Wan Masyitah binti Yahya (A187214)

COLORECTAL CANCER
1. Define Colorectal cancer
- Colon cancer is a disease that involves the large intestine (colon), which is the last
portion of the gastrointestinal (GI) tract. Polyps or small, benign groups of cells
can form inside the colon. The colorectal cancer (CRC) occurs when polyps in the
large intestine become malignant.
2. Explain the pathophysiology
- It involves a series of genetic mutations and changes in the cellular environment
that lead to the uncontrolled growth of abnormal cells.
- Initiation: the genetic mutations in the epithelial cells that line the colon and
rectum. These mutations can be caused by exposure to carcinogens, such as
tobacco smoke, alcohol, and certain chemicals.
- Promotion: During this stage, the abnormal cells begin to proliferate and grow
into a tumor.
- Progression. As the tumor grows, it can invade the surrounding tissues and spread
to nearby lymph nodes or other organs (metastasis)
3. Identify the etiology
- Genetic factors
- Diet
- Environmental factors
- Inflammatory conditions of digestive tract
- Smoking
4. Identify signs and symptoms
- Blood in urine & stools (melena)
- Unexplained anemia
- Anorexia
- Weight loss
- Fatigue
- Abdominal Pain
- Rectal Pain
- Constipation
- Diarrhea
5. Identify diagnostic test
- Complete Blood Count
- Liver Function Test
- Carcinoembryonic Antigen (CEA) Test
- Colonoscopy
- CT scan of abdomen, pelvis, chest
 6. Explain the management of colorectal cancer
Preoperative Care
1. Maintaining Optimal Nutrition
2. Prevent Infection
3. Maintain fluid volume balance
4. Education
5. Emotional Support
Postoperative Care
1. Maintaining Optimal Nutrition
2. Provide Wound Care
3. Monitor & manage complications
4. Educate self-care

7. Explain the complications of colorectal cancer

- Bleeding
- Anaemia
- Jaundice (if cancer spread to liver@tumour put pressure on liver)
- Blockage of the colon, causing bowel obstruction.
- Cancer returning in the colon.
- Cancer spreading to other organs or tissues (metastasis)
- Development of a second primary colorectal cancer.
8. Explain nursing care plan

Assessment:

● Assess the patient's medical history and current condition, including the stage and location of the
cancer
● Assess the patient's pain level, and their coping mechanisms
● Assess the patient's nutritional status, bowel function, and medication history
● Assess the patient's emotional state, and their support system
● Administer medications as prescribed, including pain medication, chemotherapy, and radiation
therapy
● Monitor for signs of infection and provide appropriate interventions if necessary
● Provide wound care, if applicable, and monitor for signs of bleeding and other complications
● Monitor patient’s bowel function and provide education on ways to maintain regular bowel
movements
● Provide emotional support and counseling to help the patient cope with anxiety and stress

Diagnosis:

- Acute pain related to tumor mass as evidenced by report of pain.

- Imbalanced nutrition, less than body requirements, related to anorexia as evidenced by fatigue
and weakness.
 - Risk for deficient fluid volume related to vomiting and dehydration.
- Risk for infection related to immunosuppression.

STOMACH CANCER
1. Definition of stomach cancer
- Also known as Gastric Cancer
- Adisease in which malignant (cancer) cells form in the lining of the stomach
- It is usually an adenocarcinoma.
- It spreads rapidly to the lungs, lymph nodes, and liver.
2. Explain the pathophysiology
- Chronic inflammation. Also known as gastritis, is an early stage in the development of
stomach cancer. This can be caused by infection H. pylori, a bacterium that can live in the
stomach for many years and can cause damage to lining of the stomach.
- Precancerous changes. Over time, chronic inflammation can lead to changes in lining of
the stomach, including dysplasia (development abnormal cells). It can progress to cancer
if left untreated.
- Invasion. As dysplastic cells continue to grow and divide, they can invade surrounding
tissue and form tumor. The tumor can grow into wall of stomach and potentially spread to
nearby lmph nodes.
- Metastasis. Tumor cells can also spread to other parts of the body through the blood or
lymphtic vessels, forming secondary tumors in other organs such as liver, lungs and
bones.
- Angiogenesis. In order to continue growing, the tumor needs a blood supply. The tumor
cells release chemical signals that stimulate formation of new blood vessels
3. Identify clinical manifestations
- Trouble swallowing
- Loss of appetite
- Belly pain
- Feeling bloated after eating
- Feeling full after eating small amounts of food
- Not feeling hungry when you would expect to be hungry
- Heartburn
- Indigestion
- Nausea
- Vomiting
- Losing weight without trying
- Fatigue/weakness
- Stools that look black
4. Identify diagnostic test and assessment
- Upper endoscopy. Commonly used to diagnose stomach cancer. Your provider inserts a thin tube
with a tiny camera at its tip into your mouth until it reaches stomach. Small surgical instruments
can pass through the endoscope, allowing your provider to remove a tissue sample (biopsy). The
sample can be tested in a lab for cancer cells.
 - Endoscopic ultrasound is a special kind of endoscopy that can help stage the cancer. The
endoscope used has an ultrasound probe attached at its tip, that can take pictures of your stomach.
It can show if the cancer’s spread from your stomach lining to your stomach wall.
- Radiologic tests, including a CT scan, barium swallow and MRI, can help identify tumors and
other abnormalities that may be cancer-related. During a barium swallow, you drink a substance
that makes your stomach lining more visible on an X-ray. A PET scan can show if cancer has
spread throughout your body.
- Blood tests can offer information about how your organs are functioning. Poor organ function
may indicate that cancer has spread to that organ.
- Laparoscopy is a type of surgery that allows your provider to assess cancer spread when less
invasive methods, like imaging, haven’t provided enough information. During laparoscopy, your
provider inserts a tiny camera into small cuts in your abdomen so they can see your organs
directly.
- Blood test. Another type of blood test looks for pieces of cancer cells in the blood. This is called
a circulating tumor DNA test. It's only used in certain situations for people with stomach cancer.
For example, this test might be used if you have advanced cancer and can't have a biopsy.
Collecting pieces of cells from the blood can give your health care team information to help plan
your treatment.
-
5. Explain the medical and surgical treatment

