Download Colorectal Cancer

Colorectal Cancer
Dr. Belal Hijji, RN, PhD
February 6, 2012
Learning Outcomes
At the end of this lecture, students will be able to:
• Describe the incidence and trend of colorectal cancer in Saudi
Arabia compared to the United States of America.
• Identify the risk factors for the development of colorectal
cancer.
• Discuss the clinical picture of colorectal cancer along with the
assessment and diagnostic evaluation.
• Discuss the medical management of a patient with colorectal
cancer.
• Describe the nursing process as a framework for caring for a
patient with colorectal cancer.
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The colon and rectum
Source: http://www.cancer.gov/cancertopics/wyntk/colon-and-rectal/page2
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Incidence of Colorectal Ca in KSA Versus USA
ASR for colorectal cancer (1994-2003) in the Kingdom of Saudi Arabia and
the United States of America
ASR for Incidence (KSA)
ASR for Incidence (USA)
Year
Males
Females
ALL
Males
Females
ALL
1994
3.36
3.45
3.38
40.80
28.90
33.41
1995
3.25
4.02
3.56
39.20
28.80
32.63
1996
2.93
3.73
3.25
40.70
28.20
33.01
1997
3.05
3.51
3.22
41.90
29.30
34.06
1998
3.45
3.52
3.48
41.00
30.20
34.14
1999
3.98
4.63
4.26
40.60
29.40
33.59
2000
3.70
4.28
3.95
39.70
28.50
32.82
2001
4.15
4.92
4.48
39.10
28.00
32.24
2002
5.09
5.07
5.07
38.20
28.40
32.11
2003
6.06
5.60
5.84
36.90
26.50
30.49
Source: Ibrahim, E. et al. (2008). Past, Present and Future of Colorectal Cancer in the
Kingdom of Saudi Arabia. The Saudi Journal of Gastroenterology. 14(4): 178–182.
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The age-standardized rate for colorectal cancer for males and females in the
Kingdom of Saudi Arabia and the USA (1994-2003).
Source: Ibrahim, E. et al. (2008). Past, Present and Future of Colorectal Cancer in the
Kingdom of Saudi Arabia. The Saudi Journal of Gastroenterology. 14(4): 178–182.
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Predicted colorectal cancer burden in the Kingdom of Saudi
Arabia, up to 2030
Year
Males
Females
No. of
patients
Changes from %
2005
No. of
patients
Changes from %
2005
2005
680
-
537
-
2010
881
30
697
30
2015
1,192
80
931
70
2020
1,792
170
1,397
160
2030
3,171
370
2,538
370
Source: Ibrahim, E. et al. (2008). Past, Present and Future of Colorectal Cancer in the
Kingdom of Saudi Arabia. The Saudi Journal of Gastroenterology. 14(4): 178–182.
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Risk Factors For Colorectal Cancer
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Increasing age (highest in people older than 85 years).
Family history.
Previous colon cancer.
High consumption of alcohol.
Cigarette smoking.
Obesity and history of gastrectomy.
History of inflammatory bowel disease.
High fat, high protein, low fiber diet.
Genital cancer or breast cancer.
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Clinical Manifestations
• Three factors greatly determine the signs and symptoms
experienced by a patient with colorectal cancer. These are:
– Location of tumor.
– Stage of disease.
– Function of the affected intestinal part.
• Most commonly, patients have change in bowel habits and
passage of stool with blood. Other clinical manifestations
include unexplained anemia, anorexia, weight loss, and
fatigue.
• Right-sided lesions are associated with:
– Abdominal pain and melena.
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Clinical Manifestations (Continued…)
• Left-sided lesions, causing obstruction, are associated with:
– Abdominal pain and cramping.
– Narrowing stools and constipation.
– Distention and bright red blood in stool.
• Rectal lesions are associated with:
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Ineffective, painful straining at stool.
Rectal pain.
A feeling of incomplete evacuation after a bowel movement.
Alternating constipation and diarrhea.
Bloody stools.
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Assessment and Diagnostic Findings
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Abdominal and rectal examination.
Stool for occult blood.
Barium enema.
Proctosigmoidescopy.
Most important
Colonoscopy.
