m Cancer is a disease process that begins when an abnormal cell

is transformed by the genetic mutation of the cellular DNA.

m This abnormal cell forms a clone and begins to proliferate
abnormally, ignoring growth-regulating signals in the
environment surrounding the cell.
m The cells acquire invasive characteristics, and changes occur in
surrounding tissues.
m The cells infiltrate these tissues and gain access to lymph and
blood vessels, which carry the cells to other areas of the body.
m This phenomenon is called m

 6cancer spread to other
parts of the body).
m Cancer is not a single disease with a single cause; rather, it is a
group of distinct diseases with different causes, manifestations,
treatments, and prognoses. A common misconception is that
cancer is one disease. Cancer is many diseases.
m Cancers comprise all diseases of cells that are altered or
transformed in some way but are able to multiply, grow and
spread.
m Cancerous cells differ from normal cells in appearance, growth
and function.
m The change from normal to neoplastic cells is a process, not a
single event or a single alteration in cells.
m The development of a cancer is a series of events that generally
occur over many years.
m Clinical manifestations are only the final stages in the natural
history of cancer.
m Classification Of Neoplasms:
À ×enign ² expands in size as it grows but does not metastasize or
infiltrate.
À Malignant ² a serious threat to the life and well-being of the host; is
able to expand in size, metastasize and infiltrate.
À According to tissue of origin
 ×enign Neoplasm 6 most common)
 Fibromas
 Lipomas
 Leiomyomas
À Malignant Neoplasms 6 most common)
 Carcinoma in situ
 Malignant fibrosarcomas
 ×ronchogenic Carcinomas
m The top cancer sites in the Philippines include those cancers whose
major causes are known , such as cancers of the lung/larynx , liver,
cervix and colon/rectum/stomach.
m Except for the liver, the top Philippine cancer sites are also the top
cancers worldwide.
m The problem of childhood cancer in the is dominated by leukemia.
m The survival experience, regardless of treatment, of patients with top
cancer sites diagnosed in 1987 and included in the DOH²RCR was
evaluated as the first population-based survival data for Filipinos. Lung
cancer had the lowest survival and breast cancer had the highest.
m Five-year survival in excess of 40% was observed for only three cancer
sites: oral cavity, colon and breast. For all other sites, survival was less
than 0%.
m Owing to the small number of cases in each category, no distinct
impact of age on relative survival could be perceived for most cancer
sites. However, both observed and relative survival rates were low for
breast cancer patients less than
years old.
m Data from the 1991/9
DOH²RCR and the DOH²HIS 1992 and 1996 data
indicated that the leading cancer site mortalities were lung, liver, breast,
leukemia, stomach, cervix uteri, colon, liver, pancreas, nasopharynx and
prostate 6in decreasing order of frequency).
m The top three mortality cancer sites among females were breast, lung
and cervix uteri and among males lung, liver and leukemia.
 Signs and symptoms of cancer vary
depending on the origin and metastatic
sites, if there are any.
m Aging
m Tobacco
m Sunlight
m Ionizing radiation
m Certain chemicals and other substances
m Some viruses and bacteria
m Certain hormones
m Family history of cancer
m Alcohol
m Poor diet, lack of physical activity, or being
overweight
m Physical exam
m Imaging
À CT
À MRI
À X-rays
À Ultrasonography
À Radionuclide scanning
m ×iopsy
À Needle biopsy
À Surgical biopsy
m Pathology tests
m Other tests depend on the specific type of
cancer
m Surgical
À Diagnostic Surgery
À Surgery for Staging
À Surgery as Treatment
À Palliative Surgery
À Reconstructive Surgery
À Preventive Surgery
m Radiation Therapy
m Chemotherapy
m Promote measures that relieve pain and discomfort.
m Promote measures that maintain intact skin integrity.
m Promote measures that maintain oral mucosa.
m Promote measures to prevent injury from abnormal bleeding.
m Promote measures to identify and prevent infection.
m Promote measures to help decrease the client·s fatigue and
increase activity level.
