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3 rd most common site of new

cancer cases and deaths in


the United States.
RISK FACTORS:
Increasing age
Family history of colon cancer or polyps
Previous colon cancer or adenomatous polyps
History of inflammatory bowel disease
High fat, high protein(w/ high intake of beef), low
fiber diet
Genital cancer or breast cancer (in women)
 
PATHOPHYSIOLOGY
 
 Benign polyp



Malignant


 Invasion and destruction of normal tissues


 Liver/other parts of the body
STAGES OF COLON CANCER
BENIG
N
POLYP
MALIGNA
NT POLYP
NORMAL COLON COLON W/
BENIGN POLYP
CLINICAL MANIFESTATIONS
Greatly determined by:
Location of the cancer
Stage of the disease
Function of intestinal segment in which it is
located
SIGNS AND SYMPTOMS
Change in bowel habits (most common)
Passage of blood in the stool (second most
common)
Unexplained anemia
Anorexia
Weight loss
Fatigue
 
SIGNS AND SYMPTOMS
Left-sided lesions Right-sided lesions

abdominal pain & dull abdominal pain


cramping melena (black, tarry
narrowing stools stools)
constipation
distention
bright red blood in the
stool
Rectal lesions
tenesmus (ineffective, painful straining at stool)
rectal pain
feeling of incomplete evacuation after a bowel
movement
alternating constipation and diarrhea
bloody stool
MOST IMPORTANT DIAGNOSTIC
PROCEDURES
 
Abdominal and rectal examination
Fecal occult blood testing
Barium enema
Proctosigmoidoscopy
Colonoscopy
CEA (not so reliable)
COMPLICATIONS
Partial or complete bowel obstruction
Intraperitoneal infection
GI bleeding
Bowel perforation
Peritonitis
MEDICAL
MANAGEMENT
IV fluids and nasogastric suction for
patients with symptoms of intestinal
obstruction.
Blood component therapy if there is
significant bleeding
Treatment includes:
Surgery to remove tumor
Supportive therapy
Adjuvant therapy
Staging of Colorectal Cancer: Duke’s Classification-
Modified Staging System
Class A: Tumor limited to muscular mucosa and
submucosa
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, lung, or
bone
TNM (tumor, nodal involvement, metastasis)
Classification
May be used to describe the anatomic extent of the
primary tumor depending on:
NURSING PROCESS: THE
PATIENT WITH COLORECTAL
CANCER
Assessment:  Fatigue
 Abdominal/rectal pain (location,
Health frequency, duration, association w
eating or defecation)
history  Past and present elimination
patterns
 Characteristic of stool (color, odor,
consistency, presence of
blood/mucus
 History of IBD/colorectal polyps
 Family history of colorectal disease
 Current medication therapy
 Dietary habits (fat and fiber intake,
amount of alcohol consumed)
 History of weight loss
NURSING PROCESS: THE
PATIENT WITH COLORECTAL
CANCER
Assessment:
 Auscultating the abdomen for bowel
sounds
 Palpating the abdomen for areas of
tenderness, distention and solid masses
 Inspection of stool specimen for character
and presence of blood
NURSING DIAGNOSES
 Imbalanced nutrition, less than body requirement,
related to nausea and anorexia
 Risk for deficient fluid volume related to vomiting and
dehydration
 Anxiety related to impending surgery and diagnosis of
cancer
 Risk for ineffective therapeutic regimen management
related to knowledge deficit concerning the diagnosis,
the surgical procedure, self-care after discharge
 Impaired skin integrity related to the surgical incisions
(abdominal & 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 & self-concept.
PLANNING AND
GOALS
Major goals  Optimal level of nutrition
 Maintenance of fluid & electrolyte
for patient balance
include: 

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/herself
 Avoidance of complications
EVALUATION
Expected Patient Outcomes:
1.Consumes a healthy diet
• Avoids foods and fluids that cause diarrhea
• Substitutes nonirritating foods and fluids for those
that are restricted
1.Maintains fluid balance
• Experiences no vomiting or diarrhea
• Experiences no signs or symptoms of dehydration
1.Feels less anxious
• Expresses concerns and fears freely
• Uses coping measures to manage stress
1.Acquires information about diagnosis, surgical
procedure, preoperative preparation, and self-care
after discharge
• Discusses the diagnosis, surgical procedure, and
post-oprative self –care
• Demonstrates techniques of ostomy care
EVALUATION
5.Maintains clean incision, stoma, and perineal wound
6.Expresses feelings and concerns about self
• Gradually increases participation in stoma and peristomal
skin care
• Discusses feelings related to changed appearance
5.Discusses sexuality in relation to ostomy and to changes
in body image
6.Recovers without complications
• Is afebrile
• Regains normal bowel activity
• Exhibits no signs and symptoms of perforation or bleeding