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03-Sep03-Sep-2010 Ns Hieu


Benign tumors of the large intestine are called polyps . The rectum is the end of the colon adjacent to the anus . Together. they form a long. Tumors of the colon and rectum are growths arising from the inner wall of the large intestine. muscular tube called the large intestine (also known as the large bowel).DESCRIPTION The colon is the part of the digestive system where the waste material is stored.

If benign polyps are not liferemoved from the large intestine. they can become malignant (cancerous) over time.DESCRIPTION Malignant tumors of the large intestine are called cancers Benign polyps do not invade nearby tissue or spread to other parts of the body. Benign polyps can be easily removed during colonoscopy and are not life-threatening. Most of the cancers of the large intestine are believed to have developed from polyps .

. cancer of the colon and rectum is the third leading cause of cancer in males and the fourth leading cause of cancer in females. It is common in the Western world and is rare in Asia and Africa. In countries where the people have adopted western diets.DESCRIPTION Globally. the incidence of colorectal cancer is increasing . The frequency of colorectal cancer varies around the world.

High fat intake 2. .DESCRIPTION #Colorectal cancer is not contagious (a person cannot catch the disease from a cancer patient) Factors that increase a person's risk of colorectal cancer include: 1. Chronic ulcerative colitis. The presence of polyps in the large intestine 4. A family history of colorectal cancer and polyps 3.

. cramps.ASSESSMENT *Symptoms of colon cancer are numerous and nonspecific * They include fatigue. red or dark blood in constipation. weakness. pain. weight loss. change in bowel habits. abdominal pain. diarrhea or constipation. narrow stools. or bloating. shortness of breath. loss. stool.

. disease can have symptoms that mimic colorectal cancer. and peptic ulcer disease. diverticulosis. ulcerative colitis. Crohn's disease.ASSESSMENT *Other conditions such as irritable bowel syndrome (spastic colon). *Symptoms vary according to where in the large bowel the tumor is located.

. Typically. abdominal pains. weakness. Therefore. and shortness of breath *The left colon is narrower than the right colon. Cancers causing partial bowel obstruction can cause symptoms of constipation. cramps. and bloating. cancers of the left colon are more likely to cause partial or complete bowel obstruction. Bright red blood in the stool may also indicate a growth near the end of the left colon or rectum. right-sided cancers cause iron rightdeficiency anemia due to the slow loss of blood over a long period of time. narrowed stool. and cancers of the right colon can grow to large sizes before they cause any abdominal symptoms.ASSESSMENT *The right colon is spacious. diarrhea. Iron deficiency anemia causes fatigue.

MYH.DIAGNOSTIC EVALUATION *Examinations of the rectum *Stool tested for hidden or "occult" blood *Blood tests are now available to test for FAP. Pelvic MRI and endorectal ultrasonography provide information about penetration and lymph node involvement. and brain may show . CT scan of the liver. and HNPCC hereditary colon cancer syndromes *Flexible sigmoidoscopies or screening colonoscopies are performed even if the stool occult blood tests are negative. lung. AFAP.

vegetables. salad dressings. non-digestible part of plant material present in nonfruits.COLLABORATIVE MANAGEMENT #Therapeutic intervention -Major sources of fat are meat. and oils used in cooking -Fiber is the insoluble. and whole-grain breads and cereals whole- -It is postulated that high fiber in the diet leads to the creation of bulky stools which can rid the intestines of potential carcinogens . dairy products. eggs.

but the cancer has penetrated deeply into the colon wall or reached adjacent lymph nodes. @ Chemotherapy in these patients may delay tumor recurrence and improve survival.Chemotherapy is the use of medications to kill cancer cells .COLLABORATIVE MANAGEMENT #Pharmacologic intervention -In some patients. . there is no evidence of distant metastasis at the time of surgery.

chemotherapy can cause hair loss. and diarrhea . vomiting. Common side effects include anemia. and a low resistance to infections. loss. loss of energy. and white blood cells are frequently affected by chemotherapy. Therefore. platelets. easy bruising. mouth sores. nausea.COLLABORATIVE MANAGEMENT -Red blood cells. Cells in the hair roots and intestines also divide rapidly.

-With radiation. the risk is lowered to approximately 7%. Side effects of radiation treatment include fatigue.COLLABORATIVE MANAGEMENT @ Radiation therapy in colorectal cancer has been limited to treating cancer of the rectum. temporary or permanent pelvic hair loss. and skin irritation in the treated areas .

in an effort to more effectively attack and control colon cancer. but who have large tumors which are causing obstruction or bleeding. a light sensitive agent is taken up by the tumor which can then be activated to cause tumor destruction . laser treatment can be used to destroy cancerous tissue and relieve associated symptoms. In patients who are poor surgical risks. Other treatments attempt to boost the immune system. the bodies' own defense system. In this treatment. Still other experimental agents include the use of photodynamic therapy.COLLABORATIVE MANAGEMENT .Such combinations can specifically seek and destroy tumor tissues in the body.

Risk for deficient fluid volume .NURSING DIAGNOSES Acute pain Anxiety Constipation Diarrhea Fatigue Imbalanced Nutrition: Less than body requirements.

frequency. occult blood. and watch for adverse reactions. consistency. and color of the stools. . Monitor the patient s dietary intake and weight. and watch for dehydration. Monitor the patient s response to radiation or chemotherapy. Monitor for excess fluid and electrolyte loss through vomiting and diarrhea.NURSING INTERVENTIONS MONITORING Monitor amount.

if the condition permits. Adjust diet before and after treatments such as chemotherapy or radiation.V. Maintain hydration through I. low residue diet for several days before surgery . or NPO as directed. bland diet . therapy and record urinary output. Serve smaller meals spaced throughout the day to maintain adequate calorie and protein intake if patient if patient is able to take nutrition orally. Serve clear liquids. Insruct the patient to take prescribed anti emetic as needed especially if receiving chemotherapy .NURSING INTERVENTIONS Supportive Care Meet the patient s nutritional needs by serving a high calorie. Metabolic tissue needs are increased and more fluids are needed to eliminate waste products.

laughter.NURSING INTERVENTIONS Supportive care ( cont. rice. such as bananas.Investigate different approaches. imaging. peanut butter and repositioning. Maintain nasogastric decompression for obstruction. such as relaxation techniques. encourage exercise and adequate fluid or fiber intake to promote bowel motility. Measure and document amount of drainage. For diarrhea related to radiation or chemotherapy ( not caused by obstruction). reading and touch for control or relief of pain. administer antidiarrheal medications and discuss foods that may slow transit time of bowel. Evaluate effectiveness of analgesic regimen. .) For constipation.

provide information and answer questions about disease process. treatment modalities and complications.) Institute an individualized activity plan after assessing the patient s activity level and tolerance.NURSING INTERVENTION Supportive Care ( cont. To minimize fear. Allow for frequent rest periods to regain energy. noting shortness of breath or tachycardia. .

and to continue teaching colostomy care. Teach and demonstrate colostomy management skills. - . and should have regular colonoscopies to look for precancerous changes in the colon lining.NURSING INTERVENTIONS EDUCATION AND HEALTH MAINTENANCE Inform patients on some recommendations: --Recently doctors are recommending screening colonoscopies for healthy individuals starting at ages 50-55 . 50Patients with a long history (greater than 10 years) of chronic ulcerative colitis have an increased risk of colon cancer. Initiate a home care nursing referral to assist with wound care and management of treatment adverse effects.

.The End . THANK YOU !! .