COLORECTAL CANCER

03-Sep03-Sep-2010 Ns Hieu

DESCRIPTION
The colon is the part of the digestive system where the waste material is stored. The rectum is the end of the colon adjacent to the anus . Together, they form a long, muscular tube called the large intestine (also known as the large bowel). Tumors of the colon and rectum are growths arising from the inner wall of the large intestine. Benign tumors of the large intestine are called polyps

DESCRIPTION
Malignant tumors of the large intestine are called cancers
Benign polyps do not invade nearby tissue or spread to other parts of the body. Benign polyps can be easily removed during colonoscopy and are not life-threatening. If benign polyps are not liferemoved from the large intestine, they can become malignant (cancerous) over time. Most of the cancers of the large intestine are believed to have developed from polyps

DESCRIPTION
Globally, cancer of the colon and rectum is the third leading cause of cancer in males and the fourth leading cause of cancer in females. The frequency of colorectal cancer varies around the world. It is common in the Western world and is rare in Asia and Africa. In countries where the people have adopted western diets, the incidence of colorectal cancer is increasing .

DESCRIPTION
#Colorectal cancer is not contagious (a person cannot catch the disease from a cancer patient)
Factors that increase a person's risk of colorectal cancer include:

1. High fat intake

2. A family history of colorectal cancer and polyps 3. The presence of polyps in the large intestine

4. Chronic ulcerative colitis.

ASSESSMENT
*Symptoms of colon cancer are numerous and

nonspecific * They include fatigue, weakness, shortness of breath, change in bowel habits, narrow stools, diarrhea or constipation, red or dark blood in constipation, loss, pain, stool, weight loss, abdominal pain, cramps, or bloating.

ASSESSMENT
*Other conditions such as irritable bowel syndrome (spastic colon), ulcerative colitis, Crohn's disease, diverticulosis, and peptic ulcer disease, disease can have symptoms that mimic colorectal cancer. *Symptoms vary according to where in the large bowel the tumor is located.

ASSESSMENT
*The right colon is spacious, and cancers of the right colon can grow to large sizes before they cause any abdominal symptoms. Typically, right-sided cancers cause iron rightdeficiency anemia due to the slow loss of blood over a long period of time. Iron deficiency anemia causes fatigue, weakness, and shortness of breath *The left colon is narrower than the right colon. Therefore, cancers of the left colon are more likely to cause partial or complete bowel obstruction. Cancers causing partial bowel obstruction can cause symptoms of constipation, narrowed stool, diarrhea, abdominal pains, cramps, and bloating. Bright red blood in the stool may also indicate a growth near the end of the left colon or rectum.

DIAGNOSTIC EVALUATION
*Examinations of the rectum
*Stool tested for hidden or "occult" blood *Blood tests are now available to test for FAP, AFAP, MYH, and HNPCC hereditary colon cancer syndromes *Flexible sigmoidoscopies or screening colonoscopies are performed even if the stool occult blood tests are negative. Pelvic MRI and endorectal ultrasonography provide information about penetration and lymph node involvement. CT scan of the liver, lung, and brain may show

COLLABORATIVE MANAGEMENT
#Therapeutic intervention -Major sources of fat are meat, eggs, dairy products, salad dressings,
and oils used in cooking

-Fiber is the insoluble, non-digestible part of plant material present in nonfruits, vegetables, and whole-grain breads and cereals whole-

-It is postulated that high fiber in the diet leads to the creation of bulky
stools which can rid the intestines of potential carcinogens

COLLABORATIVE MANAGEMENT
#Pharmacologic intervention -In some patients, there is no evidence of distant
metastasis at the time of surgery, but the cancer has penetrated deeply into the colon wall or reached adjacent lymph nodes. @ Chemotherapy in these patients may delay tumor recurrence and improve survival. - Chemotherapy is the use of medications to kill cancer cells

COLLABORATIVE MANAGEMENT
-Red blood cells, platelets, and white blood cells are
frequently affected by chemotherapy. Common side effects include anemia, loss of energy, easy bruising, and a low resistance to infections. Cells in the hair roots and intestines also divide rapidly. Therefore, chemotherapy can cause hair loss, mouth sores, nausea, loss, vomiting, and diarrhea

COLLABORATIVE MANAGEMENT
@
Radiation therapy in colorectal cancer has been limited to treating cancer of the rectum.

-With radiation, the risk is lowered to approximately 7%.

Side effects of radiation treatment include fatigue, temporary or permanent pelvic hair loss, and skin irritation in the treated areas

COLLABORATIVE MANAGEMENT
- Such combinations can specifically seek and destroy tumor tissues in
the body. Other treatments attempt to boost the immune system, the bodies' own defense system, in an effort to more effectively attack and control colon cancer. In patients who are poor surgical risks, but who have large tumors which are causing obstruction or bleeding, laser treatment can be used to destroy cancerous tissue and relieve associated symptoms. Still other experimental agents include the use of photodynamic therapy. In this treatment, a light

sensitive agent is taken up by the tumor which can then be activated to cause tumor destruction

NURSING DIAGNOSES
Acute pain Anxiety Constipation Diarrhea Fatigue Imbalanced Nutrition: Less than body requirements. Risk for deficient fluid volume

NURSING INTERVENTIONS MONITORING

Monitor amount, consistency, frequency, occult blood, and color of the stools. Monitor the patient s dietary intake and weight. Monitor for excess fluid and electrolyte loss through vomiting and diarrhea, and watch for dehydration. Monitor the patient s response to radiation or chemotherapy, and watch for adverse reactions.

NURSING INTERVENTIONS Supportive Care

Meet the patient s nutritional needs by serving a high calorie, low residue diet for several days before surgery , if the condition permits. Serve smaller meals spaced throughout the day to maintain adequate calorie and protein intake if patient if patient is able to take nutrition orally. Adjust diet before and after treatments such as chemotherapy or radiation. Serve clear liquids, bland diet , or NPO as directed. Maintain hydration through I.V. therapy and record urinary output. Metabolic tissue needs are increased and more fluids are needed to eliminate waste products. Insruct the patient to take prescribed anti emetic as needed especially if receiving chemotherapy

NURSING INTERVENTIONS Supportive care ( cont.)

For constipation, encourage exercise and adequate fluid or fiber intake to promote bowel motility. For diarrhea related to radiation or chemotherapy ( not caused by obstruction), administer antidiarrheal medications and discuss foods that may slow transit time of bowel, such as bananas, rice, peanut butter and pasta. Maintain nasogastric decompression for obstruction. Measure and document amount of drainage. Evaluate effectiveness of analgesic regimen.Investigate different approaches, such as relaxation techniques, repositioning, imaging, laughter,music, reading and touch for control or relief of pain.

NURSING INTERVENTION Supportive Care ( cont.)

Institute an individualized activity plan after assessing the patient s activity level and tolerance, noting shortness of breath or tachycardia. Allow for frequent rest periods to regain energy. To minimize fear, provide information and answer questions about disease process, treatment modalities and complications.

NURSING INTERVENTIONS EDUCATION AND HEALTH MAINTENANCE

Inform patients on some recommendations: --Recently doctors are recommending screening colonoscopies for healthy individuals starting at ages 50-55 . 50Patients with a long history (greater than 10 years) of chronic ulcerative colitis have an increased risk of colon cancer, and should have regular colonoscopies to look for precancerous changes in the colon lining. Teach and demonstrate colostomy management skills. Initiate a home care nursing referral to assist with wound care and management of treatment adverse effects, and to continue teaching colostomy care.
-

The End ..

THANK YOU !!