CANCER COLON AND

RECTUM

DEFINITION
A colorectal cancer may be benign or
malignant. Benign means the tumor will not
spread, while a malignant tumor consists of
cells that can spread to other parts of the body
and damage them.
Colorectal cancer is a cancer affecting
caecum, colon and rectum.

CLINICAL MANIFESTATION
1.
2.
3.
4.
5.
6.
7.
8.

Iron-deficiency anemia
Rectal bleeding
Abdominal pain
Change in bowel habits
Intestinal obstruction or perforation
Diarrhea
Constipation
Vomiting

ETIOLOGY
1. Inflammatory bowel disease
- chronic inflammation of all or part of your digestive tract.
2. Genetic mutations
3. Polyps

RISK FACTOR
1.
2.
3.
4.
5.
6.
7.

Older age
Male gender
High intake of fat
Alcohol or red meat
Obesity
Smoking
Lack of physical exercise

PATHOPHYSIOLOGY
Arise from dysplastic adenomatous polyps

The inactivation of a variety of tumour-suppressor and DNA

repair genes

Along with simultaneous activation of oncogenes.

A selective growth advantage to the colonic epithelial cell

The transformation from normal colonic epithelium to

adenomatous polyp

Colorectal Cancer

TREATMENT
1. Surgery : colectomies for adenocarcinoma of the colon.

 Colostomy
- Part of the colon containing the cancer and nearby healthy
tissue is removed, a stoma is created and a colostomy bag is
attach to the stoma.

2. Radiotherapy and Chemotherapy

-Chemotherapy for patient with node-positive disease.
-Radiation for patient with node-positive or transmural rectal
cancer (pre or post op)
-Adjuvant therapy : chemotherapy (colon), radiation (rectum)

MEDICATION
1. Cetuximab (Erbitux)
-treatment of KRAS mutation-negative (wild-type), epidermal
growth factor receptor (EGFR)-expressing, metastatic colorectal
cancer
2. Bevacizumab (Avastin)
-for first-line and second-line treatment for metastatic colorectal
carcinoma

INVESTIGATION
1. Colonoscopy
- Look for synchronous lesions, Alternative: air contrast
barium enema (apple core lesion) + sigmoidoscopy.
2. PET scan (positron emission tomography)
- helps to determine whether an abnormal area seen on another
imaging test is a tumor or not.
3. CT scan
- May be used if colorectal cancer has metastasized to other
organs.

HEALTH EDUCATION
1. Increase fibre in diet.
2. Decrease animal fat and red meat.
3. Decrease smoking.
4. Increase exercise and decrease BMI (body mass index).
5. Secondary prevention with screening.

NURSING CARE PLAN

Nursing diagnosis : Risk for infection related to colostomy
Supporting data
Objective data :
Subjective data :
Goal :

Nursing Intervention
1.Assess the condition of the patient such as all systems (e.g :
skin, respiratory) for sign and symptoms of infection.
R : Early recognition and intervention may prevent progression to
more serious situation or sepsis.

2. Monitor vital signs especially temperature.

R : Temperature elevation may occur (if not masked by
corticosteroids or anti-inflammatory drugs) because of
various factors, e.g : chemotherapy side effects, disease
process, or infection. Early identification of infectious process
enables appropriate therapy to be started promptly.

3. Screen or limit visitors who may have infections. Place in

reverse isolation as indicated.
R : Protects patient from sources of infection, such as visitors and
staff who may have an upper respiratory infection (URI).
4. Emphasize personal hygiene.
R : Limits potential sources of infection and or secondary
overgrowth.
5. Reposition frequently, keep linens dry and wrinkle-free.
R : Reduces pressure and irritation to tissues and may prevent
skin breakdown (potential site for bacterial growth)

6. Promote adequate rest or exercise periods.

R : Limits fatigue and encourages sufficient movement to prevent
stasis complications, e.g : pneumonia and thrombus
formation.
7. Stress the importance of good oral hygiene.
R : Development of stomatitis increases risk of infection or
secondary overgrowth.
8. Avoid or limit invasive procedures. Adhere to aseptic
techniques.
R : Reduces risk of contamination, limits portal of entry for
infectious agent.

9. Administer antibiotics as indicated.

R : May be used to treat identified infection or given
prophylactically in immunocompromised patient.
10. Record and report the conditions of the patient to the doctor.
R : For further intervention during hospitalization.
Evaluation :