Nursing Care of Patient With Colorectal Cancer: Presented By: H. Rufus Raj Lecturer, Acn

NURSING CARE OF
PATIENT WITH
COLORECTAL CANCER
PRESENTED BY:
H. RUFUS RAJ
LECTURER, ACN
copyright©rufusraj2010 rufusraj@hotmail.com
INCIDENCE
 4th most common cancer.
 3rd most common cause of cancer death.
 1.48,300 new cases each year.
 Most prevalent over the age of 50 years.
 The 5 year survival rate is 90% for early
cancer & localized cancers, 64% for cancers
that has spread to adjacent organs and
lymph nodes.
INCIDENCE OF COLORECTAL CANCER
BASED ON ANATOMICAL SITE
M 11%
F 13%
M 22%
F 27%
6%
M 11%
F 10%
M 25%
M 22% F 23%
F 27%
ory bowel
disease
RISK FACTORS
Age
copyright©rufusraj2010
rufusraj@hotmail.com
MISCELLANEOUS FACTORS
Alcohol
Lithocholic
acid
Exogenous
hormones
Environ
mental
factors
Virus
COMPARISION OF BENIGN & MALIGNANT
TUMOR
CHARACTERISTIC BENIGN MALIGNANT
ENCAPSULATED usually rarely
DIFFERENTIATED normally poorly
METASTASIS absent capable
RECURRENCE rare possible
VASCULARITY slight moderate to marked
MODE OF GROWTH expansive Infiltrative & expansive
CELL Fairly normal similar to parent Cells abnormal & become

CHARACTERISTICS cells more unlike parent cells
PATHOGENESIS
ation
otion
ession
ation
otion
ession
M
e
t
a
s
t
a
s
i
s
CLINICAL FEATURES
Changes in bowel habits
Blood in stool
MS
TO
Abdominal pain
MP Anorexia
SY
Flatulence
&
NS
Indigestion
IG
LS
Loss of energy
RA
Weight loss
EN
GE
COLORECTAL CANCER SITE SPECIFIC
SIGNS AND SYMPTOMS
Right colon Left colon

 Pain , cramps
 Usually asymptomatic
 Vague dull uncharacteristic
 Bright red blood coating in the
crampy abdominal pain stool
 Dark red blood in the stool
 Decrease in the caliber of the
stools
 Anemia  Change in bowel habits,
 Mass in right lower increased use of laxatives.
quadrant  Acute large bowel obstruction
causing progressive,
abdominal distension, pain,
vomiting and constipation
DIAGNOSTIC STUDIES
History & physical
examination
Digital rectal
examination
Sigmoidoscopy, colonoscopy
& barium enema
Blood tests & Stool

testing
USG, CT scan & MRI,
PET scan
DIGITAL RECTAL EXAMNATION
SIGMOIDOSCOPY
COLONOSCPY
TNM CLASSIFICATION
TUMOR
TX- primary tumor cannot be assessed
T0 -no evidence of primary tumor
Tis- carcinoma insitu
T1- tumor invades submucosa
T2- tumor invades muscularis propria
T3- tumor invades through the muscularis propria into
the subserosa, or into the nonperitonealized

pericolic or perirectal tissues.
T4- tumor perforates the visceral peritoneum and
directly copyright©rufusraj2010
invades otherrufusraj@hotmail.com
organs or strucures Contd…..
Contd…..
NODES
NX- regional lymph nodes cannot be assessed
N0- no regional lymph node metastasis
N1- metastasis in 1 to 3 pericolic or perirectal
lymph nodes
N2- metastasis in ≥ 4 pericolic or perirectal
lymph nodes
N3- metastasis in any lymph node along the
course of the named vascular tank, and or
copyright©rufusraj2010 rufusraj@hotmail.com Contd…..
Contd…..
METASTASIS
MX presence of distant of metastasis cannot be
assessed
M0 no distant metastasis
M1 distant metastasis
DUKE’S STAGING
DUKE’S STAGING DESCRIPTION
CLASSIFACATION
A Negative nodes, limitation of lesion to the mucosa
B1 Negative nodes, extension of lesion through mucosa but still

within the bowel wall
B2 Negative nodes, extension through the entire bowel wall
C1 Positive nodes, limitation of lesion to bowel wall
C2 Positive nodes, extension through the entire bowel wall
D Presence of distant, unresectable metastases
copyright©rufusraj2010
Routes of Metastasis
Direct
Lymphatic Extension
Hematogenous
morrh
toniti
psis
orati
cess
ial or
morrh
toniti
psis
orati
cess
ialbowel
te
ock
ge
or
steuction
nbowel
ation
COMPLICATIONS
ation
ock
ge
suction
n
PREVENTION AND SCREENING
Surveillance
 Identification of adenomatous polyps and removing during
colonoscopy.
Gold-Standard of care
Guidelines under National Comprehensive Cancer
Network, risk individuals should undergo flexible sigmoidoscopy
every 5 years with fecal occult blood testing annually or double
contrast barium enema are other options acceptable for
screening rather than colonoscopy every 10 years
WARNING SIGNS OF CANCER
C hange in bowel or bladder habits
Sore that does not heal
U nusual bleeding or discharge from any body

surface area
T hickening or a lump in the breast or elsewhere
I ndigestion or difficulty in swallowing
O bvious change in a mole or wart

