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COLORECTAL

CANCER

Submitted By:Bantilan, Rose LynChu, Dean DellDionson, Keithlyn KimLauron, Maria Julie MayRubio, Ariane May

Submitted To:Mr. Jerald Ugdoracion

COLORECTAL CANCER

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less formally known as bowel cancer

a cancer characterized by neoplasia in the colon, rectum,or vermiform appendix.

ETIOLOGY: (unknown) Yet in spite of the high incidence ofcolon

cancer, we still do not have a sound basis for delineating the causesand mechanism of colon carcinoma growth, nor do we have a meansof curing the disease in every case.

Almost all colon cancer starts in glands in the lining of the colon andrectum. There is no single cause of colon cancer. Nearly all coloncancers begin as noncancerous (benign) polyps, which slowlydevelop into cancer.

RISK FACTORS

Age. The risk of developing colorectal cancer increases as we age. Thedisease is more common in people over 50, and the chance of gettingcolorectal cancer increases with each decade. However, colorectal cancer hasalso been known to develop in younger people.

Gender. The risk overall are equal, but women have a higher risk for coloncancer, while men are more likely to develop rectal cancer.

Polyps. Polyps are non-cancerous growths on the inner wall of the colon orrectum. While they are fairly common in people over 50, one type of polyp,referred to as an adenoma, increases the risk of developing colorectal cancer.Adenomas are non-cancerous polyps that are considered precursors, or thefirst step toward colon and rectal cancer.

Personal history. Research shows that women who have a history ofovarian, uterine, or breast cancer have a somewhat increased risk ofdeveloping colorectal cancer.

Also, a person who already has had colorectal cancer may develop thedisease a second time. In addition, people who have chronic inflammatoryconditions of the colon, such as ulcerative colitis or Crohn's disease, also areat higher risk of developing colorectal cancer.

Family history. Parents, siblings, and children of a person who has hadcolorectal cancer are somewhat more likely to develop colorectal cancer

themselves.

A family history of familial polyposis, adenomatous polyps, or hereditarypolyp syndrome also increases the risk as does a syndrome known ashereditary non-polyposis colon cancer, or HNPCC. This latter syndrome alsoincreases the risk for other cancers as well.

http://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Neoplasiahttp://en.wikipedia.org/wiki/Colon_(anatomy)http://en.wikipedia.org/wiki/Rectumhttp://en.wikipedia.org/wiki/Vermiform_appendixhttp://www.lotsofessays.com/essay_search/colon_cancer.htmlhttp://www.lotsofessays.com/essay_search/colon_cancer.htmlhttp://www.pv.webmd.com/colorectal-cancer/glossary-termshttp://www.pv.webmd.com/colorectal-cancer/glossary-termshttp://www.pv.webmd.com/colorectal-cancer/guide/inherited-colorectal-cancerhttp://www.pv.webmd.com/colorectal-cancer/guide/inherited-colorectal-cancerhttp://www.pv.webmd.com/colorectal-cancer/guide/inherited-colorectal-cancerhttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Neoplasiahttp://en.wikipedia.org/wiki/Colon_(anatomy)http://en.wikipedia.org/wiki/Rectumhttp://en.wikipedia.org/wiki/Vermiform_appendixhttp://www.lotsofessays.com/essay_search/colon_cancer.htmlhttp://www.lotsofessays.com/essay_search/colon_cancer.htmlhttp://www.pv.webmd.com/colorectal-cancer/glossary-termshttp://www.pv.webmd.com/colorectal-cancer/glossary-termshttp://www.pv.webmd.com/colorectal-cancer/guide/inherited-colorectal-cancerhttp://www.pv.webmd.com/colorectal-cancer/guide/inherited-colorectal-cancerhttp://www.pv.webmd.com/colorectal-cancer/guide/inherited-colorectal-cancer

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Diet. A diet high in fat and calories and low in fiber may be linked to agreater risk of developing colorectal cancer.

