COLORECTAL CANCER
o High BMI ↑ risk of developing cancer
 Rectum is the most common affected area in
colon cancer (30%) → because that’s where the
feces are
o Feces are toxins → irregular bowel
movements → mucosa of the
rectum are exposed to the toxins →
high risk rectal cancer
 th
Ranks 4 in the Philippines
 3rd most malignant neoplasm in the world
 Risk of colorectal ↑ at age 40, rising sharply
between ages 50 to 55
 Those with symptoms related to colon including:
o Rectal bleeding
o Anemia
o Constipation
o Abdominal pain
☑ Should seek medical consult without delay
RISK FACTORS
 ↑ fat, low fiber diet
o Peristalsis becomes slow
o Fiber → goes with the feces and attracts
water to the feces enlarging the feces
mass → ↑ peristalsis
o Red meat → ↑ bile acid secretion and
plenty of anaerobic bacteria →
carcinogenic within the bowel
 Processed meat, ham, bacon,
hot dog, sausage
o High fat diet → ↑ risk of being obese →
obesity lowers immune system that will
fight the cancer cells
 Inflammatory bowel disease
o Frequent inflammation promotes
development of dysplasia which may
lead to malignancy
o Crohn’s, ulcerative colitis, diverticulosis
 Diverticulosis
- Always constipated → freq.
Valsalva maneuver → walls
of large intestine weaken
and forms bulges →
popcorn, seeds of tomatoes,
etc. can be trapped in the
diverticula → no peristalsis
in diverticula → ruptured
diverticula can lead to
peritonitis
 Obesity
 Sedentary lifestyle
 Alcohol use
o Consuming more than 4 alcoholic drinks
per week increases the risk
 Genetic
 Environmental exposure to carcinogen
SIGNS AND SYMPTOMS:
☐ Ascending colon
o Cramping/achy abdominal pain
o Dark reddish-brown stool/black tarry stool
 Blood is mixed with other
substances in the colon
o Weakness and weight loss
 Weight loss due to no appetite
because of pain
o No change in bowel habits
☐ Transverse colon
o Diarrhea/constipation
o Bloody stools (red)
o Feeling of fullness in abdomen
o Abdominal pain with cramping
☐ Descending colon
o Sense of fullness
o Constipation/diarrhea
o Ribbonlike stool
 Bright red blood
o Fever
o Weight loss
DIAGNOSTIC TESTS
 Fecal Occult Blood Test
o Often, this small amount of blood in the 1st
and sometimes the only sign of early colon
cancer, making the fecal occult blood test a
valuable screening test for colorectal
☑ Avoid medicines that can interfere with the
results. This includes NSAID and blood
thinners which can cause minor stomach
bleeding, thereby giving an abnormal test
result
☑ If you have hemorrhoids, wait until they stop
bleeding before doing the test
☑ Female shouldn’t collect stool samples near
time of menstruation
☑ Foods to avoid include red meat (the blood it
contains can turn test to positive)
 Colonoscopy
o A tube (with light) will be inserted up to the
ascending colon to see if there are tumors
o People should begin colorectal screening
earlier if they have any of the following risk
factors:
 Strong family history of cancer
needs to get screened 10 years
earlier
 If immediate family like your father
was diagnosed at age 45, have
colonoscopy at age 35
 Relative diagnosed at age 60, get
screened at age 40
◉ PREOP CARE:
o Oral administration of cathartics or fleet
enema started at least 12 to 24 hours
before surgery
o Antibiotics: sulfonamides, neomycin or
cephalexin 12 – 48 hours prior to surgery
 To ↓ bowel bacteria and postop
wound infection
 If bacteria won’t be killed,
possible peritonitis
Why do we have bacteria in the colon?
o E. coli will react with the bile (from liver)
to produce stercobilin and give brown
color to the stool
o E. coli is very important in the formation
of vitamin K
Neomycin
o Antibiotic that will kill E. coli
o Has limited absorption from the GI tract
o Exerts its antibiotic effect on the
intestinal mucosa
o In preparation for GI surgery, the level of
microbial organisms will be reduced
◉ POSTOP CARE:
o Monitoring of VS for manifestation of
infection and shock
 Hypovolemic shock due to
bleeding because of surgery
o An NGT tube (connected to a bedside
bottle) is usually in place until peristalsis
returns
 Patient under general
anesthesia → ↓ peristalsis
(paralytic ileus) → accumulation
of gastric secretions → once
patient recovers from
anesthesia, patient will be in
severe pain → stimulation of
vomiting center in the brain →
vomiting → possible to have
aspiration pneumonia → NGT to
decompress stomach
 Usually removed on the 3rd
postop day because peristalsis is
expected to be normal on the 3rd
postop day
o Insertion of rectal tube for 20 – 30
minutes if the rectum contains gas
 To prevent gas formation, do
not allow patient to talk for a
long time
 Since there is ↓ in
peristalsis, swallowed
air during talking will
accumulate in the
stomach
o Early ambulation to relieve distention
and promote peristalsis
o Petrolatum gauze over the stoma to
keep it moist followed by a dry sterile
dressing
o Monitor for color change in the stoma
 Normal stoma: pink to bright red
and shiny indicating high
vascularity and good perfusion
 Pale pink stoma → low
hemoglobin and hematocrit or
less perfusion to the stoma
 Purple to black stoma →
compromised circulation
 Notify the physician!
