Ca

COLORECTA
L
Group 2
Sri Inda Rahayu 21117113
Susanti 21117115
Syarah Huda 21117117
Tia Novelia 21117119
Tias Rido Perdana 21117121
Tinti 21117123
Tuti Dwi Sofiyanti 21117125
 DEFENITION

 Colorectal Cancer otherwise known as Ca. Colon

or Colon Cancer is a form of malignancy that
occurs in the colon, rectum, and appendix
(appendix).
 To find it is needed an action which is called a
colonoscopy, while the treatment is through
surgery followed by chemotherapy.
 ETIOLOGY

 The cause of Colon cancer is unknown. Diet and reduction in circulation time in
the large intestine (front flow of stool) which includes causative factors. Foods to
avoid:
 Red meat
 Animal fat
 Fatty foods
 Fried or grilled meat and fish
 Filtered carbohydrates (example: filtered juice)
 Food to be consumed:
 Fruits and vegetables especially Craciferous Vegetables from cabbage groups
(such as broccoli, brussels sprouts)
 Whole grain of rice
 Adequate liquid, especially water
 Signs and sympthoms
The local symptoms are:
 Changes in bowel habits
 Changes in frequency of urination, decrease (constipation) or increase (diarrhea)
 Sensation such as not finished urinating, (still wants but can't get out) and changes in the diameter and size
of the stool (feces). Both are characteristic of colorectal cancer
 Changes in physical form of feces / feces
 Stool mixed with blood or bleeding from the drain hole when defecating
 Mucous faeces are blackish in color, usually associated with bleeding in the upper digestive tract
 Pain arises accompanied by nausea and vomiting during bowel movements, resulting from obstruction of
the sewage tract by the tumor mass
 There is a lump in the stomach that may be felt by the sufferer

Other symptoms arise around the location of the tumor, because cancer can grow
about the organs and tissues surrounding the tumor, such as the bladder (blood arises
in urine, air bubbles arise, etc.), the vagina (smelling vaginal discharge, excessive
mucus appears, etc). These symptoms occur later, showing the greater the tumor and
the wider the spread. The general symptoms are :
 Weight loss without obvious cause (this is the most common symptom in all types of malignancy)
 Loss of appetite
 Anemia, the patient appears pale
 Often feeling tired
 Signs and sympthoms
Symptoms of the spread are:
Spread to the liver, causing symptoms:
a. The patient appears yellow
b. Abdominal pain, more often in the upper right, around the location of the liver
c. Enlarged liver, usually seen on a physical examination by a doctor
d. Another symptom called paraneoplastik arises, associated with increased blood viscosity
due to the spread of cancer.
Levels / Staging / Stadium of Colon Cancer There are several types of staging
classifications of colon cancer, there is a classification of TNM, Dukes classification, but what
I will describe is the following classification (similar to the Dukes classification):
e. Stage 1: Cancer occurs inside the colon wall
f. Stage 2: Cancer has spread to the muscle layer of the colon
g. Stage 3: Cancer has spread to the lymph glands
h. Stage 4: Cancer has spread to other organs.
 CLINICAL MANIFESTATIONS
 Symptoms are largely determined by the location of
the cancer, the stage of the disease, and the function of
the intestinal segment where the cancer is located. The
most prominent symptom is a change in habit of
defecation.
 . Symptoms can also be anemia of unknown cause,
anorexia, or weight loss and fatigue.
Anatomical physiology

Anatomi :
1. Intestine crassum large
intestine
2. Appendix vermiformis
3. Colon transversum
4. Colon descendens
5. Colon sigmoideu

Physiology:
The main function of the
colom is the afsorvetion
obwater and electrolytest
from kimus to fom denche
feces and accumulation of
faecal material until it cenbi
removed (guyton,2008).
 PATHOPYSIOLOG

Tumors can spread through:

 Direct infiltration into adjacent structures, such as into the bladder (urinary vesica).
 Spread through lymphogenic lymph vessels to pericolone lymph glands and
mesocolones.
 Through blood flow, hematogenous is usually to the liver because the colon drains
blood back to the portal system.
Stadium in colon cancer patients according to Syamsu Hidyat
(1197) including:
1. Stage I if the presence of cancer cells is still limited to the lining of the large
intestine (mucous layer).
2. Stage II occurs when cancer cells have entered the muscle tissue under the
mucous layer.
3. In stage III cancer cells have spread to a portion of the lymph nodes that are
mostly found around the intestine.
4. Stage IV occurs when cancer cells have attacked the entire lymph gland or
even to other organs
Pathway
 COMPLICATIONS
 Tumor growth can cause partial or complete intestinal
obstruction.
 Metastases to surrounding organs, through hematogens,
lymphogens and direct spread.
 Growth and ulceration can also attack blood vessels around the
colon which cause hemorrhage.
 Intestinal perforation can occur and result in abscess formation.
 Peritonitis and or sepsis can cause shock.
 Abscess formation Formation of the fistula in the urinary
bladder or vagina.
 MANAGEMENT
 Medical management Patients with symptoms of intestinal obstruction are
treated with IV fluid and nasogastric suction. If there is bleeding that is
significant enough therapeutic components of blood can be given.
 Surgical management Surgery is the primary action for most colon and rectal
cancers, surgery can be curative or palliative.
 The type of surgery depends on the location and size of the tumor. Selected
surgical procedures are as follows.