Lifestyle factors. You may be at increased risk for developing colorectalcancer if you drink alcohol, smoke, don't get enough exercise, and if you areoverweight.

Diabetes. People with diabetes have a 30-40% increased risk of developingcolon cancer.

SYMPTOMS

*Many cases of colon cancer is asymptomatic, however, the following symptomsmay indicate colon cancer:

Abdominal pain and tenderness in the lower abdomen Weight loss with no known reason Change in the frequency of bowel movements Diarrhea, constipation, or feeling that the bowel does not empty completely Bright red or very dark blood in the stool Stools that are narrower than usual General stomach discomfort like frequent gas pains, bloating, fullness and/or

cramps Constant fatigue Vomiting

SCREENING TESTS

Barium Enema

Sigmoidoscopy- visualization of the sigmoid colon and rectum

Colonoscopy best screening test for colon cancer

If your doctor learns that you do have colorectal cancer, more tests will be done to

see if the cancer has spread. CT or MRI scans of the abdomen, pelvic area, chest, or

brain may be used to stage the cancer. Sometimes, PET scans are also used.

Blood tests to detect tumor markers, including carcinoembryonic antigen (CEA) and

CA 19-9, may help your physician follow you during and after treatment.

COLORECTAL CANCER STAGING

Stage TNM stage TNM stage criteria forcolorectal cancer

Stage 0 Tis N0 M0 Tis: Tumor confined tomucosa; cancer-in-situ

Stage I T1 N0 M0 T1: Tumor invades

http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003120/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003107/http://en.wikipedia.org/wiki/AJCC_staging_systemhttp://en.wikipedia.org/wiki/TNM_staging_systemhttp://en.wikipedia.org/wiki/Mucosahttp://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003120/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003107/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003107/http://en.wikipedia.org/wiki/AJCC_staging_systemhttp://en.wikipedia.org/wiki/TNM_staging_systemhttp://en.wikipedia.org/wiki/Mucosa

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submucosaStage I T2 N0 M0 T2: Tumor invades

muscularis propriaStage II-A T3 N0 M0 T3: Tumor invades

subserosa or beyond(without other organsinvolved)

Stage II-B T4 N0 M0 T4: Tumor invadesadjacent organs orperforates the visceralperitoneum

Stage III-A T1-2 N1 M0 N1: Metastasis to 1 to 3regional lymph nodes. T1or T2.

Stage III-B T3-4 N1 M0 N1: Metastasis to 1 to 3regional lymph nodes. T3or T4.

Stage III-C any T, N2 M0 N2: Metastasis to 4 ormore regional lymphnodes. Any T.

Stage IV any T, any N, M1 M1: Distant metastasespresent. Any T, any N.

POSSIBLE COMPLICATIONS Blockage of the colon (Intestinal Obstruction): blockage in the intestine that

does not allow food or stool to pass through the intestine.

Gastrointestinal Bleeding

Anemia : when the polyps bleed it can result in anemia, which is alack of red blood cells and/or hemoglobin

Cancer recurrence: when colon cancer comes back after it has gone intoremission

Cancer spreading to other organs or tissues (metastasis) this is when thecolon cancer spreads to other parts of the body and organs, most often theliver, the lungs, bones and the brain

Development of a second primary colorectal cancer

COLLABORATIVE MANAGEMENT

Treatment depends partly on the stage of the cancer. In general, treatments may

include:

Surgery (most often a colectomy) to remove cancer cells

Chemotherapy to kill cancer cells

Radiation therapy to destroy cancerous tissue

http://en.wikipedia.org/wiki/Submucosahttp://en.wikipedia.org/wiki/Muscularis_propriahttp://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Lymph_nodehttp://www.nlm.nih.gov/medlineplus/ency/article/002260.htmhttp://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002941/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002324/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001918/http://en.wikipedia.org/wiki/Submucosahttp://en.wikipedia.org/wiki/Muscularis_propriahttp://en.wikipedia.org/wiki/Peritoneumhttp://en.wikipedia.org/wiki/Lymph_nodehttp://www.nlm.nih.gov/medlineplus/ency/article/002260.htmhttp://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002941/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A002324/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A001918/

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SURGERY

Stage 0 colon cancer may be treated by removing the cancer cells, often during a

colonoscopy. For stages I, II, and III cancer, more extensive surgery is needed to

remove the part of the colon that is cancerous.

