LEC 10: Colorectal Cancer Flashcards
Where dose the small and large intestine join?
Join at the cecum
What is the etiology and pathophysiology for colorectal cancer?
- Cause remains unclear
- No single use
- Some at high risk than others
- Mix of genetic and environmental factors can cause cells in the lining of the bowel to turn cancerous
- Most colon cancers typically arise from polyps
What do most colon cancers arise from?
Most colon cancers typically arise from polyps
What is polyps?
Small bulges of abnormal cells from bowel wall
What are the non-modifiable risk factors for colorectal cancer?
- Age: > 50 years
- Personal history of colorectal polyps
- Family history of colorectal cancer
- Personal history of IBD, particularly ulcerative colitis
- Family/ personal history of familia adenomatous polyposis (FAP)
- Ethnicity: African Americans, Eastern European Jewish
What are modifiable risk factors for colorectal cancer?
- Diet high in fats and calories
- Sedentary lifestyle
- Type 2 diabetes
- Obesity
- Smokin
- Heavy alcohol consumption
Clinical Manifestations of Colorectal Cancer
- No symptoms in early stages
- Vary depending on cancer location
- Blood in/on stool
- Change in bowel habits
- General abdominal discomfort
- Feeling of bowel not emptying
- Urgency with BMs
- Weight loss, tiredness
Saskatchewan Colorectal Screening
- Age 50 to 74
- Stool sample (FIT test)
- Completed at home
- Completed every 2 years
- Results sent to family doctor
- If positive result, further diagnostics test performed
What are the diagnostic studies done for colorectal cancer?
- DRE: Digital rectal exam
- Fecal occult blood test (FOB)
- Sigmoidoscopy
- Colonoscopy
- Biopsy
- Barium enema (causes constipation for the patient)
- Blood tests- CNC, LFTs, CEA
What kind of treatment do patients with colorectal cancer undergo?
- Polyp removal
- Surgical therapies
- Chemotherapy and radiation
Polyp Removal
- Colon cancer typically arises from polyps
- Early detection and removal is key to eliminating the risk
- Remove during colonoscopy
- Done if caner is in early stages: Only on colon surface
What are the 4 surgical therapies for colorectal cancer?
- Right hemicolectomy
- Left hemicolectomy
- Lower anterior resection
- Abdominal perineal resection
Surgical Therapies: Right Hemicolectomy & Left Hemocolectomy
Go in through the abdomen or laparoscopically and remove some portion of the bowel and some fo the healthy tissue. Would then reconnect the large intestine to the small intestine
Where is the cancer located for a right hemicolectomy therapy to take place?
Cancer is in:
- Cecum
- Ascending colon
- Hepatic felxure
- Part of right transverse colon
Where is the cancer located for a left hemicolectomy therapy to take place?
Cancer is in:
- Left transverse colon
- Splenic flexure
- Descending colon
- Sigmoid colon
- Upper portion of the rectum
Surgical Therapies: Lower Anterior Resection
Cut the portion of the bowel away and reconnect it. Patient would still be able to have a bowl movement out of their anus like they normally would
Where is the cancer located for a lower anterior resection therapy to take place?
Cancer is in:
- The rectosigmoid area
- Mid-upper rectum
Surgical Therapies: Abdominal Perineal Resection
Have to remove the cancer and sew the anus shit, will have a permanent ostomy and will not be able to have a bowel movement through the anus and rectum. Because there are nerves in the anus and rectum, the patient may still feel like they need to have a bowel movement out of their anus and it is not uncommon for the patient to sit on the toilet to have a bowel movement.
Where is the cancer located for a abdominal perineal resection therapy to take place?
Cancer within 5cm of anus
Ostomies
- Surgical procedure where the bowel is brought through an opening in the abdominal wall
- Edges sutured (dissolvable), inner lining of bowel exposed (stoma)
- Not every surgical IBD requires an ostomy
- Can be temporary or permanent
What are the 5 different types of ostomies?
- Ascending colostomy
- Descending colostomy
- Ileostomy
- Sigmoid colostomy single-barrel
- Transverse colostomy double-barrel
Ostomy Post Op Care
- Assess stoma
- Want the stoma to be beefy red
- Do not want it to be black, means it is dead - Protect peristimal skin
- The skin around the stoam can get irritated if the stool sits around the stoma
- Want to protect the stoma skin area and not characteristic of the skin
- Ostomy is going to be quite inflamed, not uncommon for stoma to be quite larger then with it will be 6 weeks post-ops - Containment of odour and effluent
- An ostomy will not produce stool right away, for at least 3 days (not uncommon) - Characteristics and amount of effluent
- Patients with an ostomy cannot have a high fiber diet or mushrooms
Chemotherapy
Can be done pre-op or for palliative purposes
Radiation Therapy
- Most commonly used fro rectal cancer, but can be used for both colon and rectal cancer
- Can be done pre-op, post-op, or for palliative purposes
Key Points for Colorectal Cancer
- Most colon cancers arise from polyps
- Symptoms cary depending on cancer location: Change in bowel habits and stool
- Remember to think about nursing care post-op for these patient: what are the priorities?
