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TOPIC: Colon Cancer

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by

Imaris Vera

on 29 January 2015

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Transcript of TOPIC: Colon Cancer


CLINCAL GROUP: St. Frances

Colon
Cancer

Christine Arjona
Sarah Darwursk
Kailee Hass
Sandi Hucker
Linda Song
Imaris Star Vera
Anna Zilberfayn
Statistics
Statistics
Fun/Interesting Facts
Pathophysiology
Etiology
Cultural Considerations
Health Promotion: PREVENTION
Health Promotion: SCREENING
Health Promotion: DETECTION
Clinical Manifestations
Diagnostic Procedures
Medical Management: SURGERY
Medical Management: Chemotherapy
Medical Management: Radiation
Nursing Management
Nursing Management continued
Colostomy Care: Stoma Care
Colostomy Care: Ostomy Pouches
Colostomy Care
FIN
- Usually asymptomatic until it is advanced
- Most types of colon cancer grow very slowly, taking up to 10 years before symptoms are present & even those symptoms are vague & often misdiagnosed
- Symptoms will depend mostly on location of tumor & its stage of growth

o Most common symptoms are:
• Change in bowel habits (constipation, diarrhea)
• Change in caliber of stools

o Symptom that causes the most alarm is blood in stool
o As the disease progresses, there may be weight loss, fatigue, abdominal pain, & anorexia
Clinical Manifestations Continued
- Ascending:
o Usually asymptomatic
o Because they're bulky tumors, one can usually can palpate the mass
o Tend to develop necrotic areas & ulcerate, contributing to slow blood loss & anemia
o Pain is usually a late sign

- Descending
o Small and button-like
o Rather than growing along the wall, they grow around the circumference of the wall and they spread around the entire bowel wall so obstruction is common
o Constipation is a predominant symptom because the bowel lumen becomes smaller

Linda
Sarah
Sarah
Sarah
Anna
Anna
Anna
Sandi
Sandi
Sandi
Linda
Imarís
- The lifetime risk of developing colorectal cancer is about 1 to 20 (5%) and lower in women than in men.
- The American Cancer Society predicts the number of colorectal cancer cases in the United States in 2015 will be:
→ 93,090 new cases of colon cancer
→ 39, 610 new cases of rectal cancer
→ 49,700 deaths
Kailee
• Should look pink and moist
• May initially be swollen, up to 6wks
• Shouldn’t be uncomfortable
o Replace the pouch if stinging
o Notify physician if continued discomfort

Kailee
• Empty when 1/3-1/2 full
o If you don’t it may leak
• There are 1 or 2 piece pouches
• Change every 3-4 days
• Steps to empty
o Wash hands with soap and water
o Put patient in semi-reclined position
o Drape a towel over lower abdomen
o Remove pouch and skin barrier by pushing the skin away
o Cleanse peristomal skin with a wet washcloth
o Measure stoma, trace the pattern, and cut the opening on the skin barrier
o Apply and hold hand over the attachment to allow securement
Seek medical care if:
• Change in color/size of stoma
• Bloody stools/bleeding of the stoma
• Abdominal pain, nausea, vomiting, or bloating
• Redness/irritation around the stoma
• No stool production or diarrhea
Kailee
Diagnostic Procedures
Imarís
• Go to a doctor if you have any colon cancer symptoms
• If you're 50 or older, schedule a colon cancer screening
• Eat a balanced diet
• Maintain a healthy weight
• Maintain an active lifestyle
• Consider genetic counseling
• Learn your family medical history
• Talk to a doctor about your personal medical history
• Don't smoke
• Reduce radiation exposure
Common signs and symptoms of colon cancer include:
• A change in bowel habits
--> Such as: Diarrhea, constipation, vomiting or feeling that bowels haven't emptied completely.
• Blood
--> Can either be bright red or very dark (in the stool)
• Stools that are narrower than usual
• General abdominal discomfort
--> Such as: frequent gas pains, bloating, fullness, &/or cramps.
• Weight loss with no known reason
• Constant tiredness (fatigue)
Diagnostic Procedures
Imarís
Precancerous cells- begin as
polyps
–Most polyps are benign, nearly all colon cancers begin as polyps
–Benign to malignant *most begin
adenocarcinoma
Pathophysiology Continued
Anna
Sigmoid and Rectum most common location for adenocarcinomas (cancer forms in mucus secreting gland).
Adenocarcinomas- most common type (95%)
Pathophysiology cont.
Anna
HNPCC- Hereditary Nonpolyposis Colon Cancer aka “Lynch Syndrome”
More common on the Right side-->
DNA mutation
APC
(adenomatous polyposis gene)
Anna
Pathophysiology: UP CLOSE & PERSONAL
Genetic factors (greatest correlation)
Environmental exposures- low fiber, high fat diet, increased red meat consumption
Inflammatory conditions of digestive tract
-Ulcerative colitis/ Crohn’s disease have higher risk
Majority are adenocarcinomas
-Rectum and Descending sigmoid colon
Progression premalignant lesion (adenoma) to invasive adenocarcinoma
Deficient DNA mismatch repair (mutate genes)
- “Lynch Syndrome” Right sided colon cancer
Tumor suppression genes
- DNA methylation (activate oncogenes)
- KRAS oncogene
Etiology
Anna
Smoking
Tobacco is the most deadly carcinogen
GI tract begins in the mouth [patient education]
More than 1 drink a day of alcohol
Higher risk of colon cancer