Pharmacologic Intervention

- Chemotherapeutic agents used as adjuvant (in addition to) or neoadjuvant (before surgery) often
in combination: fluorouracil, doxorubicin, methyl-CCNU, cisplatin, methotrexate, etoposide to
treat cancer that has metastasized to organs beyond stomach; shrink tumors before surgery.
- B vitamin complex tablet Combat vitamin B12deficiency and megaloblastic anemia from lack of
intrinsic factor
- Narcotic analgesics manage pain, side effects of treatment drugs such as morphine, meperidine
which increase patient comfort during end-stage disease
- Other Medications: Antiemetics may be used to control nausea, which increases as the tumor
enlarges. In the advanced stages, the physician may prescribe sedatives, narcotics, and
tranquilizers to increase the patient’s comfort. Antispasmodics and antacids may also help relieve
GI discomfort.

Medical Management
-
Removing small cancers from the stomach lining. Very small cancers can be cut away from the
inside lining of the stomach. To remove the cancer, a tube is passed down the throat and into the
stomach. Special cutting tools are passed through the tube to cut out the cancer. This procedure is
called an endoscopic mucosal resection. It might be an option for treating stage 1 cancer that's
growing on the inner lining of the stomach.

- Removing part of the stomach. This procedure is called a subtotal gastrectomy. The surgeon
removes the part of the stomach affected by cancer and some of the healthy tissue around it. It
 might be an option if your stomach cancer is located in the part of the stomach nearest the small
intestine.
- Removing the entire stomach. This procedure is called a total gastrectomy. It involves removing
all of the stomach and some surrounding tissue. The surgeon connects the oesophagus to the
small intestine to allow food to move through the digestive system. Total gastrectomy is a
treatment for cancers in the part of the stomach that is closest to the oesophagus.
- Removing lymph nodes to look for cancer. The surgeon may remove lymph nodes in your belly
to test them for cancer.
- Surgery to relieve symptoms. An operation to remove part of the stomach may relieve
symptoms of a growing cancer. This might be an option if the cancer is advanced and other
treatments haven't helped.
- Radiotherapy. Radiation therapy uses high-powered beams of energy to kill cancer cells.
Radiation therapy is often done at the same time as chemotherapy.
- Chemotherapy

6. Explain nursing care plan

Nursing Management
-Monitor nutritional intake and weigh patients regularly.
-Provide comfort measures and administer analgesics as ordered.
-Frequently turn the patient and encourage deep breathing to prevent pulmonary complications, to protect
skin, and to promote comfort.
-Administer protein and vitamin supplements to foster wound repair and tissue building.
-Eat small, frequent meals rather than three large meals.
-Reduce fluids with meals, but take them between meals.
-Encourage follow-up visits with the health care provider and routine blood studies and other testing to
detect complications or recurrence.
Nursing Diagnosis
- Acute pain related to disease process as evidenced by complaints of pain by the patient, pain score 8 or
higher out of 10.
-Fatigue related to side effects of chemotherapy as evidenced by lack of energy and inability to perform
daily living.
-Risk for infection related to invasive treatment procedures.

ULCERATION COLITIS
1. Define ulceration colitis
- Ulcerative colitis is a medical condition that involves the inflammation and ulcer
formation in the lining of the colon (large intestine) and rectum
2. Identify the causes, signs and symptoms
 Sign and symptoms
- Diarrhea that could have blood or pus
- Abdominal pain and cramping
- Rectal bleeding and/or rectal pain
- Tenesmus – increased urgency to defecate but inability to move bowels; accompanied by
cramping rectal pain
- Inability to defecate despite urgency
- Weight loss
- Fatigue
- Fever

Causes
- Idiopathic
- Some research studies are focused on the nature of ulcerative colitis being an
autoimmune condition. The immune system is the body’s way to protect itself by
attacking foreign bodies like viruses and bacteria. This process sometimes fails due to
certain factors, making the body attack its own cells. Cells in the digestive tract may be
mistakenly attacked, causing ulcerative colitis.

