Week 5 - Colo-rectal Cancer Flashcards
what is colorectal cancer
- malignant disease of the colon, rectum, or both
what are risk factors for colorectal cancer (9)
- age >50
- alcohol
- smoking
- Hx IBD (esp. UC)
- colorectal polyps
- family Hx
- obesity
- increased red meat
- low fruits & veggies
describe symptoms of colorectal cancer
- usually nonspecific
- do not occur until disease is advanced
list symptoms of colorectal cancer (5)
- rectal bleeding
- alternating CD
- change in stool calibre (narrow, ribbon like)
- sensation of incomplete evacuation
- obstruction symptoms
what diagnostic tests are used for colorectal cancer (8)
- history & FHx
- physical exam
- digital rectal exam **
- FOBT
- colonoscopy **
- CT colonography
- endorectal US
- carcinoembryonic antigen
what are the current recommendations for screening for colorectal cancer
if asymptomatic, >50, no risk factors
- FOBT & fecal immunochemical test noce a year
- flexible sigmoidoscopy every 5 years
treatment of colorectal cancer is based on?
- staging of the cancer
what 3 things can a colonoscopy be used to do
- diagnose
- take biopsy
- remove polyps
what is used to prep the bowel before a colonoscopy
purgatives:
ex. GoLytely, pico-salax
what do purgatives do? why are they imp?
- used to clean out the bowel
- by the time they go for colonoscopy, what comes out of bowel should be clear or slight yellow
- nothing solid, otherwise cant see
what are 2 categories of treatment for colorectal cancer
- surgery
- chemo & radiation
what is the only curative treatment for colorectal cancer
- surgery
what types of surgery are done for colorectal cancer (5)
- right hemicolectomy
- left hemicolectomy
- abdominal perineal resection
- low anterior resection
- sphincter sparing procedures
when is a right hemicolectomy performed? what is it?
- when cancer in cecum, ascending colon, hepatic flexure, transverse colon
- removes portion of terminal ileum, ileocecal valve, appendix
- ileotransverse anastomosis performed
what is a L hemicolectomy
resection of the :
- L transverse colon
- splenic flexor
- descending colon
- sigmoid colon
- upper portion rectum
what determines what surgical procedure is performed
- location of the rectal lesion
- must be enough rectum left for secure anastomosis and preservation of anal sphincter function
when is abdominal peritoneal resection performed
- when cancer is within 5 cm of anus
what is an abdominal peritoneal resection
- abdominal incision made
- distal sigmoid colon, rectum, and anus removed
- proximal sigmoid colon brought thru abdominal wall for permanent colostomy
what are left after an AP resection
2 wound and colostomy:
- abdominal incision
- perineal incision which is either sewn closed w drain in place, or packed and left open
- colostomy in LLQ
what are some potential complications of AP resection (6)
- delayed wound healing &infections (d/t location, lots of bacteria)
- hemorrhage
- persistent perineal sinus tracts
- UTI
- sexual dysfunction
what is a low anterior resection used fr
- tumours of the rectosigmoid and mid-to-upper rectum
when are sphincter sparing procedures performed (2)
- if pt is poor operative risk
- if early disease
when is chemo & radiation used as treatment for colorectal ca (2)
- as an adjuvant
- if not surgical candidate
what is postop care for a pt after AP resection (2)
- wound assessment and care
- positioning
describe wound assessment and care post AP resection (4)
- keep perineum clean and dry , irrigate w NS
- dressing changes
- drain care –> examine, keep area around clean and dry,
- examine wound regularly & record bleeding, drainage, or excessive odor
describe positioning for a pt after AP resection (3)
- side to side positioning –> not on rectum
- use pressure cushion if sitting
- no pressure on perineum
what is an ostomy
- a surgical opening to permit diversion of fecal material
what are 2 types of ostomies
- colostomy
- ileostomy
describe stoma assessment post-op , how often to assess and what are normal findings? (3)
assess stoma q8h
- mild to mod edema
- small amt bleeding or oozing when touched
- should be pink, rose to brick red
describe stoma drainage postop
- amt of drainage in first 24-48 h negligible
- will begin to pass flatus as peristalsis increases in ~48 h, then stool
describe pt teaching r/t colostomy and ileostomy (9)
- inspect stoma and skin for breakdown
- empty pouch when 1/3 full or inflated w gas
- use deodrants as needed
- avoid certain foods
- initially low residue diet, then increase gradually
- increase fluid intake
- observe for S&S of dehydration (esp. w ileostomy)
- support groups
- what S&S to report
- assess stool consistency
what foods should be avoid w an ostomy
- food that causes odor: onion, egg, garlic
- food that causes gas: onion, beans, cabbage, beer
- food that cause obstruction: nuts, popcorn
- food that cause diarrhea
describe stool consistency w an ileostomy vs colostomy
- ileostomy = liquid
- colostomy = formed
what S&S should a pt report post ostomy(4)
- fever
- diarrha
- constipation
- stoma problems
what are general rules to apply to all GI postop surgery
- pain control
- nausea
- constipation
describe pain control for all general GI postop (6)
- PCA or regular anasthesia for 72 hr
- assess type of pain
- pain may be from incision or gas
- ambulate to relieve gas pains
- splint incision for DB&C w pillow
- position for comfort
describe care for nausea for all general GI postop (4)
- give antiemetics
- NG to low suction
- assess BS and distension
- eliminate unpleasant sights, smells, and stimuli
describe care for constipation for all general GI surgeries
- assess for distension & BS q shift
- ambulate as tolerated
- use stool softeners or antidiarrheals
- increase fluid intake
- I&O
- stool counts
