Colorectal Cancer

Question 1

Colorectal Cancer (CRC)

Answer 1

• cancer of the rectum or colon
• most CRCs are adenocarinoma (type of cancer that forms in mucus-secreting glands throughout the body).
  a. grow slowly and begin as a polyp
  b. if caught early, polyps can be removed during a colonoscopy
  c. if left untreated, polyp will grwo and the risk of malignancy increases
• can metastasize to liver (most common), lungs, brain, or bones

Question 2

Recommendations for Prevention of CRC

Answer 2

1) can be cured if detected early
2) regular colorectal screenings and annually fecal occult blood tests for individuals 50+ yrs
- earlier and more frequently if there is a family hx of CRC
3) colonoscopy every 10 yrs after baseline colonoscopy
- if polyps are found, colonoscopies need to be done more frequently
4) diet high in fruits, vegetables, and whole grains
5) decreased intake of fats and meat proteins
6) alcohol in moderation
7) smoking cessation

Question 3

Risk Factors for CRC

Answer 3

1) colon cancer more common in women
2) rectal cancer more common in men
3) adenomatous colon polyps
4) family hx of CRC
5) inflammatory bowel disease (ulcerative colitis, Crohn’s disease)
6) high-fat, low-fiber diet
7) older than 50 yrs age

Question 4

Manifestations of CRC

Answer 4

1) blood in stool
2) change in bowel habits (constipation, diarrhea)
3) cramps, gas
4) palpable mass
5) weight loss and fatigue
6) vomiting
7) abdominal distention
8) abnormal bowel sounds (high-pitched tinkling sounds may be indicative of obstruction)

Question 5

Laboratory Tests

Answer 5

1) fecal occult blood test (FOBT)
- 2 stool samples for 3 consecutive days
2) false-positive FOBT results can occur with ingestion of some foods or medications.
- avoid meats, NSAIDs, and vitamin C for 48 hr prior to testing
3) carcinoembryoonic antigen (CEA) serum test
- CEA levels are elevated in most individuals with CRC
4) hemoglobin and hematocrit may be decreased due to intermittent bleeding

Question 6

Diagnostic Procedures

Answer 6

1) sigmoidoscopy/colonoscopy provides a definitive diagnosis of CRC
- permits visualization of tumors, removal of polyps, and tissue biopsy
2) barium enemas
3) CT scans of abdomen, pelvis, lungs, and liver
4) chest x-rays and liver scans may further identify specific location of cancer and identify sites of metastases

Question 7

Surgical Interventions

Answer 7

1) colon resection, colectomy, and abdominoperineal (AP) resection surgeries may be performed to remove portions or all of the CRC
2) CRC occurs in stages from 0 t IV according to tissue depth of lesion, and whether it has spread to local or distant sites
3) external stoma or colostomy may be necessary–temporary or permanent

Question 8

Nursing Care of Client Following Colorectal Surgery

Answer 8

1) if client has a stoma, it should be reddish pink, moist, and may have a small amount of visible blood in the immediate postoperative period
2) report any evidence of stoma ischemia or necrosis
3) maintain NG suction
4) slowly progress diet after suction is discontinued. monitor client response and bowel sounds
5) client should be educated regarding activity limits
- no lifting or use of stool softeners to avoid straining
6) provide ostomy teaching
- signs of ischemia to report
- expected output
- appliance management
7) support client who is experiencing disturbed body image
8) provide information on ostomy support groups
9) management of colostomy may be more difficult with older adult clients due to impaired vision and need for fine motor skills

Question 9

Chemotherapy and Radiation

Answer 9

1) adjuvant therapy to decrease the chance of metastases for stage II, and distant metastases for type III cancers
2) chemotherapy is routinely given for stage I cancer
3) radiation therapy in conjunction with chemotherapy improves prognosis
- usually for rectal cancer to prevent lymph node involvement and recurrence