3 rd most common site of new cancer cases and deaths in the United States.

RISK FACTORS:
Increasing age Family history of colon cancer or polyps Previous colon cancer or adenomatous polyps History of inflammatory bowel disease High fat, high protein(w/ high intake of beef), low

fiber diet Genital cancer or breast cancer (in women)  

PATHOPHYSIOLOGY
             

Benign polyp

Malignant

Invasion and destruction of normal tissues

Liver/other parts of the body

STAGES OF COLON CANCER

BENIG N POLYP

MALIGNA NT POLYP

NORMAL COLON

COLON W/ BENIGN POLYP

CLINICAL MANIFESTATIONS
Greatly determined by:
Location of the cancer Stage of the disease Function of intestinal segment in which it is

located

SIGNS AND SYMPTOMS
Change in bowel habits (most common) Passage of blood in the stool (second most

common) Unexplained anemia Anorexia Weight loss Fatigue

  SIGNS AND SYMPTOMS
Left-sided lesions Right-sided lesions

abdominal pain &

dull abdominal pain melena (black, tarry

cramping narrowing stools constipation distention bright red blood in the stool

stools)

Rectal lesions
tenesmus (ineffective, painful straining at stool) rectal pain feeling of incomplete evacuation after a bowel

movement alternating constipation and diarrhea bloody stool

MOST IMPORTANT DIAGNOSTIC PROCEDURES
 
Abdominal and rectal examination Fecal occult blood testing Barium enema Proctosigmoidoscopy Colonoscopy CEA (not so reliable)

COMPLICATIONS
Partial or complete bowel obstruction Intraperitoneal infection GI bleeding Bowel perforation Peritonitis

MEDICAL MANAGEMENT
IV fluids and nasogastric suction for

patients with symptoms of intestinal obstruction. Blood component therapy if there is significant bleeding Treatment includes:
Surgery to remove tumor Supportive therapy Adjuvant therapy

Staging of Colorectal Cancer: Duke’s ClassificationModified Staging System Class A: Tumor limited to muscular mucosa and submucosa Class B1: Tumor extends into mucosa Class B2: Tumor extends through entire bowel wall into serosa or pericolic fat, no nodal involvement Class C1: Positive nodes, tumor is limited to bowel wall Class C2: Positive nodes, tumor extends through entire bowel wall Class D: Advanced and metastasis to liver, lung, or bone TNM (tumor, nodal involvement, metastasis) Classification May be used to describe the anatomic extent of the primary tumor depending on:

NURSING PROCESS: THE PATIENT WITH COLORECTAL CANCER
Assessment: Health history
 Fatigue  Abdominal/rectal pain (location,

frequency, duration, association w eating or defecation)  Past and present elimination patterns  Characteristic of stool (color, odor, consistency, presence of blood/mucus  History of IBD/colorectal polyps  Family history of colorectal disease  Current medication therapy  Dietary habits (fat and fiber intake, amount of alcohol consumed)  History of weight loss

NURSING PROCESS: THE PATIENT WITH COLORECTAL CANCER
Assessment:
 Auscultating the abdomen for bowel

sounds  Palpating the abdomen for areas of tenderness, distention and solid masses  Inspection of stool specimen for character and presence of blood

NURSING DIAGNOSES
 Imbalanced nutrition, less than body requirement,

related to nausea and anorexia  Risk for deficient fluid volume related to vomiting and dehydration  Anxiety related to impending surgery and diagnosis of cancer  Risk for ineffective therapeutic regimen management related to knowledge deficit concerning the diagnosis, the surgical procedure, self-care after discharge  Impaired skin integrity related to the surgical incisions (abdominal & perianal), the formation of a stoma, and frequent fecal contamination of peristomal skin  Disturbed body image related to colostomy  Ineffective sexuality patterns related to presence of ostomy and changes in body image & self-concept.

PLANNING AND GOALS
Major goals for patient include:
 Optimal level of nutrition  Maintenance of fluid & electrolyte       

balance Reduction of anxiety Learning about the diagnosis, surgical procedure, and self-care after discharge Maintenance of optimal tissue healing Protection of peristomal skin Learning how to irrigate the colostomy and change the appliance Expressing feelings and concerns about the colostomy and the impact on himself/herself Avoidance of complications

EVALUATION
Expected Patient Outcomes: 1.Consumes a healthy diet • Avoids foods and fluids that cause diarrhea • Substitutes nonirritating foods and fluids for those that are restricted 1.Maintains fluid balance • Experiences no vomiting or diarrhea • Experiences no signs or symptoms of dehydration 1.Feels less anxious • Expresses concerns and fears freely • Uses coping measures to manage stress 1.Acquires information about diagnosis, surgical
• •

procedure, preoperative preparation, and self-care after discharge
Discusses the diagnosis, surgical procedure, and post-oprative self –care Demonstrates techniques of ostomy care

EVALUATION
5.Maintains clean incision, stoma, and perineal wound 6.Expresses feelings and concerns about self • Gradually increases participation in stoma and peristomal skin care • Discusses feelings related to changed appearance 5.Discusses sexuality in relation to ostomy and to changes

in body image 6.Recovers without complications
• • •

Is afebrile Regains normal bowel activity Exhibits no signs and symptoms of perforation or bleeding

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