10.2 Lung/Colorectal Cancer

Question 1

Colorectal Cancer

Answer 1

• Starts in colon/rectum
• Most predominant in men over the age of 50
• Symptoms appear when cancer is advanced.
• Most of these cancers begin as polyps (inner lining of colon or rectum)
• Some but not all polyps can become cancer

Adenomatous Polyps (Adenomas) - Most commonly associated with cancer (precancerous conditions)

S/S
- Usually asymptomatic until it is advanced (5-15 years)
- Metastasis to lungs and liver is common
- Abdominal Cramping/Pain
- Change in Bowel Habits
- Diarrhea/Constipation
- Weight loss/Anorexia
- Palpable mass
- Rectal bleeding and blood in stool
- Bowel obstruction/perforation

Risks
- Increasing Age
- Family history
- Polyps
- IBD
- Obesity/Smoking/Alcohol/Red Meat

Diagnosis
- Checking family history, palpate for masses (possible ulcerative colitis)
- DRE (Digital Rectal Exam)
- Stool Test for occult blood (guaiac-based fecal occult blood test) or Fecal Immunochemical Test (FIT)
- Colonoscopy - MOST COMMON TEST to check for polyps
- Biopsy - Remove a polyp or maybe areas of the liver to check if cancer has spread

Tumor Marker Tests
- Abnormal tumor marker may mean colorectal cancer (also checks response to cancer treatment)
- Carcinoembryonic Antigen (CEA) is the marker used
- CA 19-9 is a blood marker (elevated) in colorectal cancer

Treatment
- Surgery (rectal cancers require colostomy but not all colon cancer)
- Chemotherapy - Given post-op if cancer has spread
- Radiation therapy - Used when surgery is not an option (can relieve pain)

Question 2

Post-Op Treatment Colorectal Cancer

Answer 2

• Assist with PO nutrition (TPN)
• Semi-fowler position
• I&O
• DVT prevention
• Pain management
• Education
• VS
• NG Tube, Foley, TPN
• Drains (JP Drain)
• Incisions/Dressings
• Consistency of Stools

Question 3

Lung Cancer

Answer 3

• Leading cause of cancer death
• Smoking is the number 1 cause
• Can also be caused by asbestos, radon, nickel, family history
• REPEATED EXPOSURE IS THE MAJOR RISK
• Can spread to the brain

Question 4

Non-Small Cell Lung Cancer (NSCLC)

Answer 4

• Most common
• Adenocarcinoma (most common type for nonsmokers)
• Squamous cell carcinoma
• Large cell carcinoma

Question 5

Small Cell Lung Cancer (SCLC)

Answer 5

• Grows rapidly and spreads early
• Produces manifestations at sites not directly impacted by the tumor.

S/S
- Coughing
- Hemoptysis (spitting of blood)
- Hoarseness
- Dyspnea
- Weight loss/Anorexia
- Weakness/fatigue
- Chills/Fever
- Chest pain

Diagnosis
- Risk factor assessment, listening to lungs/heart, feeling for swollen lymph nodes, palpating liver for abnormal size

• Chest x-ray is often the first test to look for lumps or lesions
• CT/MRI can be used to see if lymph nodes are enlarged, show location/size of tumor, check if tumor has spread, guide a biopsy
• Bronchoscopy to carry out biopsy (DEFINITIVE TEST)
• Sputum tests can be examined for cancer

Tumor Marker Test
- Carcinoembryonic Antigen (CEA)

Treatment
- Antineoplastics - Immune system treatment for small cancer. (STANDARD TREATMENT FOR NSCLC)
- Surgery (pneumonectomy (removal of lung), lobectomy, wedge resection)
- Radiation - Palliative for pain to shrink the tumor. Can be used to treat superior vena cava syndrome

Complications of Treatment
- Superior Vena Cava Syndrome - Partial/complete obstruction (facial/neck edema, dizziness, visual changes, syncope)
- Paraneoplastic Syndrome - SIADH, Cushing’s Syndrome, PE, DVT
- Muscle Wasting (first sign of disease)
- Pneumonia
- Depression

Question 6

Post-Op for Lung Cancer

Answer 6

• Respiratory assessments
• O2
• I&O, Daily Weight
• Pain management
• Semi-fowler
• Monitor chemotherapy