m Promote measures that ensure adequate nutritional intake.
m Promote measures that ensure adequate fluid and electrolyte
balance.
m Promote measures to enhance body image.
m Never communicate that hair loss is an insignificant problem
compared with life-threatening alternatives; the client·s
emotional needs may be at least as great as physical needs.
m Promote measures that address preventing complications of
cancer therapy.
m Instruct the client and family about the disease process
and treatments, and provide necessary information for
self-care.
m Promote measures that help the client and family cope
effectively with disease process and grieving process.
m Promote measures to reduce social isolation.
m Provide nursing interventions for the client undergoing
surgery for cancer.
m Provide nursing interventions for the client undergoing
radiation therapy.
m Provide nursing interventions for the client undergoing
chemotherapy.
m Provide nursing interventions for the clients undergoing
bone marrow transplantation.
m Provide nursing interventions for a client receiving
immunotherapy.
m Nursing interventions for a client receiving immunotherapy
with ×RMs.
m Provide nursing interventions for a client receiving gene
therapy.
m Cancer prevention focuses on reducing modifiable risk
factors in the external and internal environment that
increase a person·s susceptibility to cancer development.
À Avoid obesity
À Decrease total dietary fat intake
À Eat more high-fiber foods, such as whole grain cereals, fruits and
vegetables
À Include foods rich in vitamins A and C in the daily diet
À Include cruciferous vegetables 6eg. Cabbage, broccoli, ×russels
sprouts, kohirabi, cauliflower) in the diet
À Consume alcoholic beverages only in moderation
À Consume salt-cured, smoked and nitrite-cured foods only in
moderation
À Avoid tobacco use in all forms
À Avoid excessive sun exposure and use SPF 0 or above and large
hats and long sleeved clothing
À Avoid exposure to industrial agents known to increase cancer risk
6e.g. nickel asbestos, coal tar, rubber manufacture)
m Colorectal cancer, commonly known as bowel cancer, includes
cancerous growths in the colon, rectum, appendix and
depending on the definition used can include those found in the
anus as well. Virtually 98 % of all cancers in the large intestine are
adenocarcinomas. They represent one of the prime challenges
to the medical profession because they arise in polyps and
produce symptoms relatively early and at a stage generally
curable by resection. Most tumors are found in the distal portion
of the large bowel, from the sigmoid colon to the anus.
m STAGING OF COLORECTAL CANCER 6Duke·s Classification):
À 6 Tumor limited to muscular mucosa and submucosa
À 6  Tumor extends into mucosa
À 6 
Tumor extends through entire bowel wall into serosa or pericolic
fat, no nodal involvement
À 6 6 Positive nodes, tumor is limited to bowel wall
À 6 6
Positive nodes, tumor extends through entire bowel wall
À 6 Advanced and metastasis to liver, lung, or bone
m Colorectal cancer is the third most common cancer and, next to Lung cancer and
×reast cancer, the third leading cause of cancer deaths in the country today.
m According to EJACC·s Metro Cebu Population-based Cancer Registry statistics,
incidence rate and mortality rate of colorectal cancer among men and women aged
0 years old and above are high. Within 199 to 200
, about 77 men and 600 women
who are 0 years old and beyond were recorded to have the disease.
m Within the same period, 464 men and 44 women aged 0 and above have died of the
cancer. There were 47 people aged 0 to 29 who acquired colorectal cancer and 2
of
them died of it from 199 to 200
.
m Early diagnosis and prompt treatment could save almost three of every four people with
colorectal cancer.
m Survival following diagnosis correlates with the stage of tumor invasion.
À If the disease is detected and treated at an early stage, the
-year survival rate is 90%, but only
4% of colorectal cancers are found at an early stage. Most people are asymptomatic for long
periods and seek health care only when they notice a change in bowel habits or rectal bleeding.
À Survival rates after late diagnosis are very low. Once the cancer has spread to other organs, the

