Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City 2700 Ilocos Sur

COLORECTAL CANCER
ANATOMY VIEW OF THE COLORECTAL
 DEFINITION:
COLERECTAL CANCER

• Colorectal cancer, also known as bowel

cancer, colon cancer, or rectal cancer, is any
cancer that affects the colon and rectum.
• Colorectal cancer is a type of cancer that
happens when cells of the colon or rectum
divide uncontrollably.
• This usually begins as polyps, which are small
growths of tissue in the the colon. Most of
them are not cancerous, but some may grow
out of control and become cancerous.
STAGE OF COLERECTAL CANCER

• Stage 0: This is called cancer in situ. The cancer cells are

only in the mucosa, or the inner lining, of the colon or
rectum.
STAGE OF COLERECTAL CANCER

• Stage I: The cancer has grown through the mucosa and has
invaded the muscular layer of the colon or rectum. It has not
spread into nearby tissue or lymph nodes (T1 or T2, N0, M0).
STAGE OF COLERECTAL CANCER

• Stage IIA: The cancer has grown through the wall of the

colon or rectum but has not spread to nearby tissue or to
the nearby lymph nodes (T3, N0, M0).
STAGE OF COLERECTAL CANCER

• Stage IIIA: The cancer has grown through the inner lining or into the muscle layers of
the intestine. It has spread to 1 to 3 lymph nodes or to a nodule of tumor cells in tissues
around the colon or rectum that do not appear to be lymph nodes but has not spread to
other parts of the body (T1 or T2, N1 or N1c, M0; or T1, N2a, M0).
STAGE OF COLERECTAL CANCER

• Stage IVA: The cancer has spread to a single distant part of

the body, such as the liver or lungs (any T, any N, M1a).
 DIAGNOSTIC:
COLERECTAL CANCER

If your signs and symptoms indicate that you could have colon cancer, your
doctor may recommend one or more tests and procedures, including:
• Using a scope to examine the inside of your colon
(colonoscopy). Colonoscopy uses a long, flexible and slender tube attached
to a video camera and monitor to view your entire colon and rectum. If any
suspicious areas are found, your doctor can pass surgical tools through the
tube to take tissue samples (biopsies) for analysis and remove polyps.
• Blood tests. No blood test can tell you if you have colon cancer. But your
doctor may test your blood for clues about your overall health, such as
kidney and liver function tests.
• Your doctor may also test your blood for a chemical sometimes produced by
colon cancers (carcinoembryonic antigen, or CEA). Tracked over time, the
level of CEA in your blood may help your doctor understand your prognosis
and whether your cancer is responding to treatment
 STATISTICS OF COLORECTAL CANCER

• Colorectal cancer is the 3rd most common cancer worldwide.

• Colorectal (also known as bowel) cancer is the 3rd most common cancer worldwide. It is the 3rd most
common cancer in men and the 2nd most common cancer in women.
• There were more than 1.9 million new cases of colorectal cancer in 2020.
• The burden of colorectal cancer is highest in Asia, where more than half of all cases and deaths are
recorded.
• China alone accounts for more than half a million new cases and more than 280 000 deaths per year.
• Japan records the second highest number of deaths from colorectal cancer, almost 60 000 per year.
• According to the World Health Organization (WHO), colorectal cancer is the fourth leading cause of
cancer-related death worldwide and accounted for 608,000 deaths, affecting mostly individuals over
50 years of age. In the Philippines, colorectal cancer ranks fourth among the cancer-related deaths of
Filipinos. According to the Philippine Cancer Society, Inc., almost 75 percent of the individuals affected
were aged 50 and above while only about three percent were children 14 years old and below. It is
estimated that one out of 1800 Filipinos will develop the cancer yearly.
STATISTICS OF COLORECTAL CANCER
 RISK FACTORS
• These characteristics may increase the risk of developing colorectal
cancer:

• Age—Colorectal cancer cases are increasing in people younger than

age 64, and increasing even faster for those younger than 50
RISK FACTORS

• Race and ethnicity—Colorectal cancer diagnosis and deaths are

highest among non-Hispanic African Americans.
RISK FACTORS

• Certain health conditions—Inflammatory bowel disease (IBD, including

ulcerative colitis or Crohn's disease), Gardner syndrome or type 2 diabetes
• Family health history
RISK FACTORS

• Diet: The risk is higher for those who eat a high-fat diet, a lot of processed meat or red meat.
• Drinking: Moderate to heavy alcohol consumption, and even light to moderate drinking
• Weight: The risk for colorectal cancer is higher for people who are overweight or obese, especially for men.
• Activity level: People who spend a lot of the day sitting or lying down may be more likely to develop colorectal
cancer.
RISK FACTORS

• Smoking
RISK FACTORS

• Preventive medications: Taking aspirin or other nonsteroidal anti-

inflammatory drugs (NSAIDs) regularly and for a long-term period
SIGNS AND SYMPTOMS

A change in bowel habits, such as diarrhea,

constipation, or narrowing of the stool, that lasts
for more than a few days
 SIGNS AND SYMPTOMS

A feeling that you need to have a bowel movement

that is not relieved by having one
 SIGNS AND SYMPTOMS

• Rectal bleeding with bright red blood

• Blood in the stool, which might make it look

dark brown or black
SIGNS AND SYMPTOMS

• Cramping or abdominal (belly) pain

• Weakness and fatigue
• Losing weight without trying
 INTERVENTION

1. Monitor intake and output.

 Diarrhea can cause dehydration. Monitoring the patient’s intake and output can help monitor the patient’s fluid status and prevent
dehydration.

