MS Test 2 Flashcards
Third most common form of cancer 9% of cancer deaths are due to CRC More common in men Highest mortality rates among African American men and women Risk of contracting the disease increases with age Of new cases, 90% in people older than 50 The incidence of CRC in individuals older than 50 is decreasing as a result of increased screening to detect precancerous lesions
Colorectal Cancer
has an insidious onset, and symptoms do not appear until the disease is advanced. Regular screening is necessary to detect precancerous lesions. Approximately one half of all colon cancers occur in the rectosigmoid area
Colorectal Cancer
CRC Mortality rates are highest among _____ and _____. About 90% of new CRC cases are detected in people older than 50, and about a third occur in patients with a family history of CRC.
African American men and women.
Diet Risk factors for CRC
High in red or processed meat
Low in fruits and vegetables
Lifestyle factors for CRC
Obesity
Physical inactivity
Alcohol
Long-term smoking
How can we decrease the risk of CRC?
Physical exercise and a diet with large amounts of fruits, vegetables, and grains may decrease the risk.
NSAIDs (e.g., aspirin) in women also may decrease the risk.
Most common type of CRC
Adenocarcinoma is the most common type of CRC About 85% arise from adenomatous polyps Tumors spread through the walls of the colon into musculature and into the lymphatic and vascular systems
Most common sites for metastasis of CRC
Most common sites of metastasis
Regional lymph nodes
Liver
Lungs
Bones
Brain
Why is the liver a common site of metastasis from CRC?
Because venous blood leaving the colon and rectum flows through the portal vein and the inferior rectal vein,
Clinical manifestations of CRC?
Insidious onset .
Symptoms often do not appear until disease is in advanced stages.
Change in bowel habits
Unexplained weight loss
Vague abdominal pain
Symptoms of cancer in the left side of the colon appear earlier
Symptoms of cancerous lesions (CRC)
Rectal bleeding is most common
Alternating constipation and diarrhea
Change in stool caliber
Narrow, ribbon-like
Sensation of incomplete evacuation
Obstruction
Manifestations of CRC
Weakness and fatigue
Iron-deficiency anemia
occult bleeding
Complications of CRC
Obstruction
Bleeding
Perforation
Peritonitis
Fistula formation
Signs and symptoms of CRC based on location: Transverse Colon
Pain
obstruction
change in bowel habits
anemia
Signs and symptoms of CRC based on location: Descending Colon
Pain
change in Bowel habits
Bright red blood in the stool
obstruction
Signs and symptoms of CRC based on location: Rectum
Blood in stool
Change in bowel habits
Rectal Pain
Signs and symptoms of CRC based on location: Ascending Colon
Pain
mass
change in bowel habits
anemia
At what age should person get a colonoscopy?
Beginning at age 50, both men and women at average risk for developing CRC should undergo screening tests to detect both polyps and cancer
Where do most CRC come from?
Most CRC arises from adenomatous polyps. Therefore, early detection and removal of precancerous polyps could prevent most CRC
CT colonography
is also called virtual colonoscopy.
How often should diagnostic tests be done for CRC?
Regular screening for polyps and cancer Flexible sigmoidoscopy every 5 years Colonoscopy every 10 years Double-contrast barium enema study every 5 years CT colonography every 5 years
Annual screening tests for CRC?
Annual screening primarily for cancer.
Fecal occult blood test (FOBT)
Fecal immunochemical test (FIT) Test for blood in the stool Must be done frequently to catch the intermittent bleeding common with tumors
Colonoscopy
“Gold standard” test.
Entire colon is examined, Biopsy samples can be obtained Polyps can be immediately removed and sent to the laboratory for examination
What percent of CRC are found in colonoscopy?
Only 50% of CRCs are detected by sigmoidoscopy
How often should people have a colonoscopy?
every 10 years beginning at age 50, except for African Americans, who should have the first colonoscopy at age 45.
Those who have a first-degree relative who developed colorectal cancer before the age of 60, or who have two first-degree relatives with CRC, should have a colonoscopy every 5 years beginning at age 40, or 10 years earlier than the youngest age at which a relative developed cancer.
What other lab studies must be done after diagnosis of CRC?
Colonoscopy and tissue biopsies confirm diagnosis
Additional laboratory studies must be done
CBC to check for anemia
Coagulation studies
Liver function tests
What is Carcinoembryonic antigen (CEA)? (Diagnostic test)
Complex glycoprotein Sometimes produced by colorectal cancer cells. May be used to monitor for disease recurrence after surgery or chemotherapy NOT a good screening tool because of a large number of false positives
How is a CRC tumor staged?
Prognosis and treatment correlate with pathologic staging of the disease TNM system (to stage)
Prognosis worsens with Greater size and depth of tumor Lymph node involvement.
Surgical goals for CRC?
Complete resection of tumor.
Thorough exploration of abdomen.
Removal of all lymph nodes that drain the area
Restoration of bowel continuity
Prevention of surgical complications
How do we know surgical therapy was successful for CRC?
Successful when Resected margin of the polyp is free of cancer.
Cancer is well differentiated
No lymphatic or blood vessel involvement is apparent
Surgical therapy for CRC
Polypectomy during colonoscopy is used to resect colorectal cancer in situ
Some polyps can be removed during colonoscopy, whereas others necessitate surgery.
How do we determine the site of the colon resection?
The site of the colon and rectal cancer dictates the site of the resection (e.g., right hemicolectomy, left hemicolectomy
How do we treat stage 1 CRC tumors?