-year survival rate decreases to 6
%.
À For clients with metastasis to distant organs, the
-year survival rate is 8%.
m Men are most likely to have colorectal cancer than women.
m The incidence rates have been declining in the last 20 years, a trend most likely
attributable to increases in screening and polyp removal.
m Likewise, mortality rates have also been declining, most likely a reflection of falling
incidence rates and rising survival rates from early diagnosis and treatment.
m Rectal bleeding
m Changed bowel habits
m Abdominal pain and cramping
m Weight loss
m Anemia
m Anorexia
m Nausea
m Vomiting
m Dark, reddish brown stools
m Weakness
m Debility
m Palpable mass
m Ribbon-like stools
m ×right red blood and mucus
m Tenesmus
m Low-residue, high-fat diets and highly
refined foods with an inadequate intake
of fruits and vegetables
m Residents of cities and industrialized
countries
m Familial tendency
m Increased age 660 - 70 y.o.)
m History of ulcerative colitis and familial
polyposis
m Constipation
m Fecal occult blood testing
m ×arium enema
m Proctosigmoidoscopy
m Colonoscopy
m ×iopsy of mass
m Carcinoembryonic antigen studies
m For intestinal obstruction symptoms: IV fluids and nasogastric suction
m Significant bleeding: blood component therapy
m Adjuvant therapy 6radiation and chemotherapy)
m Radiation therapy
m Chemotherapy
m Surgery
À Segmental resection with anastomosis 6ie, removal of the tumor and portions of the
bowel on either side of the growth, as well as the blood vessels and lymphatic
nodes)
À Abdominoperineal resection with permanent sigmoid colostomy 6ie, removal of the
tumor and a portion of the sigmoid and all of the rectum and anal sphincter)
À Temporary colostomy followed by segmental resection and anastomosis and
subsequent reanastomosis of the colostomy, allowing initial bowel decompression
and bowel preparation before resection
À Permanent colostomy or ileostomy for palliation of unresectable obstructing lesions
À Construction of a coloanal reservoir called a colonic J pouch is performed in two
steps. A temporary loop ileostomy is constructed to divert intestinal flow, and the
newly constructed J pouch 6made from 6 to 10 cm of colon) is reattached to the
anal stump. About months after the initial stage, the ileostomy is reversed, and
intestinal continuity is restored. The anal sphincter and therefore continence are
preserved.
m Promote measures that relieve pain and discomfort.
m Promote measures to prevent injury from abnormal bleeding.
m Promote measures to identify and prevent infection.
m Promote measures to help decrease the client·s fatigue and increase
activity level.
m Promote measures that ensure adequate nutritional intake.
m Promote measures that ensure adequate fluid and electrolyte balance.
m Promote measures to enhance body image.
m Never communicate that hair loss is an insignificant problem compared
with life-threatening alternatives; the client·s emotional needs may be at
least as great as physical needs.
m Promote measures that address preventing complications of cancer
therapy.
m Instruct the client and family about the disease process and treatments,
and provide necessary information for self-care.
m Promote measures that help the client and family cope effectively with
disease process and grieving process.
m Provide nursing interventions for the client undergoing surgery for
colorectal cancer.
m Large bowel resection consists of the surgical
resection of any extent of the large intestine. This
surgery is also called colectomy.
m Colectomy is performed to treat a variety of
conditions, including the following:
À Colorectal cancer
À Inflammatory intestinal diseases 6eg, colitis , Crohn·s
disease)
À Intestinal obstruction
À Trauma to the intestine
À Diverticular disease
À Precancerous polyps, especially those seen in familial
polyposis
À Colonic perforation
À ×leeding from the colon
m ×efore surgery, the bowel must be prepared to decrease
the incidence of infection. Preparation begins a few days
prior to colon surgery. The patient is placed on a low
residue diet for 2- days prior to surgery and on liquids the
day before surgery, with complete fasting from the
midnight before surgery
m The patient is usually admitted to the hospital on the day
before surgery and is given some purgatives to cleanse
the large bowel along with antibiotics.
m Intravenous fluids are given on the night before surgery to
avoid dehydration resulting from the diarrhea due to the
cleansing action of the purgatives
m Intravenous antibiotics are usually administered just before
surgery to reduce the incidence of infections. They may
be continued after surgery.
m General anesthesia is given right before surgery.
Laparoscopic or open surgery will be done. Depending on
the type of surgery to be done, the surgeon will make 1 or
more incisions in the abdomen.
m In a laparoscopic colectomy, the surgeon uses a camera to see inside
the abdomen and small instruments to remove the part of the large
bowel. Three to
small cuts in the lower abdomen will be made. The
surgeon passes the medical instruments through these cuts.
À An incision of about 2 to inches may also be made if the surgeon needs to put a
hand inside the abdomen.
À The abdomen will be filled with gas to expand it. This makes the area easier to see
and work in.
À The surgeon will remove the diseased part of the large bowel.
À The surgeon will then sew the healthy ends of the bowel back together. This is called
resecting.
À Then the incisions will be closed with stitches.
m For open colectomy, the surgeon will make a 6-inch incision in the lower
abdomen.
À The surgeon will find the part of the colon that is diseased.
À The surgeon will put clamps on both ends of this part to close it off.
À Care is taken to identify the ureters, small intestine and other organs so as to avoid
injury to these organs
À Then the surgeon will remove the diseased part.
À If there is enough healthy large intestine left, the surgeon will sew or staple the
healthy ends back together. Most patients have this done.
À If there is not enough healthy large intestine to reconnect, the surgeon will make an
opening called a stoma through the skin of the belly. The large intestine will be
attached to the outer wall of the abdomen. Stool will go through the stoma into a
drainage bag outside the body body. This is called a colostomy.
À In the last ten years, special instrumentation has greatly simplified the procedure. A
stapler placed across the colon seals the colon on each side of the stapler and
then cuts the colon between the staples. Likewise, a different type of stapler staples
the anastomosis together.
m When the resection is complete, the
surgeon has the option of immediately
restoring the bowel, by stitching or stapling
together both the cut ends 6primary
anastomosis), or creating a colostomy.
Several factors are taken into account,
including:
À Circumstances of the operation 6elective vs.
emergency);
À Disease being treated;
À Acute physiological state of the patient;
À Impact of living with a colostomy, albeit
temporarily;
À Use of a specific preoperative regimen of low
residue diet and laxatives 6so-called ´bowel
prepµ).
m AFTER SURGERY
À The recovery period after colon surgery is widely variable.
It usually involves a stay in the hospital from -10 days in
uncomplicated cases
À The patient will have a catheter in the urinary bladder for
a few days and will be given adequate pain relief,
intravenous fluids, antibiotics etc
À For patients who do not have any oral intake for several
days, nutrition may be provided intravenously or through a
tube in the stomach or bowel
À The function of the bowel is monitored closely to await the
passage of gas and stool after surgery
À The patient then gradually begins to take liquids by mouth
and solid food later on, following which they will be
discharged home
À The patient resumes normal activity in 1- weeks
À Heavy exertion and lifting is avoided weights for 4-6 weeks
À If a colostomy is required, the patient receives instruction
on its care
m TYPES:
À ^
 m 
m  

