CA Surgery
Definitive treatment for colorectal CA Low anterior resection through an abdominal incision used most

extensively Temporary colostomy to allow for bowel rest and healing (temp/permanent) Type of surgery depends on location and size tumor

Pre-Operative Teaching
Parenteral nutrition: Abdominal status
Monitor electrolyte balance Incisions, NGT, and wound drainage

Need for ostomy if applicable

Post-Operative Care
Maintain F/E balance: NGT drainage-out, patency, IV

fluids, daily weight Assess abdominal status and return of peristalsis Assess stoma, avoid constipation Check for rectal bleeding, H & H monitoring Evaluate ability to apply and remove appliance Promote optimal nutrition Promote ventilation

Preventive Measures
High Fiber, low fat diet
Avoid salt cured or nitrite cured foods Avoid obesity

Annual occult exam above 50 years old (F/M)

Sigmoidoscopy every 5-10 years Total colon exam every 5-10 yrs

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References: Black, J. & Hawks, H. (2005). Medical-surgical nursing (4th ed.) Singapore: Elsevier Pte Ltd. Porth, C. & Heymann, G. (2004). Pathophysiology concepts of altered health states. New York: Lippincott Williams & Wilkins, Inc. Smeltzer, S.C. & Bare, B. (2004). Brunner & Suddarths textbook of medical-surgical nursing (10th ed). Philadelphia: Lippincott Williams & Wilkins. Tortora, G. & Derrickson, B. (2009). Principles of anatomyand physiology (12th ed). Massachusetts: John Wiley and Sons Pte Ltd.