Surgical removal of stage I cancer includes removal of the tumor and at least 5 cm of intestine on either side of the tumor plus removal of nearby lymph nodes. Laparoscopic surgery is sometimes used for stage I tumors, especially those in the left colon.
How do we treat low risk Stage 2 CRC tumors?
Low-risk stage II tumors are treated with wide resection and reanastomosis, but chemotherapy is used in addition to surgery for high-risk stage II tumors.
How do we treat stage 3 CRC tumors?
Stage III tumors are treated with surgery and chemotherapy.
How do we treat stage 4 CRC tumors?
Stage IV tumors Indicates cancer has spread to distant sites
Surgery is palliative
Chemotherapy is directed at controlling the spread of the cancer
Radiation may be used to provide pain relief
Why would we perform a temporary colonoscopy?
Perforation
Peritonitis
Hemodynamic instability
Later, the ends of the colon can be surgically reconnected.
3 surgical options in rectal cancer?
Local excision
Low anterior resection (LAR) to preserve sphincter function
Abdominal-perineal resection (APR) with a permanent colostomy
Abdominal-perineal resection (APR) with a permanent colostomy
In APR, both the tumor and the entire rectum are removed, and the patient has a permanent colostomy.
The perineal wound may be closed around a drain or left open with packing to allow healing by granulation. Complications that can occur are delayed wound healing, hemorrhage, persistent perineal sinus tracts, infections, and urinary tract and sexual dysfunctions.
Low anterior resection (LAR) to preserve sphincter function
The LAR is used more frequently because of the potential for more normal control over defecation. When the tumor is not resectable or if metastasis is present, palliative surgery is done to control hemorrhage or relieve a malignant bowel obstruction. An LAR may be indicated for tumors of the rectosigmoid and the middle to upper rectum. If the tumor is far enough from the anal sphincters, the sphincters may be left intact. The use of end-to-end anastomosis staplers has allowed lower (<5 cm from anus) and more secure anastomoses.
What is a J pouch?
created by folding the distal colon back on itself and suturing it to form a pouch, which will replace the rectum as a reservoir for stool.
Why do we use chemo for CRC?
to shrink a tumor before surgery
An adjuvant treatment following colon resection
For stage III and high-risk stage II tumors
Palliative treatment for nonresectable colorectal cancer
What therapy is there besides chemo for CRC?
Biologic and targeted therapy is also used.
Drug alert for capecitabine (Xeloda):
Instruct patient not to get immunizations without physician’s approval.
Report temperature > 100.5º F/38º C immediately.
What chemo drugs are used for CRC?
5-Fluorouracil (5-FU) plus folinic acid.
Leucovorin is used alone or in combination with oxaliplatin (Eloxatin)
Eloxatin is preferred if patients can tolerate the side effects
Oral fluoropyrimidines (capecitabine [Xeloda]) have been found equally effective
Angiogenesis inhibitors
inhibits the blood supply to tumors,
bevacizumab (Avastin) and
ziv-aflibercept (Zaltrap)
Regorafenib (Stivarga) is a multikinase inhibitor that blocks several enzymes that promote cancer growth.
Cetuximab (Erbitux) and panitumumab (Vectibix) block the epidermal growth factor receptor. They are used in the treatment of metastatic CRC.
Radiation therapy for CRC?
May be used postoperatively
As an adjuvant to surgery and chemotherapy
As palliative therapy for metastasis
To reduce tumor size
To provide symptomatic relief
Nursing implementation for CRC screening
Encourage all persons older than 50 to have regular CRC screening
Help identify those at high risk
Participate in early cancer screening to help decrease mortality rates
Realize that fear and lack of information create barriers to prevention activities
What should nurse teach about colonoscopy?
Colonoscopy detects polyps only when the bowel has been adequately prepared.
Provide teaching about bowel cleansing for outpatient procedures
Correctly administer cleansing preparations to inpatients
What is the bowel prep procedure for colonoscopy?
clear liquid diet for 24 to 48 hours before procedure
4 L of oral polyethylene glycol (PEG) solution the evening before the procedure. Drinking 2 L the evening before and 2 L the morning of the procedure provides better cleansing, especially for endoscopy scheduled for the afternoon. Because many people find the PEG lavage solution difficult to drink and experience nausea and bloating, manufacturers have modified the PEG solutions to improve taste and palatability.
Magnesium citrate solution
bisacodyl tablets are sometimes given before the PEG lavage to remove the bulk of stool so that only 2 L of PEG is needed. Encourage patients to continue drinking and to drink all of the solution. Stools will be clear or clear yellow liquid when the colon is clean.Make sure drink is cold to make it more palatable.
Nursing care for pt with colon resection
Provide care, information, and emotional support.
Provide information about prognosis future screening
Provide support in dealing with diagnosis Inform about the extent of the surgical procedure
mental care for pt with permanent ostomy?
Patients who have an APR will have a permanent ostomy and consequently will need intense emotional support.
Care for pt with permanent ostomy?
Consult a wound, ostomy, and continence nurse specialist
Select the ostomy site
Provide follow-up care and teaching
Postoperative care for CRC
Sterile dressing changes
care of drains
patient and caregiver teaching about the stoma
Care of pt with APR extensive surgery?
Patients with more extensive surgery (e.g., APR) may have an open wound and drains (e.g., Jackson-Pratt, Hemovac), as well as a permanent stoma.
Care of pt with reanastomosis of bowel:
general postoperative care.