Generally, large bowel resection is surgery to remove all or part of your large bowel.

This surgery is also called colectomy. The large bowel is also called the large

intestine or colon.

Removal of the entire

colon and the rectum is

called a

proctocolectomy.

Removal of part or all of

the colon but not the

rectum is called

subtotal colectomy.

HERE ARE SOME OF THE SURGERIES:1. Wide segmental bowel resection of tumor,

including regional lymph nodes and blood

vessels.

2. Transanal excision for small, localized,

accessible tumors.

3. Low anterior resection for upper rectal

tumors; possible temporary diversion loop

colostomy while rectal anastomosis heals;

2nd procedure for takedown of colostomy.

4. Colonic J-pouch is a new technique that may be offered for rectal tumors.

Laparoscopic procedures are controversial.

5. Abdominoperineal resection with permanent end colostomy for lower rectal

tumors when adequate margins cannot be obtained or anal sphincters are

involved.

6. Temporary loop colostomy to decompress bowel and divert fecal stream,

followed by later bowel resection, anastomosis, and takedown of colostomy.

Colonic J-

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7. Diverting colostomy or ileostomy as

palliation for obstructing, unresectable

tumors.

8. Total proctocolectomy and possible ileal

reservoir- anal anastomosis for patients

with familial adenomatous polyposis and

CUC before cancer is confirmed.

9. More extensive surgery involving removal

of other organs if cancer has spread

(bladder, uterus, small intestine)

CHEMOTHERAPY

Almost all patients with stage III colon cancer should receive chemotherapy after

surgery for approximately 6 - 8 months. The chemotherapy drug 5-fluorouracil has

been shown to increase the chance of a cure in certain patients.

Chemotherapy is also used to improve symptoms and prolong survival in patients

with stage IV colon cancer.

Irinotecan, oxaliplatin, capecitabine, and 5-fluorouracil are the three

most commonly used drugs.

Monoclonal antibodies, including cetuximab (Erbitux), panitumumab

(Vectibix), bevacizumab (Avastin), and other drugs have been used alone or

in combination with chemotherapy.

You may receive just one type, or a combination of these drugs. Chemotherapy may

be used as adjuvant therapy to improve survival time. May be used for residual

disease, recurrence of disease, unresectable tumors and metastatic disease.

RADIATION

Although radiation therapy is occasionally used in patients with colon cancer, it is

usually used in combination with chemotherapy for patients with stage III rectal

cancer.

Ileostomy

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000755/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001043/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000755/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000755/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001043/http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000755/

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Other Therapeutic InterventionsBlood replacement or other treatments if severe anemia exists.

For patients with stage IV disease that has spread to the liver, various treatments

directed specifically at the liver can be used. This may include:

Burning the cancer (ablation)

Delivering chemotherapy or radiation directly into the liver

Freezing the cancer (cryotherapy)

Surgery

NURSING MANAGEMENT

o Prepare the patient for surgery, as indicated.o Provide comfort measures and reassurance for patients undergoing radiation

therapy.o Prepare the patient for the adverse effects of chemotherapy and take steps

to minimize this effects.o Use strict aseptic technique when caring for I.V. catheters.o Have the patient wash his hands before and after meals and after going to

the bathroom.o Listen to the patients fears and concerns, stay with him during periods of

severe stress and anxiety.o Encourage the patient to identify actions and care measures that will

promote his comfort and relaxation.o Monitor the patients bowel patterns.o Monitors the patients diet modification, and assess the adequacy of his

nutrition intake.o Direct the patient to follow a high fiber diet.o Caution him to take laxatives or an antidiarrheal medications only as

prescribed by the doctor.o Inform the patient about screening and early detection.