N agging cough or hoarseness
LIFE STYLE
AND
NUTRITION
Chemoprevention
Chemoprevention is defined as the
administration of natural or synthetic
chemical agents to prevent the
initiation or promotion of events that
occur during the carcinogenesis.
Potential agents- Vit C and E , other
antioxidants, estrogen, calcium and
low fat, high fiber diet,
What is the follow-up
care for colon cancer?
The aims of follow-up are to diagnose

in the earliest possible stage
 Follow-up exams are important
 Follow-up exams include a physical
examination by the doctor, blood tests
of liver enzymes, chest x-rays, CAT
scans of the abdomen and pelvis,
colonoscopies, and blood CEA level
Contd…..
Contd…..
The American cancer society’s
recommendation for screening of
asymptomatic pt are as follows:
 for individuals over 40 an annual Digital
rectal examination.
 for individuals over 50. annual DRE plus
annual stool and flexible sigmoidoscopy
 fecal occult blood testing annually
 double contrast barium enema every 5-10
years
 colonoscopy every 10 years
MANAGEMENT
SURGICAL
THERAPY
RADIAT
CHEMO
ION
THERAP
THERAP
Y
Y
BIOLOGIC &
TARGETED
THERAPY
CHEMOTHERAPY
 Combination of 5-flurouracil plus leucovorin
and irinotecan-(for metastatic colorectal
cancer)
 Combination of 5-flurouracil plus levamisole

with or without leucovorin
 Additional agents include oxaplatin and

raltitrexed.
RADIATION THERAPY
Postoperativel Palliative
y as an measure for
adjuvant to patients with
surgery or metastatic
chemotherapy cancer
NURSING PROCESS
APPLICATION
LIST OF NURSING DIAGNOSES
i. Acute pain related to difficulty in passing stools
because of partial or complete obstruction from
tumor.
ii. Diarrhea or constipation related to altered bowel
elimination patterns- infalmmatory and proliferative
intestinal obstruction.
iii. Imbalanced nutrition less than body requirement
related to anorexia, nausea, intestinal obstruction
iv. Fear related to diagnosis of colorectal cancer,
surgical or therapeutic interventions, and possible
terminal illness.
v. Ineffective coping related to diagnosis of cancer and
side effects of treatment.
Postoperative Nursing diagnoses
 Acute pain (abdomen) related to surgical intervention.
 Disturbed body image related to presence of ostomy

as evidenced by verbalization of embarrassment.
 Risk for impaired skin integrity related to irritation

from fecal drainage around peristomal area & lack of
knowledge of skin care.
 Knowledge deficit regarding lifestyle modification with

colostomy.
PROGNOSIS
 Survival is directly related to detection and the type
of cancer involved.
 Survival rates for early stage detection is about 5

times that of late stage cancers.
 Survival rates is also directly related to the prognosis

of disease, since its level correlates with the bulk of
tumor tissue.

Nursing Care of Patient With Colorectal Cancer: Presented By: H. Rufus Raj Lecturer, Acn

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NURSING CARE OF

ENCAPSULATED usually rarely

DIFFERENTIATED normally poorly

METASTASIS absent capable

RECURRENCE rare possible

VASCULARITY slight moderate to marked

MODE OF GROWTH expansive Infiltrative & expansive

CELL Fairly normal similar to parent Cells abnormal & become

Right colon Left colon

Blood tests & Stool

the subserosa, or into the nonperitonealized

A Negative nodes, limitation of lesion to the mucosa

B1 Negative nodes, extension of lesion through mucosa but still

B2 Negative nodes, extension through the entire bowel wall

C1 Positive nodes, limitation of lesion to bowel wall

C2 Positive nodes, extension through the entire bowel wall

D Presence of distant, unresectable metastases

Sore that does not heal

U nusual bleeding or discharge from any body

T hickening or a lump in the breast or elsewhere

I ndigestion or difficulty in swallowing

O bvious change in a mole or wart

 Combination of 5-flurouracil plus levamisole

 Additional agents include oxaplatin and

 Disturbed body image related to presence of ostomy

 Risk for impaired skin integrity related to irritation

 Knowledge deficit regarding lifestyle modification with

 Survival rates for early stage detection is about 5

 Survival rates is also directly related to the prognosis

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