STOMA
- A small amount of bleeding at stoma is normal
- Ideal stoma is protruding lightly to allow stoma
to drain into pouch
- Stoma shrinks within 8 weeks
- Complete healing of the wound may take 6 – 8
months
- Measure the stoma once weekly for the 1st 6 to
8 weeks to ensure proper fit of the ____
- Swelling of the stoma is normal for 2 to 3 weeks
after surgery
o Ascending colon → liquid, watery stool; loose
o Transverse → semi-liquid; mushy; soft; pasty
o Descending → semi-solid
POSTOP CARE FOR STOMA
 Monitor the pouch system for proper fit of signs
of leakage
o Wash the surrounding skin and dry it
thoroughly
o Don’t apply friction because it can cause
maceration of the skin
o Apply the bag after drying. Secure
adhesion on all sides
 Expect the stool is liquid in the immediate postop
period
 Empty the pouch when it is 1/3 to half-full
o Don’t allow the bag to be filled with
feces because the bag might not be able
to hold it
 Colostomy begins to function 3 to 6 days after
surgery
o (+) peristalsis
 A stoma does not have voluntary muscle
contraction and may empty at irregular intervals
COLOSTOMY IRRIGATION
Purposes:
 To regulate bowel movements at a regular time
 To empty the colon of gas, mucous and feces
 Best time → the patient’s former schedule of
bowel movement
o Bowel is “trained” to evacuate @ this
time
o After breakfast, gastrocolic reflex occurs
o Perform irrigation preferably 2 hours
____ meal
 Water should flow 5 to 10 minutes period
o 300 mL of fluid may be all that is needed
to stimulate evacuation
 Most of the water, feces and flatus will be
expelled in 10 to 15 minutes after irrigation
 Schedule of irrigation gradually progress to every
other day, every two days, or even 2x a week
 Begins on the 4th or 5th postop day
o Peristalsis is expected to function on the
3rd to 6th day postop
 Amount: 500 to 1000 mL tepid or lukewarm H2O
 Position: sit on a toilet sit or over the toilet
 Remove air by flushing with ____ _____
 Hang the container of irrigation so that the
bottom of the solution is above the patient’s
shoulder
o 12 inches above the shoulder
o 18 to 20 inches above the stoma
 Lubricate the distal end of the catheter and
slowly insert the catheter into the stoma for
about 2 to 3 inches
 If cramping occurs while doing the irrigation,
stop the flow of solution temporarily and ask the
patient to take few deep breaths
o You can also lower down the solution
 Allow 30 – 45 minutes for the solution and feces
to be expelled (minimum 10 minutes)
 If ______ fails to return properly (after 1 hour
there is still nothing expelled)
o Gently massage the lower abdomen
o Take several deep breaths
o Drink warm water
o If there is ___ _____, try the next day
o If there is no return on the 3rd day, notify
the physician
 The client should never:
o Use more than 1000 cc
o Irrigate the colostomy more than 1x/day
o Irrigate the colostomy if diarrhea is
present
 Risk for fluid and electrolyte
imbalance
COLOSTOMY CARE
 The peristomal should be cleaned well with mild
soap and water
 Dry skin well before the skin barrier and a new
pouch is applied
o If moist, the bag will not adhere to the
skin
 Skin should be ___ with skin barrier
 Empty when 1/3 full
☐ Colostomy pouch
 Best time to change the pouching system when
the bowel is least active, usually 2 to 4 hours
after meals
 Early in the morning before eating or drinking,
when bowel and kidneys will be least active
 Expected bowel after surgery is liquid
DIET CONSIDERATIONS:
 Teach patient to chew food thoroughly so no
undigested food will enter the colostomy
 Instruct to drink at least 2 quarts of fluid per day,
preferably water
 Control flatus/gas
o Intestinal gas is created by swallowed air
and by bacterial action on indigested
carbohydrates
 o Avoid the ff:
 Drinking with straw
 Chewing gum
 Smoking
 Skipping meals
o Avoid gas-producing foods:
 Beans
 Bananas
 Eggplant
 Onions
 Carrots
 Cabbage
 Broccoli
 Cauliflower
 Milk & milk products
 Carbonated beverages
 Minimize odor
o Avoid odor-producing foods:
 Asparagus
 Fish
 Eggs
 Garlic
 Broccoli
 Beer

 Crackers, toast, yogurt can help prevent gas

 Cranberry juice, parsley, yogurt can help prevent
odor