African Americans have a greater risk of colon cancer than people of other races
-32% higher death rate in AA than Caucasians males
-16% higher for females
Ashkenazi Jews have higher rate among Caucasians
Majority of people diagnosed are >50 yrs old
Socioeconomic factors
–Healthcare insurance for screening for early detection
Flexible sigmoidoscopy
Double-Contrast Barium Enema
Virtual (CT Colonography) & traditional Colonoscopies
Guaiac-based FOBT
Stool DNA test
Surgery
• Main treatment
• Piece of the colon or rectum with the tumor is removed and the ends are sewn back together
• Examples: colectomy, segmental resection, low anterior resection, and protectomy with colo-anal anastomosis
• Colostomy- An abdominoperineal (AP) resection is a surgery for rectal cancer where one end comes out to form a colostomy.
• Ileostomy- the end of the small intestine
• Colonoscopy- removing the polyp completely
Christine
• The use of drugs to fight cancer
• Used to help relieve symptoms of advanced cancer and help some people live longer
• Chemo before surgery: to shrink the cancer and make the surgery easier
• Chemo after surgery: to lower the chance of the cancer coming back
• Chemoradiation: helps the radiation to work better
• Regional chemotherapy: chemo drugs are put into an artery leading to the tumor
o Fewer side effects
o Sometimes used for colon cancer that has spread to the liver
Radiation
• The use of high-energy rays (x-rays) to kill cancer cells or shrink tumors
• Before surgery: used to shrink the tumor
• After surgery: used to kill any cancer cells that may have been left behind (but couldn’t be seen)
• For people who can’t have surgery: used to help control rectal cancers in people who are not healthy enough for surgery.
• For advanced cancers: used to ease symptoms of advanced cancer, such as intestinal blockage, bleeding, or pain; used to treat colon cancer that has spread (bones or the brain)

Types of radiation treatment
• External beam radiation*- radiation is focused on the cancer from a machine outside the body
• Endocavitary radiation therapy- given to the rectum with a small device that is placed through the anus and into the rectum
• Brachytherapy- the placement of small pellets or seeds of radioactive material into a tube or container so that they are next to or right into the cancer

Christine
• Pre-Operative:
o Ensure valid consent for the procedure
o Assess the client & family understanding about the procedure, clarification & call for an interpreter as needed; Patient education is key.
o Provide instructions on what to expect during the postoperative period: pain management, hose fitting NGT / IVFD, breathing exercises, reintroduction of oral intake of food and fluids
o Bowel preparation procedure- to cleanse the colon and reduce the risk of peritoneal contamination by intestinal contents during surgery [GoLytely]
Post-Operative Nursing care of Patient
o Monitor vital signs, I/O including gastric and other drainage from the wound drain, assess bleeding from abdominal and perineal incision, colostomy, or anus, and valuation of the other wound complications and maintain the integrity of psychology
• Monitor bowel sounds, abdominal distension degrees and signs of ileus
• Provide pharmaceutical pain management
• Provide comfort and decrease skin complications with position changes
• Assess respiratory status, prop abdomen with a blanket or pillow to help cough
• Assess the position and patency of NGT, linkage suction. When folded hoses, irrigation with sterile saline carefully.
• Assess the color, number, and the smell of drainage and colostomy (if any) noted various changes or clot or bleeding bright red.
• Giving antacid, histamine 2 receptor antagonists and antibiotic therapy is recommended
• Encourage ambulation to stimulate peristaltic
• Provide education and discharge planning.

