nursing management of colorectal cancer

1. Colorectal cancer
BY- BABLI SHAMA
M.SC 1ST YEAR(MSN)
NETAJI SUBHASH COLLEGE OF NURSING
PALAMPUR

2. Learning Objectives
 Anatomy review
 Introduction & definition
 Incidences & Epidemiology
 Risk factors
 Pathophysiology
 Stages of disease
 Sign and symptoms
 Diagnostic procedures
 Medical management
 Surgical management
 Nursing management
 Prognosis
 Prevention and health education

3. Anatomy

4. Anatomy
The colon makes up the first 5 to 6 feet of the large
intestine, and the rectum makes up the last 6 inches,
ending at the anus .The colon and rectum have 5 sections.
The ascending colon is the portion that extends from a
pouch called the cecum to the portion of the colon that is
near the liver.

5. Anatomy
 The cecum is the beginning of the large intestine
into which the small intestine empties .it’s on the
right side of the abdomen. The transverse colon
crosses the top of the abdomen. The descending
colon takes waste down the left side. Finally, the
sigmoid colon at the bottom takes waste a few
more inches, down to the rectum. Waste leaves the
body through the anus

6. introduction
 Colorectal cancer can begin in either the colon or the rectum. Cancer that
begins in the colon is called colon cancer. Cancer that begins in the rectum is
called rectal cancer. Most colon and rectal cancers are a type of tumor called
adenocarcinoma, which is cancer of the cells that line the inside tissue of the
colon and rectum. This section specifically covers adenocarcinoma. Other
types of cancer that occur far less often but can begin in the colon or rectum
include neuroendocrine tumor of the gastrointestinal tract, gastrointestinal
stromal tumor (GIST), small cell carcinoma, and lymphoma.

7. Colorectal cancer
 Definition -
Malignant growth of tumour that begins from the inner wall
of colon or rectum, can also involve the anal canal

8. Incidences
 The colorectal cancer is a third most common cancer case in the India
. Incidence is increased with age and is higher in the people with
family history of colorectal Cancer , men having higher risk than
women.
 The annual incident rate in women is being 3.9 per 1 lakh population
of colon cancer and in men 4.6 and 4.1 per 1 lakh population of
colon and rectal cancer.
 90% CRCcases detected in people older than 50 years.
 CRC effect 1 in 500 to 2000 people globally

9. Risk Factors
 Age
 Diet
 Polyp
 Personal medical history
 Family medical history
 Genetic factors
 Inflammatory bowel disease

10. Colorectal Polyps
 Colorectal cancer most often begins as a polyp, a noncancerous growth that may
develop on the inner wall of the colon or rectum as people get older. If not treated
or removed, a polyp can become a potentially life-threatening cancer. Finding and
removing precancerous polyps can prevent colorectal cancer. There are several
forms of polyps. Adenomatous polyps, or adenomas, are growths that may
become cancerous. They can be found with a colonoscopy

11. Pathophysiology

12. Pathophysiology

13. Distribution of colorectal cancer

14. Staging of colorectal cancer

15. Staging of colorectal cancer

16. Staging of colorectal cancer

17.  A change in bowel habits ,Diarrhea, constipation, or feeling
that the bowel does not empty completely
 Bright red or very dark blood in the stool
 Stools that look narrower or thinner than normal
 Discomfort in the abdomen, including frequent gas pains,
bloating, fullness, and cramps
 Weight loss with no known explanation
 Constant tiredness or fatigue
 Unexplained iron-deficiency anemia, which is a low number of
red blood cells
Sign and Symptoms

18. Sign and Symptoms

19.  History and physical examination
 Abdominal and rectal examination
 Blood test – CBC , CEA(carcinoembryonic antigen)
 CT SCAN
 MRI
 Ultrasound
 PET CT (positron emission tomography )
 Biomarker testing of tumor
 Biopsy
 Colonoscopy
 Double contrast barium enema
Diagnostics procedures

20. Colonoscopy

21. Treatment of CRC
 Treatment of cancer depends on location , site and stage
of cancer such as –
 Surgery
 Radiation
 Chemotherapy
 Targeted molecular therapy

22. Treatment of CRC (surgery)
 Local excision - removing cancer without cutting through
abdominal wall . Put a tube through rectum into the colon .
 Anastomosis - part of colon containing the cancer and
nearby healthy tissue you are removed and then cut end of
colon are joint.

23. Treatment of CRC
 Colostomy- part of colon containing the cancer and
nearby healthy tissue are removed .A stoma is created and
colostomy bag is attached to stoma.

24. Treatment of CRC
Chemotherapy use drugs to stop the growth of cancer cell
-killing the cells
-stopping them from dividing
Types of chemotherapy
1. systematic chemotherapy- taken orally or intravenously
2. regional chemotherapy- placed directly into the spinal
column ,an organ or body cavity
chemotherapy

25. Treatment of CRC
Radiations
high energy x-ray to kill cancer cells or keep them from growing.
Local therapy affect the cancer cell only in treated area.
1.External Radiation therapy- uses a machine outside the body to send
the radiation toward the cancer
2.Internal Radiation therapy -uses radioactive substances sealed in
needle or catheter that are placed directly into or near the the cancer.

28. Nursing management
 PRE-OPERATIVE NURSING MANAGEMENT :-
 Assessment.
 Nursing diagnosis :-
 Acute pain related to damage of mucosa layer of the colon and rectum
 Fluid volume deficit related to increased intestinal movement.
 Imbalanced nutrition less than body requirement related to disease process.
 Sleeping pattern disturbance related to pain.
 Anxiety related to hospitalization.
 Knowledge deficit related to treatment process. o Intervention.

29. Nursing management
 POST-OPERATIVE NURSING MANAGEMENT :-
Nursing diagnosis :-
 Acute pain related to surgical incision.
 Fluid volume deficit related to blood loss during surgery.
 Imbalance nutrition less than body requirement related to surgical intervention.
 Sleeping pattern disturbance related to pain.
 Anxiety related to hospitalization.
 Knowledge deficit related to treatment process. o Intervention

30. PREVENTION OF COLORECTAL CANCER
 Take an occasional aspirin
 Don’t smoke
 Avoid red meat
 Get enough calcium and vitamin D
 Exercise.
 Genetic counselling.

31. Bibliography
 Brunner & Suddarth, “Textbook of Medical Surgical Nursing”,
12th edition,2014, vol-I, Wloters kluwer,New delhi, Page no-
1098-1107.
 Lewis, “ Medical Surgical Nursing”, 2014 edition, New delhi,
South asian publication, Page no – 1075-1088.
 Lippincott, “Manual of Nursing Practice”, 10th edition, 2014,
Wloter kluwer, New delhi Page no- 705-708.