Colorectal Cancer Ch38 PDF

Colorectal Cancer Dr. Raed Shudifat Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Colorectal Cancer Tumors of colon and rectum 3rd most common form of new cancer cases in USA 2nd leading cause of cancer-related deaths scr...

Colorectal Cancer Dr. Raed Shudifat Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Colorectal Cancer Tumors of colon and rectum 3rd most common form of new cancer cases in USA 2nd leading cause of cancer-related deaths screening strategies have helped reduce number of deaths from colon cancer in recent years. Prevention and early screening are key to detection and reduction of mortality rates. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology and Pathophysiology More common in men actual cause : unknown predominantly (95%) adenocarcinoma (ie, arising from epithelial lining of intestine) It may start as a benign polyp but may become malignant Cancer cells may migrate away from primary tumor and spread to other parts of the body ===metastasis Most common sites of metastasis ▪ Regional lymph nodes ▪ Liver ▪ Lungs ▪ Peritoneum Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Etiology and Pathophysiology Risk Factors for Colorectal Cancer (Chart 38-9) Increasing age ▪ It is most frequently diagnosed in adults between 65 and 74 years of ag Family history of colon cancer or polyps Previous colon cancer History of inflammatory bowel disease High-fat, high-protein (with high intake of beef), low-fiber diet Genital cancer (eg, endometrial cancer, ovarian cancer or breast cancer in women) Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Chart 47-9 RISK FACTORS Cigarette smoking Family history of colon cancer (Lynch syndrome) or polyps (familial adenomatous polyposis) High consumption of alcohol High-fat, high-protein (with high intake of beef), low-fiber diet History of genital cancer (e.g., endometrial cancer, ovarian cancer) or breast cancer (in women) History of inflammatory bowel disease History of type 2 diabetes Increasing age Male gender Overweight or obesity Previous colon cancer or adenomatous polyps Racial/ethnic background: African American or Ashkenazi Jewish Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Colorectal Cancer Clinical Manifestations According to : location of cancer, stage of disease, and function of intestinal segment in which it is located. In many instances, symptoms do not develop until colorectal cancer is at an advanced stage. Usually nonspecific, do not appear until advanced changes in bowel habits. most common blood in stools Abdominal pain unexplained anemia Anorexia weight loss Weakness and fatigue Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations (Cont’d) Right-sided lesions ▪ dull abdominal pain ▪ melena (black, tarry stools). Left-sided lesions Narrow stools abdominal pain and cramping Constipation Distention Rectal bleeding (bright-red blood ) Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Clinical Manifestations (Cont’d) Rectal lesions Tenesmus (ie, ineffective, painful straining at stool) Feeling of incomplete evacuation after bowel movement Rectal pain Alternating constipation and diarrhea Bloody stool. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Colorectal Cancer Complications Partial or complete bowel obstruction. Extension of tumor and ulceration into surrounding blood vessels result in hemorrhage. Perforation Abscess formation Peritonitis Sepsis Shock Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diagnostic Studies Family history Physical examination Digital rectal examination fecal occult blood testing barium enema Proctosigmoidoscopy colonoscopy with biopsy or cytology smears CT scan or MRI Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Colorectal Cancer Medical Management Depends on stage of disease Consists of Surgery (remove tumor) Supportive therapy Adjuvant therapy include:  chemotherapy, radiation therapy immunotherapy Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Colorectal Cancer Surgical Management primary treatment for most colon and rectal cancers. type of surgery depends on location and size of tumor. Cancers limited to one site can be removed through colonoscopy. Bowel resection indicated for most class A lesions and all class B and C lesions. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Colorectal Cancer Surgery may be curative or palliative Curative surgery ▪ Cancer: localized ▪ Tumor can be resected ▪ Polypectomy during colonoscopy used to resect colorectal cancer in situ Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Colorectal Cancer Palliative surgery recommended for class D colon cancer nonresectable tumor (cancer has spread to distant sites ( liver, lungs, ovaries) Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Colorectal Cancer Surgical procedures include the following: Bowel resection with anastomosis fig. 38-7 Removal of tumor and a portion of sigmoid and all of rectum and anal sphincter with permanent sigmoid colostomy fig. 38-8 Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Colorectal Cancer colostomy surgical creation of an opening (stoma) into colon. allow intestinal contents to pass from bowel through an opening in skin of abdomen. temporary or permanent. consistency of drainage is related to placement of colostomy Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Chemotherapy indications ▪ Positive lymph nodes at time of surgery or ▪ Metastatic disease Used as ▪ Adjuvant therapy after colon resection ▪ primary treatment for nonresectable colorectal cancer Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Radiation therapy indications ▪ Used before, during, and after surgery to shrink tumor ▪ Reduce risk of tumor recurrence ▪ Palliative for metastatic cancer and unresectable tumor Intracavitary and implantable devices used to deliver radiation to site. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management Nursing Process Patient With Colorectal Cancer Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Interventions Health Promotion ▪ American Cancer Society recommends starting at 50 years of age ▪ Regular Screening tests  Yearly fecal occult blood test  Double contrast enema every 5 years  Sigmoidoscopy every 5 years  Colonoscopy every 10 years ▪ Screening for high-risk patients should begin before 50 years of age and at more frequent intervals Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing Management ProvidingPreoperative care Preparing the Patient for Surgery Providing Postoperative care ▪ Drainage and wound assessment ▪ Providing Wound Care ▪ Monitor suture line for infection ▪ Ostomy care ▪ Pain control ▪ Maintaining Optimal Nutrition Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Nursing management ProvidingEmotional support Monitoring and Managing Complications Removing and Applying the Colostomy Appliance Irrigating the Colostomy Supporting a Positive Body Image Pt teaching ▪ stoma care Stoma should be pink Dusky blue stoma indicate ischemia. Brown-black stoma indicate necrosis Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.