Colon Cancer Flashcards
Colorectal Cancer
Colon + rectum = colorectal [lrg intestine/lrg bowel]
* 95% are adenocarcinomas (tumors that arise from glandular epithelial tissue)
* 3rd most common cancer in men & women
Metastasis can happen by direct extension to adjacent organs, through lymphatic system or bloodstream
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These are small growths in the intestinal tract that are covered w/mucosa & are attached to the surface of the intestine
2 types - sessile & pedunculated
Polyps
___ polyps are more raised, whereas ___ polyps are flat
pedunculated; sessile
- Both types can become cancerous or cause obstruction or intussusception of the bowel
- Complications are a bit higher w/sessile polyps
! First indicator if there’s a problem = rectal bleeding; most pts are asymptomatic
Colorectal cancer can metastasize to the liver, lungs, brain, bone, & adrenal glands
It can also spreading by a process called ___
> We try to remove the tumor; the tumor is excised, but in the process, cancer cells break off and can implant themselves in other areas (i.e., peritoneal cavity)
seeding
Risk Factors
- Over 50 y.o.
- Genetic predisposition
- Family h/o CRC
- FAP (familial adenomatous polyposis)
- Hereditary nonpolyposis (CRC aka Lynch syndrome)
- IBD >10 yrs [UC, Crohn’s]
- High fat, low fiber diets
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People w/this dz have a greater risk of developing multiple types of cancers, like endometrial, uterine, stomach, breast, ovarian, small bowel, pancreatic, prostate, urinary tract, liver, kidney, & bile duct
> autosomal dominant; 3%
> involves MLH1 & MLH2 genes
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- Rare; 1%; autosomal dominant inherited genetic disorder
> Mutations in the APC gene
✓ hereditary nonpolyposis colorectal cancer (HNPCC) syndrome aka Lynch syndrome
✓ FAP (familial adenomatous polyposis)
Promoting Prevention
- high, healthy fibers
- organic fruits & vegetables; occasionally whole grains; avoid grilled, blackened meats
- excessive GMO consumption is unhealthy & destructive to the body; causes obesity & depresses immune system
- long-term smoking; inc body fat; heavy alcohol intake (≥4 drinks/wk)
Health Promotion & Maintenance
- Diet modification
- Screening - colonoscopy (considered gold standard)
> @ 50
> could be q6mos, q5-10 yrs - regular screenings & FOB testing
- stop smoking
- increase activity
- decrease alcohol consumption
- maintain ideal body wt
Recognize Cues
- Most common signs - rectal bleeding, anemia, and a change in stool
- Clinical manifestations depend upon location of the tumor
- Blood in stools, palpable mass, wt loss, fatigue, N/V, abd distention, change in appearance or freq of BM’s, abn bowel sounds
- Rectal discomfort, feeling of incomplete evacuation
These symptoms are signs of which side of colorectal cancer?
- Obstruction
- Ribbon-like stool
- Blood or mucous
- Change in bowel pattern
- Palpable mass
- Tenesmus (feeling that you need to pass stools, even though bowels are empty)
Left colon, rectum
These symptoms are signs of which side of colorectal cancer?’
- Abd pain, cramping
- N/V, wt loss
- Melena, anemia, palpable mass
Right colon, small bowel
___ colon
- Pain
- S/S of obstruction
- Change in bowel habits
- Anemia
- Fatigue
Transverse
___ colon
- Pain
- Change in bowel habits
- Bright red blood in stools
- S/S obstruction
Descending
___ colon
- Abdominal pain/cramping
- Change in bowel habits
- Anemia
- Fatigue
Ascending
Abdominoperineal (AP) resection
- removal of sigmoid colon, rectum, & anus through a combined AP incision
- usually done when rectal tumors are present
- colon removed through abd incision & rectum through a perineal incision
- anus is closed
- ostomy is permanent
- if ALL of the colon was removed, pt wil get an ileostomy; if any of the lrg intestine left, could have a colostomy
Types of Colostomies
Is surgical creation of the opening of the colon into the surface of the abd
Hopefully surgery will include a colon resection where tumor is removed & colon is re-anastomosed (if not = colostomy)
Appearance of the stoma
Normal stoma should be reddish pink & moist & protrude about 2 cm or 3/4 in from the abdominal wall
You should never see any gross bleeding or necrosis or purulent drainage from the stoma; all of that is abnormal
✓ pass flatus
✓ dec abd distention w/ambulation
✓ rectal tubes for trapped gas
Teaching Plan
- May take several wks to regain strength
- Ok to resume ADLs, swimming, & sexual relations >a couple of wks
- Normal to have excessive flatulence for 4-8 wks
- Refer pt/family to support groups
- Identify sources for supplies
! Do not reuse non-reusable bags - Many require home health care or enterostomal therapy nurse
- Ostomy rehab clinics may be an option
