Shaheed Zulfiqar Ali Bhutto Medical University (CON PIMS ISLAMABAD)

COLORECTAL CANCER

Present by
Group no 5
Group members are

1. Muhammad wali ullah

2. Amjad khan

3. Lyba mansoor

4. Sonia Iqbal

5. Ammara shaukat
 OBJECTIVE

1. Anatomy And Physiology

2. Causes / Etiology
3. Clinical Manifestation/sign & symptom
4. Pathophysiology
5. Diagnose
6. Management
a. Medical Management
b. Surgical Management
7.Nursing Intervention
 DEFINITION
 Cancer is a disease in which some of the body's cells grow uncontrollably and spread to other parts of the body.

COLORECTAL CANCER
Colorectal cancer is a disease in which cancer cells grow either colon or in
rectum. The colon is the part of digestive system, normally the cells of colon and
rectum divide in a regular manner, if cells keep on dividing a mass of tissue forms tumor
that may be benign or malignant (medical encyclopedia).

• Colorectal cancer, also known as bowel cancer, colon cancer, or rectal cancer, is any cancer that affects the
colon and rectum.
• Colon cancer is a type of cancer that begins in the large intestine (colon). The colon is the final part of the
digestive tract.
• Colorectal cancer is the third most common cancer in the U.S. after the lung cancer and the second cause of
cancer-related deaths.
 ANATOMY AND PHYSIOLOGY

Colon
is 150cm long and is subdivided into
• Ascending colon
• Transverse colon
• Descending colon
• Sigmoid colon
Physiology
Water reabsorption
Absorb salt when needed

Rectum
Rectum comes from Latin word rectum intestinum
meaning straight intestine.
The rectum is a chamber that begins at the end of the large
intestine, immediately following the sigmoid colon, and ends
at the anus.
Physiology
Temporary store of feaces.
 CAUSES AND ETIOLOGY
Etiology
1. Inflammatory bowel disease like
Ulcerative colitis
Pt. with extensive colitis and for long duration are at high risk of developing colorectal cancer
Crohn’s disease is also associated with increased risk of cancer.
2. Genetic mutation Play small but very important role in etiology of colonic cancer.
a. Familial adenomatous polyposis (FAP) b HEREDITARY NON-POLYPOSIS COLORECTAL
CANCER (HNPCC)
3. Polyps are benign growth on the inner wall of colon and rectum . Colonic polyps are well
known cause of colorectal cancer.
Risk factors include
• Older age this disease is more common in people over the age of 50.
• Male sex
•  Diet High intake of fat, Sugar, Red meat ,Processed meats, low in fiber (increased fecal bile
salt-postcholeccystectomy)
•   Alcohol  
•  Obesity
• Smoking
• A lack of physical exercise
SIGN AND SYMPTOMS
STAGES OF CANCER
 PATHOPHYSIOLOGY
1. Most colorectal cancers, regardless of etiology, arise from adenomatous polyps.
Whats is polyps? A grossly visible protrusion from the mucosal proliferation.

Two types of polyps According to function

Neoplastic polyps Nonneoplastic colonic polyps
1. Adenomatous polyp they do have the 1. Hyperplastic polyps are harmless and don’t develop into cancer.
potential to become colon cancer. 2. Inflammatory polyps An inflammatory polyp is a non-cancerous
growth that develops from the tissue that lines the inside of the stomach.
3. Hamartomatous polyps these types of colon polyps are generally
noncancerous.
According to structure
1. Those without stalk are referred to as sessile.
2. Polyps with stalks are termed as pedunculated.

2. Tumor spread to the wall of colon into musculature and into lymaphatic and vascular system.
CONTINUE...…
Etiology

Begin as adenomatous polyp that arise from the mucosa lining of colon
and rectum.

Progress down from the tip of polyp through the body and stalk.

Invasive and penetrate the muscularis mucosa

Tumor cell generation occurs to the regional lymhnodes and vascular system.