Endoscopic Biopsy
Gives a definitive diagnosis

Barium Enema
Visualization of the colon from outside the body. *If a polyp or mass is detected, a colonoscopy will be done. Less sensitive than colonoscopy for detecting small polyps and cancers.

Nursing Actions:
Administer a laxative after procedure as barium could harden in the intestine.
Fecal Occult Blood Testing (FOBT)
Tests for tiny amount of blood (not visible to the naked eye) in feces
Two types:
1. Guaiac (gFOBT)
Uses the Chemical guaiac to detect heme
2. Fecal Immunochemical (iFOBT)
Uses antibodies to detect hemoglobin protein

Nursing Actions for FOBT:
Stool samples are collected by the patient, using a kit, and returned to the physician.

Do not use stool from a digital rectal exam

Instruct patient not to consume red meat, anti-inflammatory medications, and vitamin C for 48 hours prior to testing.
Colonoscopy/Sigmoidoscopy
Allows for visualization of polyps or lesions

CT Scan
Allows for visualization of lesions. CT guided colonoscopy is more accurate

Nursing Actions:
Instruct patient to be on a clear liquid diet then NPO after midnight. As well as any bowel preparation the physician orders.
It is common for patients to have a negative feeling about Colon CA screenings such as colonoscopies.
This is an opportunity for pertinent patient education and teaching
Try you best to make them feel comfortable about it.
Christine
Sarah
Linda
References

Bains, M., Munir, F., Yarker, J., Bowley, D., Thomas, A., Armitage, N., & Steward, W. (2012). The impact of colorectal cancer and self-efficacy beliefs on work ability and employment status: a longitudinal study. European Journal Of Cancer Care, 21(5), 634-641.

Consedine, N. S., Reddig, M. K., Ladwig, I., & Broadbent, E. A. (2011). Gender and Ethnic Differences in Colorectal Cancer Screening Embarrassment and Physician Gender Preferences. Oncology Nursing Forum, 38(6), E409-E417.

Éva, J., Katalin, H., & Mária, G. (2012). Imaging the Adverse and Late Effects in the Treatment of Colorectal Cancer. Acta Medica Marisiensis, 58(4), 239-242.

Grant, M., McMullen, C. K., Altschuler, A., Mohler, M. J., Hornbrook, M. C., Herrinton, L. J., & ... Krouse, R. S. (2011). Gender Differences in Quality of Life Among Long-Term Colorectal Cancer Survivors With Ostomies. Oncology Nursing Forum, 38(5), 587- 596.

Green, B. B., Coronado, G. D., Devoe, J. E., & Allison, J. (2014). Navigating the Murky Waters of Colorectal Cancer Screening and Health Reform. American Journal Of Public Health, 104(6), 982-986.

Hoverman, J. R., Cartwright, T. H., Patt, D. A., Espirito, J. L., Clayton, M. P., Garey, J. S., & ... Beveridge, R. A. (2011). Pathways, outcomes, and costs in colon cancer: retrospective evaluations in two distinct databases. Journal Of Oncology Practice/ American Society Of Clinical Oncology, 7(3 Suppl), 52s-59s.

Saldana-Ruiz, N., P. Clouston, S. A., Rubin, M. S., Colen, C. G., & Link, B. G. (2013). Fundamental Causes of Colorectal Cancer Mortality in the United States: Understanding the Importance of Socioeconomic Status in Creating Inequality in Mortality. American Journal Of Public Health, 103(1), 99-104.

Turner, P. S., Burke, D., & Finan, P. J. (2013). Nonresectional management of colorectal cancer: multidisciplinary factors that influence treatment strategy. Colorectal Disease, 15(10), e569-e575.

Thank you
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