1. Segmental resection with anastomosis (removal of the tumor and portion of the
intestine on the growth side, blood vessels and lymphatic nodes)
2. Abominoperineal resection with permanent sigmoid colostomy (removal of the
tumor and sigmoid portion and all the rectum and anal sphincter)
3.Temporary colostomy is followed by segmental resection and anastomosis and
further reanastomosis of the colostomy
4. Permanent colostomy or iliostomy (to cure unresectable obstruction lesions).
NURSING MANAGEMENT

1. Support adaptation and independence.

2. Increase comfort.
3. Maintain optimal physiological functions.
4. Prevent complications.
5. Provides information about process / disease
conditions, prognosis, and treatment needs.
EXAMINATION OF SUPPORTERS

1. Endoscopy.
2. Radiology
3. Ultrasonography (USG
4. Histopathology
5. Laboratory
6. Scan
7. Biopsy
8. Complete blood count with differential and platelet: Can show
anemia, changes in red blood cells and white blood cells: platelets
increase or decrease.
9. Chest X-ray
CLASSIFICATION and TYPE

Tumors in the colon and rectum (colorectal) or large intestine are

of two kinds,
Benign tumors are divided into:
1. Epithelial tumors, consisting of: Adenoma and Adenomatosis
2. Nonepithelial tumors, consisting of: Leomioma, Hemangioma,
and Lipoma

Malignant tumors consist of:

3. Carcinoma
4. Sarcoma
NURSING DIAGNOSIS

 Nursing diagnoses based on data analysis according to Marilynn E.

Doenges (1999), Brunner and Suddarth (2001), and Lynda Selll
Carpenito (1997).
1. Anxiety / fear is related to crisis situations (cancer)
2. Pain (acute) associated with tissue trauma and muscle spasm reflex
secondary to colon cancer.
3. Changes in nutrition less than the body's needs are related to
hypometabolic status with regard to cancer.
4. High risk of lack of fluid volume is associated with less fluid input
5. Fatigue is related to changes in body chemistry: side effects of
drugs, chemotherapy.
 NURSING
INTERVENTION
1. Anxiety / fear is related to crisis situations (cancer)
Objective: After nursing actions anxiety can be reduced or can be controlled.
Intervention:
a. Encourage patients to express thoughts and feelings.
b. Provide an open environment where patients feel safe.
c. Maintain frequent contact with patients.
d. Help the patient / person closest to recognizing fear
e. Improve calm and calm environment
 
2. Pain (acute) is associated with discontinuation of continuity of skin tissue secondary to
surgical procedures.
Objective: After nursing action is expected the patient can report maximum pain relief /
control with minimal influence.
Intervention:
a. Determine the history of pain, such as the location of pain, frequency, duration, and
intensity, and the remedial actions performed.
b. Give basic comfort actions and entertainment activities.
 NURSING INTERVENTION
c. Encourage pain management skills such as deep breathing relaxation techniques (by
pulling the breath through the nose hold up to a count of ten, then exhale softly through the
mouth while feeling), laughing, music, and therapeutic touches.
d. Pain relief / control evaluation.
 
4. Changes in nutrition less than the body's needs are related to hypermetabolic status with
regard to cancer.
Objective: After nursing action is expected the patient can demonstrate a stable body weight.
Intervention:
a. Monitor input every day.
b. Weigh your weight every day or as indicated.
c. Encourage patients to eat high-calorie and nutrient-rich diets with adequate fluid input.
d. Encourage patients to eat small but frequent meals.
e. Create a pleasant dining atmosphere.
f. Identify patients who have anticipated nausea / vomiting.
CONCLUSION

 Colon cancer is a cancer that is in the colon. Colon

cancer is the second leading cause of death in the
United States after lung cancer (ACS 1998) This
disease is a deadly disease because the disease is
often not known to a more severe extent. Surgery
is the only way to change Colon cancer.
Thank you