^
 

m 
m refer to the
resection of the ascending colon 6right) and the descending
colon 6left), respectively. When part of the transverse colon is
also resected, it may be referred to as an 
 
m 
m.

m
À u    
m is also possible, though uncommon.
À èm 
m is a resection of the sigmoid colon, sometimes
including part or all of the rectum 6proctosigmoidectomy). When
a sigmoidectomy is followed by terminal colostomy and closure
of the rectal stump, it is called a 
m 


; this is
usually done out of impossibility to perform a ´double-barrelµ or
   
m

m, which is preferred because it makes
´takedownµ 6reoperation to restore normal intestinal continuity
by means of an anastomosis) considerably easier.
À When the entire colon is removed, this is called a

 
 
m

m, also known as   
.

 If the rectum is also
removed, it is a

 
 
 
m

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m is resection of part of the colon or a
resection of all of the colon without complete resection of the
rectum.
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 Most people who have a large bowel
resection recover fully. Even with a
colostomy, most people are able to do
most activities they were doing before their
surgery. This includes most sports, travel,
gardening, hiking, and other outdoor
activities, and most types of work. If the
client has a long-term 6chronic) condition,
such as cancer, Crohn·s disease, or ulcerative
colitis, he/she may need ongoing medical
treatment.
m Since cancer is common and widely-known, the researchers believe
that they have an obligation to educate themselves and their fellow
peers about the necessary information regarding the disease. Aside
from the disease being interesting, the researchers believe that the
information they will gather from this study about colorectal cancer will
help them improve the care they will be giving to cancer patients in the
future. In addition to this, the researchers believed that choosing to
study a case on colorectal cancer will give them a background on
oncological nursing which they will be taking up during the first semester
of their senior year.
m Jean Watson·s Theory of Human Care was chosen as the theoretical
basis because it is applicable to the chosen case. Cancer patients have
great physical, emotional, psychological and social needs which can
be met by applying the concepts of the Theory of Human Caring. The
patient in this case has only been newly diagnosed with
adenocarcinoma of the sigmoid colon and had just undergone radical
sigmoidectomy. He is going through a number of transitions in his life due
to his condition. When caring for this patient, the student nurses must
provide proper care to meet all of the new needs that are arising from
his condition. Simply viewing the patient as an object that needs fixing
will not be effective in providing
Jean Watson·s theory of Human Caring
emphasizes the humanistic aspects of
nursing in combination with scientific
knowledge. Watson designed this theory to
bring meaning and focus to nursing as a
distinct health profession.

The ten carative factors, transpersonal

caring relationship and the caring occasion
constitute the elements of Jean Watson·s
Theory of Human Caring.
1. Formation of a humanistic-altruistic system of values.
2. Instillation of faith-hope.
. Cultivation of sensitivity to one·s self and to others.
4. Development of a helping-trusting, human caring
relationship.

. Promotion and acceptance of the expression of
positive and negative feelings.
6. Systematic use of a creative problem-solving caring
process.
7. Promotion of transpersonal teaching-learning.
8. Provision for a supportive, protective, and/or
corrective mental, physical, societal, and spiritual
environment.
9. Assistance with gratification of human needs.
10. Allowance for existential-phenomenological spiritual
forces.
Her second concept, the transpersonal
caring relationship, happens when the
nurse goes beyond her objective
assessment and shows more concern
towards the subjective and deeper
meaning of the client towards her own
health care situation.

Lastly, her third concept defines what a

caring occasion really is. To Watson, a
caring occasion is the focal point in space
and in time wherein two persons come
together in creating a caring occasion.