Management of patient that is for surgery:

Preoperative Management:1. Preparing the client for surgery.

Physical preparation building the patients stamina and cleansing the bowel

prior to surgery

Assess patients knowledge about the diagnosis, prognosis, surgical

procedure, and expected level of functioning after surgery.

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Assess patients anxiety level and coping mechanisms and suggest methods

for reducing anxiety such as deep breathing exercises.

Intraoperative Management:

1. Maintenance of safety

Maintains aseptic, controlled environment.2. Effectively manages human resources, equipment, and supplies for

individualized patient care.

3. Transfer patient to operating room table.

4. Position the patient, exposing the surgical site.

5. Applies grounding device to patient.

6. Ensure that the sponge, needle, and instrument counts are correct.

Postoperative Management:1. Pain management during the immediate postoperative period, monitor for

complications such as leakage from the site of anastomosis, prolapse of thestoma, perforation, stoma retraction, skin irritation, and pulmonary

complications.

2. Maintaining optimal nutrition The patient avoids foods that cause excessive

odor and gas, including foods in the cabbage family, eggs, fish, beans, and high-

cellulose products such as peanuts. Fluid intake of at least 2 L/day.

3. Providing wound care

The nurse frequently examines the abdominal dressing during the first 24

hours after surgery to detect signs of hemorrhage.

Splint the abdominal incision during coughing and deep breathing to lessen

tension on the edges of the incision.

Monitor vital signs to detect an infectious process.

With colostomy stoma is examined for swelling (slight edema from surgical

manipulation is normal), color (a healthy stoma is pink or red), discharge

(small amount of oozing is normal), and bleeding (an ABNORMAL sign)

4. Monitoring and managing complications

Frequently assess the abdomen, including decreasing or changing bowel

sounds and increasing abdominal girth to detect bowel obstruction.

Monitor hematocrit and haemoglobin levels and administer blood products as

prescribed.

For pulmonary complications frequent activity (turning to sides every 2

hours), deep breathing exercises, coughing, and early ambulation

5. Removing and applying the colostomy appliance The colostomy begins to

function 3 to 6 days after surgery.

Advise patient to protect the periostomal skin by washing the area gently

with a moist soft cloth and a mild soap.

6. Irrigating the colostomy to empty the colon of gas, mucus, and feces

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7. Supporting a positive image Help the patient overcome aversion to the

stoma or fear of self injury by providing care and teaching in an open, accepting

manner and by encouraging the patient to talk about his or her feelings about

the stoma.

Sources:

http://www.health.am/cr/colorectal-cancer/

http://en.wikipedia.org/wiki/Colorectal_cancer

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001308/

http://www.lotsofessays.com/viewpaper/1688759.htmlhttp://www.webmd.com/colorectal-cancer/guide/risk-factors-colorectal-cancer

http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-

colorectal-cancer.html

http://www.medicinenet.com/colon_cancer/page4.htm

http://www.health.am/cr/colorectal-cancer/http://en.wikipedia.org/wiki/Colorectal_cancerhttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001308/http://www.lotsofessays.com/viewpaper/1688759.htmlhttp://www.webmd.com/colorectal-cancer/guide/risk-factors-colorectal-cancerhttp://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-colorectal-cancer.htmlhttp://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-colorectal-cancer.htmlhttp://www.medicinenet.com/colon_cancer/page4.htmhttp://www.health.am/cr/colorectal-cancer/http://en.wikipedia.org/wiki/Colorectal_cancerhttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001308/http://www.lotsofessays.com/viewpaper/1688759.htmlhttp://www.webmd.com/colorectal-cancer/guide/risk-factors-colorectal-cancerhttp://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-colorectal-cancer.htmlhttp://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-colorectal-cancer.htmlhttp://www.medicinenet.com/colon_cancer/page4.htm