Colorectal Cancer Flashcards
Where does colorectal cancer start?
Colon or rectum
1 in how many will develop colorectal cancer?
1 : 20
What gender is more at risk?
Men
Most common over what age?
50
Incidence rises with increasing age
Nearly all of colorectal start of as?
Polyps
What are polyps?
Small vascular growths on the mucous membrane (in the glandular tissue of intestinal lining)
Where do most tumors develop ?
Sigmoid colon or rectum
What are hyperplastic polyps?
Generally harmless, small
What are adenomatous polyps?
Common: small tumor of epithelial tissue
What does most colorectal cancer from from?
Adenomatous — > Adenocarcinomas
What are polypsosis syndromes?
Hereditary conditions which cause polyps
Usually rare, occurs in young people
High chance of becoming cancerous
What are some risk factors of colorectal cancer?
- Personal or family history of colorectal cancer, polypsosis disorders, inflammatory bowel disease
- Age >50
- Smoking
- Obesity
- Alcohol
- Radiation exposure
- Diets high in calories, fats, and meat proteins
- Presence of anaerobic gut bacteria
What is key in prevention of colorectal cancer?
Screening
For individuals over 50, what should they do for prevention?
- Yearly fecal occult blood test
- Stool DNA test
- Flexible Sigmoidoscopy every 5 year
- Double contrast barium enema every 5 years
- Colonoscopy every 10 years
- CT colonography every 5 years
- *MAY reduce incidence: exercise, MVI, aspirin, NSAIDS
What is the initial manifestation to seek care?
Rectal bleeding
Clinical manifestations of colorectal cancer?
Changes in bowel habits Pain Anorexia/weight loss Abdominal mass Fatigue Anemia
What are some diagnostic tools/tests used for colorectal cancer?
- Endoscopy (Full colonoscopy better than sigmoidoscopy- can detect 50-65%)
- Biopsy of tissue
- Fecal blood tests
- CBC
- Carcinoembryonic Antigen (CEA)
What can CEA be used for?
Monitor course of treatment, prognosis
*Detect possible areas of metastasis
TNM Staging system: Colorectal Cancer
T is for what?
How far a tumor has grown into the intestinal wall and whether it has grown into nearby areas
TNM Staging system: Colorectal Cancer
N is for what?
The extent to nearby (regional) lymph nodes
TNM Staging system: Colorectal Cancer
M is for what?
Whether the cancer has spread (metasized) to other organs of the body (most common in colorectal cancer- liver and lungs)
What is a “treatment of choice” for colorectal cancer?
Surgical resection (w/ anastomosis) of tumor, adjacent colon and regional lymph node
What are some medical treatments for colorectal cancer?
- Surgical resection
- Excision of tumor (sometimes done during endoscopy)
- Laser photocoagulation
- Abdominal resection with permanent colostomy
- Fulguration
- Chemo and EBR (post-op typically)
- Brachytherapy
What is laser photocoagulation?
Beam of light to generate heat, destroys small tumors, palliative-obstructions
In abdominal resection with permanent colostomy, what wants to be preserved and avoided?
Attempt to preserve anal sphincter and avoid colostomy
What is fulguration?
Uses electrical current to kill cancer tissue similar to cauterization
In a bowel resection, what is removed?
All or part of large intestine
For what type of patients is bowel resection used?
Patients with early stage tumors
High cure rate
Bowel resection often leads to what?
Creation of a colostomy (can be either permanent or temporary depending on factors)
What are the two types of bowel resection?
Open and laparascopic
What chemo drugs are usually used with colorectal cancer?
Fluorouracil (5-FU) Folonic Acid (Leucovorin)
How are the chemo drugs usually given?
IV
sometimes topically
What are the side effects of Flurouracil and Folonic Acid?
N/V Diarrhea Alopecia Photosensitivity Cardiotoxicity CNS Damage
Fluorouracil is usually combined with what other therapy?
Radiation
What is a sigmoid colostomy?
Most common: permanent: Cancer of the rectum
A double barrel colostomy has what kinds of stomas?
Objective?
- Distal stoma- colon is bypassed expels mucus
- Proximal stoma- functional, diverts feces to abdominal wall
Colostomy:
Transverse Loop
Emergency to relieve obstruction or address perforation:
Temporary
Colostomy:
Hartman Procedure
Temporary
Distal portion left in place and oversewn for closure
Follow up 3-6 months with reanastamosis
Usually for trauma
What should included in the ostomy education?
- Promote quality of life “live your life”
- Monitor medications (changes in bowel habits)
- Well-balanced diet (avoid certain foods)
- Colostomy irrigation (enema through stoma)
What should be included in ostomy care?
- Clean with soap and water, pat dry
- Post-op, watch for incision
- Check for leaks
- Cut wafer slightly larger than stoma
- Stoma paste-various products
- Bag “burp” if full of gas
What should be emphasized on patient education with colorectal cancer?
Screening
What is the survival rate for people with stage 1?
5 year rate of 74-90%
How does colon cancer spread throughout?
Direct extension of the entire bowel, circumference, submucosa and outer bowel walls, neighboring structures
What is another name of Lynch syndrome?
Hereditary nonpolyposis
What is lynch syndrome?
Autosomal dominant disorder
Increase occurrence of all cancers
What is the indicator that the bag is working?
Bag “burp” if full of gas
