CECEP E.
KOSASIH
The incidence increases with age (> 85 years of age)
and people with a family history of colon cancer or polyps. The exact cause of colon and rectal cancer is still unknown, but risk factors have been identified
The distribution of cancer sites
The incidence of cancer in the sigmoid and rectal areas has decreased, whereas the incidence of cancer in the cecum, ascending, and descending colon has increased
Pathophysiology
Ca colon and rectum is predominantly (95%)
adenocarcinoma. It may start as a benign polyp but may become malignant, invade and destroy normal tissues, and extend into surrounding structures. Cancer cells may break away from the primary tumor and spread to other parts of the body (most often to the liver).
Clinical Manifestations
The symptoms are determined by the location of the
cancer, the stage of the disease, and the function of the intestinal segment. change in bowel habits. blood in the stools Symptoms include unexplained anemia, anorexia, weight loss, and fatigue.
dull abdominal pain and melena (ie, black, tarry
stools). cramping, narrowing stools, constipation, and distention tenesmus (ie, ineffective, painful straining at stool), rectal pain, the feeling of incomplete evacuation after a bowel movement, alternating constipation and diarrhea
Risk Factors for Colorectal Cancer
Increasing age
Family history of colon cancer or polyps Previous colon cancer or adenomatous polyps
History of inflammatory bowel disease
High-fat, high-protein (beef), low-fiber diet Genital cancer or breast cancer (in women)
Staging of Colorectal Cancer: Dukes ClassificationModified Staging System
Class A: Tumor limited to muscular mucosa and
Submucosa Class B1: Tumor extends into mucosa Class B2 : Tumor extends through entire bowel wall into serosa or pericolic fat, no nodal involvement Class C1: Positive nodes, tumor is limited to bowel wall Class C2 : Positive nodes, tumor extends through entire bowel wall Class D: Advanced and metastasis to liver, lung, or bone
Assessment and Diagnostic Findings
fecal occult blood testing, barium enema,
proctosigmoidoscopy, and colonoscopy sigmoidoscopy with biopsy or cytology smears Carcinoembryonic antigen (CEA) With complete excision of the tumor, the elevated levels of CEA should return to normal within 48 hours. Elevations of CEA at a later date suggest recurrence
Complications
Partial or complete bowel obstruction.
Hemorrhage. Perforation,
Abscess formation,
Peritonitis Sepsis Shock
Medical Management
Surgery to remove the tumor,
Supportive therapy, and adjuvant therapy. Chemotherapy Radiation therapy Immunotherapy, or multimodality therapy
ADJUVANT THERAPY
Colon cancer is the 5-fluorouracil plus levamisole
regimen Rectal cancer are given 5-fluorouracil and high doses of pelvic irradiation. Mitomycin is also used. Radiation therapy is used before, during, and after surgery to shrink the tumor, to achieve better results from surgery, and to reduce the risk of recurrence.
SURGICAL MANAGEMENT
Cancers limited to one site colonoscope.
Laparoscopic colotomy with polypectomy. the neodymium/yttriumaluminum- garnet (Nd:YAG)
laser. Bowel resection is indicated for most class A lesions and all class B and C lesions. Surgery is sometimes recommended for class D colon cancer, goal is palliative; if the tumor has spread and involves surrounding vital structures, nonresectable
Surgical procedures
Segmental resection with anastomosis.
Abdominoperineal resection with permanent sigmoid
colostomy Temporary colostomy Permanent colostomy or ileostomy Construction of a coloanal reservoir.
NURSING PROCESS: THE PATIENT WITH COLORECTAL CANCER
Assessment
Diagnosis Planning and Goals
Intervention
Evaluation
Assessment
health history about fatigue, abdominal or rectal pain
(eg, location, frequency, duration, association with eating or defecation), past and present elimination patterns, and characteristics of stool (eg, color, odor, consistency, presence of blood or mucus). history of colorectal polyps, a family history of colorectal disease, and current medication therapy.
identifies dietary habits, including fat and fiber intake,
as well as amounts of alcohol. history of weight loss. includes auscultating for bowel sounds and palpating for areas of tenderness, distention, and solid masses. Stool specimens are inspected for character and presence of blood.
NURSING DIAGNOSES
Imbalanced nutrition, less than body requirements, related to nausea
and anorexia Risk for deficient fluid volume related to vomiting and dehydration Anxiety related to impending surgery and the diagnosis of cancer Risk for ineffective therapeutic regimen management related to knowledge deficit concerning the diagnosis, the surgical procedure, and self-care after discharge Impaired skin integrity related to the surgical incisions (abdominal and perianal), the formation of a stoma, and frequent fecal contamination of peristomal skin Disturbed body image related to colostomy Ineffective sexuality patterns related to presence of ostomy and changes in body image and self-concept
COLLABORATIVE PROBLEMS/ POTENTIAL COMPLICATIONS
Intraperitoneal infection
Complete large bowel obstruction GI bleeding
Bowel perforation
Peritonitis, abscess, and sepsis
Planning and Goals
attainment of optimal level of nutrition; maintenance of fluid and electrolyte balance; reduction of anxiety; learning about the diagnosis, surgical
procedure, and self-care after discharge; maintenance of optimal tissue healing; protection of peristomal skin; learning how to irrigate the colostomy and change the appliance; expressing feelings and concerns about the colostomy and the impact on himself or herself; avoidance of complications.
PREPARING THE PATIENT FOR SURGERY PROVIDING EMOTIONAL SUPPORT PROVIDING POSTOPERATIVE CARE MAINTAINING OPTIMAL NUTRITION PROVIDING WOUND CARE MONITORING AND MANAGING COMPLICATIONS REMOVING AND APPLYING THE COLOSTOMY APPLIANCE IRRIGATING THE COLOSTOMY SUPPORTING A POSITIVE BODY IMAGE
