COLORECTAL

CANCER
 COLORECTAL
CANCER
A tumor of the colon and rectum. Most common
gastrointestinal malignancy
Happens when cancerous cells arise in the large
intestines (colon and rectum).
Most colorectal cancers are adenocarcinomas
COLORECTAL
CANCER
COLORECTAL
CANCER
 COLORECTAL
Forms/Types CANCER
• Polyploid - ·appears as a raised, exophytic mass that
protrudes into the lumen of the colon or rectum.
• Ulcerative - Presents as a flat or depressed lesion with
ulceration at its center.
• Stenosing - Causes a constriction or narrowing of the bowel
lumen.
• Infiltrative – Spreads diffusely and invades surrounding
tissues.
 RISK FACTORS
• Age: older adults (beginning at 50)
• Sex: more common in male
• Cigarette smoking
• Family history of colon cancer (lynch
syndrome/HNPPC) or polyps (familial
adenomatous polysis)
• High consumption of alcohol
• High fat, high protein , low fiber diet
• History of genital cancer
• History of inflammatory bowel disease
 RISK FACTORS
• History of type 2 diabetes
• Increasing age
• Male gender
• Overweight or obesity
• Previous colon cancer or adenomatous
polyps
• Race/ethnic background (African American
or Ashkenazi Jewish)
 PREVENTIVE
FACTORS
• Tobacco cessation
• Physical activity
• Diet and weight reduction strategies
 SIGNS AND
SYMPTOMS
• Determined by the location of tumor and
stage of the disease
• Change in bowel habits
• Passage of blood in or on the stool
• Unexplained anemia
• Anorexia
• Weight loss
• Fatigue
 SIGNS AND
Right-sided lesion Left-sided lesion
• AsymptomaticSYMPTOMS
• Associated with obstruction
• Palpable mass • Abdominal pain
• Dull abdominal pain • Cramping
• Melena • Narrowing stools
• Constipation
Rectal lesions • Distention
• Tenesmus • Bright red blood in stool
• Rectal pain
• Feeling of incomplete evacuation
• Alternating constipation
• Diarrhea
• Bloody stool
SIGNS AND
SYMPTOMS
 ASSESSMENT AND
DIAGNOSTIC EVALUATION
• Colonoscopy - visualization of colon by inserting
colonoscope to anus. The only screening test
that can also remove precancerous polyps.

CONSIDERATIONS:
• Under general anesthesia
 ASSESSMENT AND
DIAGNOSTIC EVALUATION
• ·Fecal occult blood test – for GI bleeding
• Proctoscope – to check for obvious masses and source
of bleeding
• Laboratory studies
- CBC
- Chemistry panel
- Liver function test – to screen possible liver
metastasis
• Carcinoembryonic antigen
• ·Barium Enema – (+) is apple core sign
• Contrast CT scans of the abdomen, pelvis, and chest
 ASSESSMENT AND
DIAGNOSTIC EVALUATION
 MEDICAL AND SURGICAL
MANAGEMENT
Depends on the stage of the disease and consist of
surgery to remove tumor, supportive therapy, and
adjuvant therapy.
 SURGICAL MANAGEMENT
• Endoscopic or laparoscopic excision – for stage 0
• Laparoscopic surgery – for stage I, II, III colorectal
tumor
• Segmental resection with anastomosis
• Abdominoperineal resection with permanent sigmoid
colostomy
• Temporary colostomy followed by segmental resection
and anastomosis and subsequent reanastomasis of
colostomy
• Permanent colostomy or ileostomy for palliation of
unresected obstructing lesions
• Colonic J-pouch or construction of a coloanal reservoir
SURGICAL MANAGEMENT
 SURGICAL MANAGEMENT
Colostomy
• Where: The large intestine (colon).
• What happens: Part of the colon is brought to the surface
of the abdomen to create a stoma (an opening).
• Stool consistency: Stool is more solid and formed because
it comes from the colon.
• When is it needed: Conditions affecting the colon, like
colorectal cancer, diverticulitis, or injury to the large
intestine.
• Output bag care: Needs to be emptied less frequently
since the stool is more solid
 SURGICAL MANAGEMENT
Ileostomy
• Where: The small intestine (ileum).
• What happens: Part of the ileum is brought to the surface
of the abdomen to create a stoma.
• Stool consistency: Stool is liquid or semi-liquid because it
hasn’t reached the colon where water is absorbed.
• When is it needed?: Conditions affecting the colon and
rectum, like ulcerative colitis, Crohn’s disease, or
colorectal cancer.
• Output bag care: Needs more frequent emptying because
the stool is liquid and produced more often.
 ADJUVANT/ONGOING
• MANAGEMENT
Stage 0 or 1 do not require chemotherapy or radiation
therapy

• Stage 1 should have follow up colonoscopies 1 year

postoperatively, then in another 3 years, then every 5
years.
 ADJUVANT/ONGOING
• Stage II – notMANAGEMENT
all require adjuvant chemotherapy. But
some in this stage have mutations in their DNA
mismatch repair genes that are classified as proficient
(MMR-P).

Capecitabine (Xeloda)
- an antimetabolite chemotherapeutic drug.
- Equivalent to dual chemotherapeutic drugs 5-
fluorouracil and leucovorin.
- SE: anemia, neutropenia, fatigue, diarrhea, palmar-
plantar erythrodysesthesia
 ADJUVANT/ONGOING
• Stage III MANAGEMENT
FOLFOX
- A combination therapeutic drug of 5-fluorouracil,
leucovorin, oxaplatin
- Given IV in 2-week cycle over 6 months
- SE: the same as capecitabine plus paresthesia of the
hands and which which typically cease after therapy.
 ADJUVANT/ONGOING
MANAGEMENT
• Stage II and Stage III – should have routine follow ups

- CEA testing every 3 to 6 months for 5 years.

- CT scan annually for 3 years.
- Colonoscopy after 1 year postoperatively, then every 5
years.
 ADJUVANT/ONGOING
• Stage IV
MANAGEMENT

- The same drug prescribed to stage II and III

- Monoclonal antibodies - cetuximal, bevacizumab
- Anti-vascular endothelial growth factor (anti-VEGH)
agents – Aflibercept
- For liver metastasis – surgical resection, radiofrequency
ablation, intra-arterial chemotherapy.
 NURSING MANAGEMENT
Preoperative
- Maintain optimal nutrition
- Prevent infection
- Maintain fluid volume balance
- Preoperative education – expected appearance of the
wound, dietary restrictions, pain management
- Provide emotional support
 NURSING MANAGEMENT
Postoperative
- Monitoring TPR
- Wound care
- Detect signs of hemorrhage
- Splinting during deep breathing and coughing
THANK YOU