- Heredity. Family history is a apparent in some, but not all, people with ulcerative colitis.

3. Identify diagnostic test related to ulceration Colitis

- Blood tests: Your blood can show signs of infection or anemia. Anemia is a low level of
iron in your blood. It can mean you have bleeding in your colon or rectum.
- Stool samples: Signs of infection, parasites (tiny organisms that can live in a person’s
body) and inflammation can show up in your poop (feces).
- Imaging tests: Your healthcare provider may need a picture of your colon and rectum.
You may have tests including a magnetic resonance imaging (MRI) scan or computed
tomography (CT) scan.
- Endoscopic tests: An endoscope is a thin, flexible tube with a tiny camera. Specialized
doctors can insert the endoscope through your anus to check the health of your rectum
and colon. Common endoscopic tests include colonoscopy and sigmoidoscopy.
- X-ray. If you have severe symptoms, your provider may use a standard X-ray of your
abdominal area to rule out serious complications, such as a megacolon or a perforated
colon.
- CT scan. A CT scan of your abdomen or pelvis may be performed if a complication from
ulcerative colitis is suspected. A CT scan may also reveal how much of the colon is
inflamed.
- Computerized tomography (CT) enterography and magnetic resonance (MR)
enterography. These types of noninvasive tests may be recommended to exclude any
inflammation in the small intestine. These tests are more sensitive for finding
inflammation in the bowel than are conventional imaging tests. MR enterography is a
radiation-free alternative.

4. Explain the treatment of Ulceration Colitis.

 Medications
- Anti- inflammatory drug. These are the first line of treatment for people with
ulcerative colitis.
- 5-Aminosalicylates (Oral or Suppository). Anti-inflammatory agents to reduce
the severity of bowel symptoms in mild to moderate ulcerative colitis
- Corticosteroid. To treat severe form of ulcerative colitis, such as prednisone or
budesonide.
- Immunomodulators. These medicines include 6-mercaptopurine, azathioprine
or methotrexate. These medications help calm an overactive immune system.
- Biologics. treat moderate to severe ulcerative colitis by targeting parts of your
immune system to quiet it down. Medications like infliximab, adalimumab,
golimumab, certolizumab pegol, vedolizumab and ustekinumab are biologics.
- Janus kinase (JAK) inhibitors. To stop one of the body’s enzymes from
triggering inflammation.
- Anti- diarrheal medications (Loperamide).
- Pain relievers. For mild pain can use acetaminophen, but not ibuprofen (Advil,
Motrin IB, others), naproxen sodium (Aleve) and diclofenac sodium, which can
worsen symptoms and increase the severity of disease.
- Antispasmodics. Sometimes health care providers will prescribe antispasmodic
therapies to help with cramps.
- Iron supplements. If you have chronic intestinal bleeding, you may develop iron
deficiency anemia and be given iron supplements.

Surgery
- Proctocolectomy and ileoanal pouch (also called J-pouch surgery) is the most common
procedure for ulcerative colitis. This procedure typically requires more than one surgery,
and there are several ways to do it. First, your surgeon does a proctocolectomy a
procedure that removes your colon and rectum. Then, the surgeon forms an ileoanal
pouch to create a new rectum.

5. Explain the nursing care plan

Nursing Management
1. Monitor patient’s vital signs such as blood pressure, temperature, respiration rate, pulse
rate and oxygen saturation levels.
2. Monitor patient’s intake and output chart. Review the patient's electrolyte levels.
3. Position patient comfortably. The left side of the abdomen or the rectum often hurts in
colitis. Certain positions can worsen ulcerative colitis pain depending on which side of
the intestinal tract is inflamed.
4. Teach patient deep breathing exercise and relaxation techniques for effective pain
management.
5. Administer analgesics & anti-diarrheals medications as prescribed.
6. Educate patient to avoid triggering factors by eating a healthy and balanced diet.

Nursing Diagnosis
1. Acute pain related to persistent diarrhea as evidenced by verbal complaints of abdominal
pain.
Desired Outcome - Within hospitalization, patient will report relief from abdominal pain
with decrease in pain score level from 4/10 to 2/10.

2. Diarrhea related to inflammation of colon as evidenced by loose and watery stools.

Desired Outcome - Within hospitalization, patient will report a decrease in frequency and
urgency to less than three stools per day.

3. Risk for deficient fluid volume related to persistent diarrhea.

Desired Outcome - Within hospitalization, patient will maintain fluid and electrolyte
balance within normal limits.