CANCER COLON AND RECTUM

DEFINITION A colorectal cancer may be benign or malignant. Benign means the tumor will not spread, while a malignant tumor consists of cells that can spread to other parts of the body and damage them.

Colorectal cancer is a cancer affecting caecum, colon and rectum.

CLINICAL MANIFESTATIONIron-deficiency anemiaRectal bleedingAbdominal painChange in bowel habitsIntestinal obstruction or perforationDiarrheaConstipationVomiting

ETIOLOGYInflammatory bowel disease - chronic inflammation of all or part of your digestive tract.

Genetic mutations

3. Polyps

RISK FACTOROlder ageMale genderHigh intake of fatAlcohol or red meatObesitySmokingLack of physical exercise

PATHOPHYSIOLOGY Arise from dysplastic adenomatous polyps

The inactivation of a variety of tumour-suppressor and DNA repair genes

Along with simultaneous activation of oncogenes.

A selective growth advantage to the colonic epithelial cell

The transformation from normal colonic epithelium to adenomatous polyp

Colorectal Cancer

TREATMENT1. Surgery : colectomies for adenocarcinoma of the colon.

Colostomy- Part of the colon containing the cancer and nearby healthy tissue is removed, a stoma is created and a colostomy bag is attach to the stoma.

2. Radiotherapy and ChemotherapyChemotherapy for patient with node-positive disease.Radiation for patient with node-positive or transmural rectal cancer (pre or post op)Adjuvant therapy : chemotherapy (colon), radiation (rectum)

MEDICATION 1. Cetuximab (Erbitux)treatment of KRAS mutation-negative (wild-type), epidermal growth factor receptor (EGFR)-expressing, metastatic colorectal cancer

2. Bevacizumab (Avastin)for first-line and second-line treatment for metastatic colorectal carcinoma

INVESTIGATIONColonoscopy - Look for synchronous lesions, Alternative: air contrast barium enema (apple core lesion) + sigmoidoscopy.

2. PET scan (positron emission tomography) - helps to determine whether an abnormal area seen on another imaging test is a tumor or not.

3. CT scan - May be used if colorectal cancer has metastasized to other organs.

HEALTH EDUCATIONIncrease fibre in diet.

Decrease animal fat and red meat.

Decrease smoking.

Increase exercise and decrease BMI (body mass index).

Secondary prevention with screening.

NURSING CARE PLANNursing diagnosis : Risk for infection related to colostomy

Supporting data

Objective data : Subjective data :

Goal :

Nursing Intervention

Assess the condition of the patient such as all systems (e.g : skin, respiratory) for sign and symptoms of infection. R : Early recognition and intervention may prevent progression to more serious situation or sepsis.

2. Monitor vital signs especially temperature.R : Temperature elevation may occur (if not masked by corticosteroids or anti-inflammatory drugs) because of various factors, e.g : chemotherapy side effects, disease process, or infection. Early identification of infectious process enables appropriate therapy to be started promptly.

3. Screen or limit visitors who may have infections. Place in reverse isolation as indicated.R : Protects patient from sources of infection, such as visitors and staff who may have an upper respiratory infection (URI).

4. Emphasize personal hygiene.R : Limits potential sources of infection and or secondary overgrowth.

5. Reposition frequently, keep linens dry and wrinkle-free.R : Reduces pressure and irritation to tissues and may prevent skin breakdown (potential site for bacterial growth)

6. Promote adequate rest or exercise periods.R : Limits fatigue and encourages sufficient movement to prevent stasis complications, e.g : pneumonia and thrombus formation.

7. Stress the importance of good oral hygiene.R : Development of stomatitis increases risk of infection or secondary overgrowth.

8. Avoid or limit invasive procedures. Adhere to aseptic techniques.R : Reduces risk of contamination, limits portal of entry for infectious agent.

9. Administer antibiotics as indicated.R : May be used to treat identified infection or given prophylactically in immunocompromised patient.

10. Record and report the conditions of the patient to the doctor.R : For further intervention during hospitalization.

Evaluation :