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Care of People with Cancer of the Colon or Rectum Definition:

o An abnormal malignant growth that involves the colon or rectum (Saunders

Manual of Nursing Care) o A neoplasm in the colon or rectum characterized by uncontrolled growth of anaplastic cells that tend to invade surrounding tissue and metastasize to other body sites (The Lippincott Manual of Nursing Practice)
o

Incidence
o Accounts for over 60, 000 deaths annually- the third highest overall death

rate in the US for any type of cancer. o Highest incidence for men than women o Most often seen in those 50 to 60 years of age o Most frequent sites: the recto sigmoid, then the cecum.

Etiology and Risk Factors


o Familial Polyyposis- numerous pedunculated growths or polyps arising from

the mucosa and extending into the lumen of the intestine o Chronic Ulcerative Colitis- definite risk of colon cancer(up to 20 % after 20 years of age with active disease) o Diverticulosis and Cancer- may be fond together and simulate each other o Cultural Factors Occurs more frequently in developed countries and is probably related to the relatively low fiber and excess animal fat(particularly beef) in the diet in these areas

Pathophysiology
o The tumor originates in the mucosal and submucosal layers. Eventually, it

invades deeper layers and may spread to the lymph system. o Polyps can arise from the mucosal surface of the colon o Please refer to the video for a more thorough explanation

Clinical Manifestations
o Distribution of cancer in the colon (Please refer to the diagram presented) o Signs and symptoms are usually vague in early stages and later vary,

depending on the side of the colon involved. o Changes in bowel habits occur more frequently with cancers of the left side of the colon. o Weakness, fatigue, and anemia may be the first signs of a right-sided colon cancer. Most Common Symptoms Additional Signs Progression of Disease

Blood in the stool, usually Progressive weakness,Ribbon-like stools, passing occult, causing anemia fatigue, anorexia, weightof stools and flatus and Partial Obstruction- loss, shortness of breath,relieves pain, bright red

causing constipation alternating with diarrhea, lower abdominal pains (crampy), and distention.

anginal pain, anemia,blood in the feces, and pallor, cachexia, ascites,mucus in or on the stools. hepatomegaly, lymphadenopathy, vertigo, vomiting and other signs of intestinal obstruction.

Diagnostic Evaluation
o Digital Rectal Exam-half of the all colon and rectal cancers are found this way o Endoscopy (fiberoptic sigmoidoscopy/colonoscopy)-two thirds of all colon and

rectal cancers can be seen o Barium Enema Especially significant in unexplained abdominal mass Napkin-ring type outline clearly indicates bowel obstruction and possible tumor o Stool Examination for Blood Often reveals evidence for carcinoma when the patient is otherwise asymptomatic o Intravenous Pyelography and Cystoscopy- may be indicated to assess whether malignancy has spread locally to involve ureter or bladder o Carcinoembryonic Antigen (CEA/CA)-cannot be used for early diagnosis, but it can detect metastasis or recurrence o Diagnosis confirmed by: Removing recto sigmoid polyps through sigmoidoscope for histological study Removing polyps above recto sigmoid by colonoscopy or laparotomy (if other symptoms are present) to verify diagnosis

Management
o Goal s are to remove the tumor and establish a bowel regimen Surgical Therapeutic Plan Colectomy Wide segmented resection of the colon and mesentery with

anastomosis Abdominoperineal resection with colostomy Radon Seed Implantation-combined surgery and preoperative radiation therapy Local Fulguration via colonoscope or proctoscope Colostomy-temporary or permanent opening of the colon through the abdominal wall Please refer to the video presentation to know more about Colostomy Chemotherapy Pain Medications 5-FU in combination with cisplatin, mitomycin, etc. Radiation Therapy May be used before or after surgery to reduce the tumor

Complications
o Obstruction o Hemorrhage/Anemia

Nursing Diagnosis
o Altered Nutrition less than body requirements

related to malignant tumor

effects and weight loss o Pain related to spread of malignancy, inflammation and possible intestinal obstruction o Fear related to anesthesia, results of surgery, and potential for complications o Other possible nursing diagnoses Knowledge deficit regarding diagnosis and treatment Potential for Infection Body image disturbance related to colostomy Impaired skin integrity Altered sexual patterns Impaired home maintenance management

Nursing Interventions
o Achieving Adequate Nutrition High calorie, low residue diet o Relieving Pain Analgesics and/or Nonpharmacologic

Interventions like music, repositioning, relaxation techniques, etc. o Preoperative Preparation Determine the nature of anticipated surgery Make specific plans for the patient's understanding and acceptance of a colostomy o Postoperative Nursing Interventions General Postoperative Care Initial Care of the Colostomy Minimize Fear o Patient Education Skin Care around the Stoma Odor Control-avoid foods know to cause odor Control of Gas-avoid gas forming foods and swallowing of air Diet- avoid overeating and eating irregularly, chew food well Enhanced life-style- sexuality, pregnancy, travel, showering

Prognosis
o Five year survival rate for localized disease and those that are found in

adjacent organs or nodes is about 50 percent o Response rates for chemotherapy vary widely

References:
o Luckmann, J. (1997).Saunders Manual of Nursing Care. Phaildelphia: W.B.

Saunders Company.

o Suddarth, D.S. (1991). The Lippincott Manual of Nursing Practice, 5th Edition.

Philadelphia: J.B. Lippincott Company.

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