Metastasis (liver, lung, peritoneum)

 DIAGNOSIS

Biopsy. A biopsy is Computed
Colonoscopy. Is Biomarker testing Blood tomography (CT or
popular the removal of a
of the tumor. Your tests. Because CAT) scan. A 
examination which small amount of
doctor may colorectal cancer CT scan takes
involve the use of tissue for recommend running often bleeds into the pictures of the inside
a colonoscopy. It examination under laboratory tests on a large intestine or of the body using x-
has tiny camera at a microscope. tumor sample to rectum, people with rays taken from
the end, attached Other tests can identify specific the disease may different angles. A
to a long tube, suggest that genes, proteins, and become anemic. A computer combines
cancer is present, other factors unique test of the number these pictures into a
which is inserted to the tumor. This of red cells in the detailed, 3-
through the anus but only a biopsy
may also be called blood, which is part dimensional image
into the colon. The can make a
molecular testing of of  that shows any
camera is able to definite diagnosis
the tumor. Results of a complete blood abnormalities or
take high quality of colorectal these tests can help count (CBC) tumors. A CT scan
images of large cancer. determine your  , can indicate that can be used to
from inside. treatment options bleeding may be measure the tumor’s
occurring size. 
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body.
MRI can be used to measure the tumor’s size
 MANAGEMENT
Medical management
Treatment for colon cancer is based largely on the stage (extent) of the cancer
1.surgery
2.chemotherapy,
3.radiation therapy
Surgery
Surgery is the removal of the tumor and some surrounding healthy tissue during an
operation. It is often called surgical resection. This is the most common treatment for
colorectal cancer.
Laparoscopic surgery. Some patients may be able to have laparoscopic colorectal
cancer surgery. With this technique, several viewing scopes are passed into the
abdomen while a patient is under anesthesia.
Colostomy for rectal cancer. Less often, a person with rectal cancer may need to have a
colostomy. This is a surgical opening, or stoma, through which the colon is connected
to the abdominal surface to provide a pathway for waste to exit the body.
 RADIATION THERAPY
Radiation therapy is the use of high-energy x-rays to destroy cancer cells. It is
commonly used for treating rectal cancer because this kind of tumor tends to recur near
where it originally started.
External-beam radiation therapy. External-beam radiation therapy uses a machine to deliver
x-rays to where the cancer is located. Radiation treatment is usually given 5 days a week for
several weeks.
Stereotactic radiation therapy. Stereotactic radiation therapy is a type of external-beam
radiation therapy that may be used if a tumor has spread to the liver or lungs.
Brachytherapy. Brachytherapy is the use of radioactive "seeds" placed inside the body. In 1
type of brachytherapy with a product called SIR-Spheres, tiny amounts of a radioactive
substance called yttrium-90 are injected into the liver to treat colorectal cancer that has
spread to the liver when surgery is not an option.
Adjuvant therapy  For rectal cancer, radiation therapy may be used before surgery, called
neoadjuvant therapy, to shrink the tumor so that it is easier to remove. It may also be used
after surgery to destroy any remaining cancer cells.
 CHEMOTHERAPY
Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the
cancer cells from growing,
dividing, and making more cells.
Chemotherapy may be given after surgery to eliminate any remaining cancer cells.
For some people with rectal cancer, the doctor will give chemotherapy and radiation
therapy before surgery to reduce the size of a rectal tumor and reduce the chance of
the cancer returning.
Many drugs are approved by the U.S. Food and Drug Administration (FDA) to treat
colorectal cancer
Capecitabine (Xeloda)
Fluorouracil (5-FU)
Irinotecan (Camptosar)
Oxaliplatin (Eloxatin)
Trifluridine/tipiracil (Lonsurf)
 NURSING MANAGEMENT
• Preparing the patient for surgery
• Providing emotional support
• Maintaining nutrition
• Providing wound care
• Monitoring and managing complications
• Supporting a positive body image
• Maintaining Fluid and Electrolyte Balance
 NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING Intervention Evaluation

SUBJECTIVE: Fatigue related
♦ Plan care to allow
I feel to altered body Short term goal After my shift of
chemistry, side
rest periods. nursing
very tired and ♦ After my shift of
weak and effects of pain nursing interventions, ♦ Schedule activities interventions, th
difficulty in and other the patient will report for periods when e patient has
swallowing medications, improved sense of patient has most able to report an
as verbalized by Chemotherapy. Energy. energy. improved sense
the patient. Long term goal ♦ Assist pt. with self- of energy.
OBJECTIVE: ♦ Administer care need.
♦ Disinterest in chemotherapy agents ♦ Provide clean and
surrounding. as ordered, provide comfort
♦ Lethargy care for the client
environment.
♦ V/S taken as receiving
follows: chemotherapy. ♦Provide medication
T: 37.3 ♦ Provide care for the on time as
P: 90 client with bowel prescribed by
R: 22 surgery. doctor’s.
BP: 120/80
THANK
YOU