2. Encourage fluid intake as indicated.

 Adequate fluid intake can improve bowel consistency and promote hydration.

3. Refer the patient to a dietitian.

 Colorectal cancer patients may need specialized meals to help ensure adequate dietary intake and facilitate recovery. Some foods may
need to be avoided to reduce gastric irritability.

4. Encourage perianal skin care.

 Diarrhea can cause altered skin integrity in the perineal/rectal area. Instruct on proper cleaning and comfort with the use of medicated
or wet wipes and barrier creams.

5. Administer medications as needed.

 Antidiarrheal medications are prescribed to help relieve symptoms of diarrhea.
 PREVENTION
 Get screened for colorectal cancer. Screenings are tests that look for cancer before signs and
symptoms develop. These tests can find colon or rectal cancer earlier, when treatments are more
likely to be successful. Some colorectal screening tests can also find and remove precancerous
growths (polyps) in the colon or rectum.
 Managing your body weight. Being overweight or obese increases your risk of getting and dying
from colon or rectal cancer. Eating healthier and increasing your physical activity can help you
control your weight.
 Being physically active. Adults should get 150 to 300 minutes of moderate-intensity physical
activity per week or 75 to 150 minutes of vigorous-intensity physical activity, or a combination
of these. Children and teens should get at least 1 hour of moderate- or vigorous-intensity activity
every day.
 Managing your food choices. A diet rich in fruits and vegetables and low in red meat may help
reduce the risk of colorectal cancer. Some studies have also found that people who take calcium
and vitamin D supplements have a lower risk of colorectal cancer
 PREVENTION

 Don’t smoke. People who have been smoking for a long time are more likely than people who
don't smoke to develop and die from colon or rectal cancer.
 Limit alcohol – Zero is best. Alcohol use has been linked with a higher risk of colorectal
cancer.  But if you do, the American Cancer Society recommends no more than 2 drinks a day
for men and 1 drink a day for women. A single drink equals 12 ounces of beer, 5 ounces of
wine or 1½ ounces of 80-proof distilled spirits (hard liquor).
 TREATMENT
Chemo may be used at different times during treatment for colorectal cancer:

 Adjuvant chemo is given after surgery. The goal is to kill cancer cells that might have been left
behind at surgery because they were too small to see, as well as cancer cells that might have
escaped from the main colon or rectal cancer to settle in other parts of the body but are too
small to see on imaging tests. This helps lower the chance that the cancer will come back.
 Neoadjuvant chemo is given (sometimes with radiation) before surgery to try to shrink the
cancer and make it easier to remove. This is often done for rectal cancer.
 For advanced cancers that have spread to other organs like the liver, chemo can be used to help
shrink tumors and ease problems they're causing. While it's not likely to cure the cancer, this
often helps people feel better and live longer.).
TREATMENT
Radiation therapy
Radiation therapy uses powerful energy sources, such as X-rays and protons, to kill cancer
cells. It might be used to shrink a large cancer before an operation so that it can be removed
more easily.
When surgery isn't an option, radiation therapy might be used to relieve symptoms, such as
pain. Sometimes radiation is combined with chemotherapy.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells. By
blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
Targeted drugs are usually combined with chemotherapy. Targeted drugs are typically
reserved for people with advanced colon cancer.
URGICAL INTEVENTION
Surgery for early-stage colon cancer
If your colon cancer is very small, your doctor may recommend a minimally invasive approach to surgery,
such as:

• Removing polyps during a colonoscopy (polypectomy). If your cancer is small, localized, completely
contained within a polyp and in a very early stage, your doctor may be able to remove it completely during a
colonoscopy.
• Endoscopic mucosal resection. Larger polyps might be removed during colonoscopy using special tools to
remove the polyp and a small amount of the inner lining of the colon in a procedure called an endoscopic
mucosal resection.
• Minimally invasive surgery (laparoscopic surgery). Polyps that can't be removed during a colonoscopy may be
removed using laparoscopic surgery. In this procedure, your surgeon performs the operation through several
small incisions in your abdominal wall, inserting instruments with attached cameras that display your colon on
a video monitor. The surgeon may also take samples from lymph nodes in the area where the cancer is located.
URGICAL INTEVENTION
Surgery for more advanced colon cancer
Surgery for early-stage colon cancer
If the cancer has grown into or through your colon, your surgeon may recommend:

• Partial colectomy. During this procedure, the surgeon removes the part of your colon that contains the cancer, along
with a margin of normal tissue on either side of the cancer. Your surgeon is often able to reconnect the healthy
portions of your colon or rectum. This procedure can commonly be done by a minimally invasive approach
(laparoscopy).
• Surgery to create a way for waste to leave your body. When it's not possible to reconnect the healthy portions of
your colon or rectum, you may need an ostomy. This involves creating an opening in the wall of your abdomen from
a portion of the remaining bowel for the elimination of stool into a bag that fits securely over the opening.
• Sometimes the ostomy is only temporary, allowing your colon or rectum time to heal after surgery. In some cases,
however, the colostomy may be permanent.
• Lymph node removal. Nearby lymph nodes are usually also removed during colon cancer surgery and tested for
cancer.
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