Colorectal Cancer

Non-Modifiable
Modifiable Factors:
Factors:
1. Diet
1. Idiopathic
2. Obesity
2. Hereditary
3. Smoking
Syndromes
4. Drug Effects
3. Family History
5. Inflammatory Bowel Disease

Stage 0. Also known as carcinoma in site, in this stage abnormal cells are
only in the inner lining of the colon or rectum.
Stage 1. The cancer has penetrated the lining, or mucosa, of the colon or Cell line mutations Classifications of tumor/ abnormal
rectum and may have grown into the muscle layer. It hasn’t spread to growth:
1. Adenoma - a benign tumor from
nearby lymph nodes or to other parts of the body.
uncontrolled cell glandular structures
Stage 2. The cancer has spread to the walls of the colon or rectum, or
division in the colon 2. Carcinoma - cancer arising from the
through the walls to nearby tissues, but hasn’t affected the lymph and rectum epithelial tissue of the skin or the
nodes. lining of internal organs
Stage 3. The cancer has moved to the lymph nodes but not to other 3. Sarcoma - cancer arising from
parts of the body. Tubular adenomas connective tissue
(pre-cancerous polyps)
Stage 4. The cancer has spread to other distant organs, such as the liver
or lungs.
develops overtime that
leads to COLORECTAL
CANCER

tumor bowel lumen tumor cells spread friable vessels supply

local growth of tumor
caliber distally tumor

metastatic disease
abdominal outside bowel
in rectum mass effect
mechanical bowel ribbon (thin) distension/ pain serosa occult bleeding and
obstruction stool vessels rupture
melena
cancer invades rectal
sphincters, muscles, host immune cells tumors develop in liver,
backed up contents compressing ureters, invades blood bowel to bowel/
vessels, and nerves compressing release cytokines to lungs, brain, hematochezia slow, chronic blood
may be regurgitated urine backs up into the vessels local organ
stomach combat cancer peritoneum, and lymph (passage of fresh blood loss depletes stores of
kidney fistulation
nodes in stool) iron
local bleeding
nausea and metabolic
obstipation tenesmus abnormalities,
vomiting hydronephrosis appetite
bowel perforation energy use acute blood loss iron deficiency anemia
rectal pain

hematochezia bowel contents

weight loss weight loss
leak

abdominal
abscess

NURSING DX (Pre-Operative) DIAGNOSTIC TESTS: MANAGEMENT:

PATIENT TEACHING
Acute Pain related to damage of the mucosa layer of NURSING DX (Post-Operative) Fecal occult blood test (FOBT) – checks for hidden blood in the Surgical management:
Teach the patient the care related to the abdominal
the colon and the rectum Acute Pain related to surgical incision stool. Sometimes cancers or polyps can bleed and this test is 1. Surgical Resection
incision and any perineal wounds. Give instructions Management per Colorectal Cancer Stages:
Imbalanced Nutrition, Less Than Body Requirements Fluid Volume deficit r/t blood lodd during used to pick up small amounts of bleeding. Have this test every 2. Laparoscopic Surgery
about when to notify the physician (if the wound 1. Stage 0 - Polepectomy (removal of the polyp) during a
related to nausea and anorexia surgery year. 3. Colostomy
separates or if any redness, bleeding, purulent colonoscopy
Risk for fluid volume deficit related to vomiting and Imbalanced nutrition les than body Flexible sigmoidoscopy – an exam where a health care provider 4. Radiofrequency ablation (RFA) or Cyroablation
drainage, unusual odor, or excessive pain is present). 2. Stage 1 - Surgical removal of the tumor and lymph
diarrhea requirements r/t surgical intervention looks at the rectum and the lower part of the colon using a
Advise the patient not to perform any heavy lifting nodes can be done
Anxiety related to cancer diagnosis and surgery Sleeping pattern disturbance r/t pain sigmoidoscope, a tube with a light on the end. Have this test Medical Management:
(10 lbs),pushing,or pulling for 6 weeks after surgery. 3. Stage 2 - Surgery is the first management, in some
planning Anxiety r/t hospitalization every 5 years. 1. Chemotherapy (5-Flouracil, Capecitabine (Xeloda),
If the patient has a perineal incision, instruct her or cases, adjuvant therapy may be recommended.
Sleeping pattern disturbance r/t pain Knowledge deficit r/t treatment process Biopsy - removal of a small amount of tissue for examination Irinotecan (Camptosar), Oxaliplatin (Eloxatin)
him not to sit for long periods of time and to use a 4. Stage 3 - treatment usually involves surgical removal
Knowledge deficit r/t treatment process under a microscope 2. Biologic and targeted therapy (two drugs target
soft or “waffle”pillow rather than a rubber ring of the tumor followed by adjuvant therapy.
Biomarker testing - identify factors and to determine treatment epithelial growth receptor factor that is Cetuximab,
whenever in the sitting position. 5. Stage 4 - treatment plan may include chemotherapy,
options Panitumumab and other drug targets vascular growth
Teach the patient colostomy care and colostomy targeted therapy, immunotherapy, surgery, and
Colonoscopy – an exam when a health care provider looks at the factor that is Bevacizumab)
irrigation. radiation therapy.
rectum and the entire colon using a colonoscope, an instrument 3. Immunotherapy (Pembrolizumab (Keytruda),
Give the following instructions for care of skin in the
NURSING INTERVENTIONS with a light on the end. If polyps are found, they can be removed. Nivolumab (Opdivo), Dostarlimab (Jemperli)
external radiation field:Tell the patient to wash the
Provide comfort measures and reassurance for patients Have this test every 5 to 10 years. 4. Radiation therapy
skin gently with mild soap,rinse with warm water,and
Have the patient wash his hands before and after meals and after going to the bathroom Double contrast barium enema (DCBE) – a series of x-rays of the
pat the skin dry each day; not to wash off the dark ink
Listen to the patient’s fears and concerns, stay with him during periods of severe stress and anxiety colon and rectum. You are first given an enema with barium in it,
marking that outlines the radiation field; to avoid
Encourage the patient to identify actions and care measures that will promote his comfort and relaxation which outlines the colon and rectum on the x-rays. Have this test
applying any lotions, perfumes,deodorants,and
Monitor the patient’s bowel patterns every 5 to 10 years (only if not having a colonoscopy every 10
powder to the treatment area; to wear nonrestrictive
Monitor the patient’s diet modification, and assess the adequacy of his nutrition intake years).
soft cotton cloth- ing directly over the treatment
Encourage fluid intake as indicated Digital rectal exam – a health care provider inserts a lubricated,
area; and to protect skin from sunlight and extreme
Administer medications as needed gloved finger into the rectum to feel for any problem areas. Have
cold.
Colostomy care (patients who undergo surgical procedures) this test every 5 to 10 years at the time of other screening tests
Explain the purpose, action,dosage,and side effects
(flexible sigmoidoscopy, colonoscopy, or DCBE).
of all medications prescribed by the physician.
MRI - used to measure the tumor's size
PET Scan and CT Scan - produces images of the internal
organs/tissue and is used to measure the tumor's size
PREVENTION Ultrasound - to find out if cancer has spread
1. Don't smoke
2. Avoid red meat
3. Get enough calcium and Vitamin D
4. Exercise
5. Genetic Counseling

FOLLOW-UP
Stress the need to maintain a schedule for follow-up
visits recommended by the physician.
Encourage patients with early-stage disease and
complete healing of the bowel to eat a diet consisting
of a low-fat and high-fiber content with cruciferous
vegetables (Brussels
sprouts,cauliflower,broccoli,cabbage).
Most colorectal tumors grow undetected as
symptoms slowly develop. Survival rates are best
when the disease is discovered in the early stages and
when the patient is asymptomatic. Unfortunately,50%
of patients have positive lymph node involvement at
the time of diagnosis. Participation in procedures for
the early detection of colorectal cancer needs to be
encouraged.
Suggest follow-up involvement with community
resources