Carcinoembryonic antigen may be useful
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Medical Management of a Patient With Colorectal
Cancer
• If there is intestinal obstruction, patients are treated with IV fluids
and nasogastric suction. Blood transfusion if there is significant
blood loss.
• Treatment of this disease depends on its stage and consists of
surgical removal of tumor, supportive therapy, and adjuvant therapy.
By adjuvant therapy we mean chemotherapy, radiotherapy,
immunotherapy that a patient with non-metastasised colon cancer
would receive. The standard adjuvant therapy is 5-fluorouracil and
leucovorin calcium. Radiotherapy is used before, during, and after
surgery to shrink the tumor and to reduce recurrence.
• Radiotherapy is also used for unresectable tumors for symptoms
relief.
• Surgery is the primary treatment for most colorectal cancers.
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Medical Management of a Patient With Colorectal
Cancer (Continued…)
• Colostomy: This is a surgical creation of an opening into the colon.
It could be temporary or permanent.
Permanent colostomy for rectal cancer
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• Colostomy (Continued…):
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Nursing Management of a Patient With Colorectal
Cancer
Assessment
• Collect subjective data about:
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Presence of fatigue.
Abdominal or rectal pain.
Past and present elimination pattern.
Characteristics of stool.
Family history and fat and fiber intake.
Alcohol intake and smoking.
Weight loss.
• Auscultate the abdomen for bowel sounds.
• Palpate the abdomen for distention and solid masses.
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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
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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 cancer diagnosis and impending surgery.
Impaired skin integrity related to surgical incisions.
Disturbed body image related to colostomy.
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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
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Planning and goals
Attainment of optimal nutrition.
Maintenance of fluid and electrolyte balance.
Reduction of anxiety.
Attainment of optimal wound healing.
Expressing feelings and concern about colostomy and the
impact on self.
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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Interventions
• Patient Preparation for Surgery.
• Build the patient’s stamina days before surgery.
• Cleanse the bowel the day before surgery.
• If possible, provide a diet high in calories, protein, and
carbohydrate for several days before surgery.
• Provide full liquid diet if prescribed 24 to 48 hours before
surgery to reduce bulk.
• Clean the bowel with laxatives and/ or enemas the evening
before and the morning of surgery.
• Record intake and output to provide an accurate record of fluid
balance.
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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Interventions
• Patient Preparation for Surgery (Continued…).
• Insert nasogastric tube if ordered to drain accumulated fluids
and prevent abdominal distention.
• Monitor the patient for increasing abdominal distention, loss of
bowel sounds, and pain or rigidity, which may indicate intestinal
obstruction or perforation.
• Observe the patient for signs of hypovolemia (tachycardia,
hypotension, decreased pulse volume).
• Assess hydration status.
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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Interventions (Continued…)
• Providing Emotional Support.
• Assess the patient’s level of anxiety.
• Suggest methods for reducing anxiety such as deep breathing
exercises and visualising a patient who successfully recovered
from surgery and cancer.
• Provide factual information about the colostomy site to reduce
the patient’s fear that everybody will be aware of the ostomy.
• Providing Postoperative Care.
• Pain management.
• Abdominal assessment for bowel sounds.
• Mobilise the patient out of bed on the 1st day postop.
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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Interventions (Continued…)
• Maintaining Optimal Nutrition.
• Teach patients undergoing surgery about the health benefits of
consuming healthy diet.
• Perform complete nutritional assessment to evaluate the
nutritional status of the patient.
• Advise the patient on avoiding foods that cause excessive odor
and gas such as foods in cabbage family, eggs, asparagus, fish,
and beans.
• Help the patient identify any foods or fluids that may cause
diarrhea including fruits, high fiber foods, soda, coffee, tea, or
carbonated drinks.
• Advise a fluid intake of at least 2 L/ day
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Nursing Management of a Patient With Colorectal
Cancer (Continued…)
Nursing Interventions (Continued…)
• Supporting a Positive body Image.
• Encourage the patient to verbalise feelings and concerns about
altered body image, and to discuss the surgery and the stoma if
one was created.
• If applicable, teach the patient about colostomy care in an open,
accepting manner and encourage him to talk about his feeling
about the stoma.
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