SYLABUS ON COLON CANCER
Time allotment: 1 hour
Topic description: This topic deals with the concept of
colorectal cancer - it emphasizes on the discussion of the
disturbances and its implication to the care management of the
patient experiencing these disturbances. Patient with such
disturbances is of great challenge to nursing care and their
support system. Questions are given to evaluate the listeners
understanding about the topic.Central objective: At the end of the
ward class, the learners will gain broader knowledge, develop
beginning skills and manifest desirable attitudes in the management
of patient with colorectal cancer.
Specific objectivesContentT.A.T-L ActivitiesEvaluation
After the ward class, the learners will:
Identify what is Colon Cancer or Colorectal Cancer, Colon Cancer
Cell Type and its Causes.
Know the different types of Assessment and Diagnostic Findings
for a patient with Colorectal Cancer.
Identify Sign and symptoms of patient with Colorectal Cancer
Know the Clinical Manifestations of Colorectal Cancer.
Identify Possible Complications of patient having Colorectal
Cancer and its Management
Identify preventive measures for the occurrence of the disease
condition Colorectal Cancer
Know the medical management appropriate for a client with
Colorectal Cancer.
Appreciate the applicable roles of the nurse to various nursing
implications.
Be able identify ways and technique to promote home based care
for a client with Colorectal Cancer.
I. PrayerII. IntroductionCancer of the lower intestinal tract
(colorectal cancer) is the third most common cause of cancer and
cancer death. It accounts for 9% to 10% of all cancer death. Cancer
of the colon tends to occur in individuals older than 50 years and
is rare in children. Cancer of the colon maybe sporadic event
associated with genetic and epigenetic events. III.
Colorectal/Colon CancerColorectal cancer is cancer that starts in
the colon or the rectum. These cancers can also be referred to
separately as colon cancer or rectal cancer, depending on where
they start. Colon cancer and rectal cancer have many features in
common.Most colorectal cancers develop slowly over several years.
Before a cancer develops, a growth of tissue or tumor usually
begins as a non-cancerous polyp on the inner lining of the colon or
rectum. A tumor is abnormal tissue and can be benign (not cancer)
or malignant (cancer). A polyp is a benign, non-cancerous tumor.
Some polyps can change into cancer but not all do. The chance of
changing into a cancer depends upon the kind of polyp:
Adenomatous polyps (adenomas) are polyps that can change into
cancer. Because of this, adenomas are called a pre-cancerous
condition. Hyperplastic polyps and inflammatory polyps, in general,
are not pre-cancerous. But some doctors think that some
hyperplastic polyps can become pre-cancerous or might be a sign of
having a greater risk of developing
IV. Common Colon Cancer Cell Typea. Adenocarcinoma- these
cancers start in cells that form glands that make mucus to
lubricate the inside of the colon and rectum.b. Lymphoma- these are
cancers of immune system cells that typically start in lymph nodes,
but they may also start in the colon, rectum, or other organs.
V. CausesA. Inflammatory Bowel Disease - People withinflammatory
bowel disease(ulcerative colitisandCrohn's disease) are at
increased risk of colon cancer.B. Genetics- Those with a family
history in two or morefirst-degree relativeshave a two to threefold
greater risk of disease and this group accounts for about 20% of
all cases. A number of genetic syndromes are also associated with
higher rates of colorectal cancer. The most common of these
ishereditary nonpolyposis colorectal cancer(HNPCC or Lynch
syndrome) which is present in about 3% of people with colorectal
cancer.VI. Assessment and Diagnostic FindingsA. Abdominal and
Rectal ExaminationB. Laboratory ExamsB1. Fecal Occult Blood
Testing- checks for hidden (occult)bloodin the stool that may arise
from the bleeding in the intestine.B2. Barium Enema- is a medical
procedure used to examine and diagnose problems with the
humancolon(large intestine).X-ray pictures are taken whilebarium
sulfatefills the colon via the rectum.B3. Proctosigmoidoscopy-
examination of the lower colon using a sigmoidoscope, inserted into
the rectum.B4.Colonoscopy-is theendoscopicexamination of thelarge
boweland the distalpart of thesmall bowelwith aCCD cameraor afiber
opticcamera on a flexible tube passed through theanus.B5.
Sigmoidoscopy with Biopsy- is the minimally
invasivemedicalexamination of the largeintestinefrom
therectumthrough the last part of thecolon. B6. Cytology Smear- the
product of a diagnostic technique where cells are scraped off the
surface of a lesion found in the oral cavity. Cells are then
examined under a microscope for indications of a variety of
diseases.C. Carcinoembryonic antigen (CEA) Studies- is a laboratory
blood study. EA is a substance which is normally found only during
fetal development, but may reappear in adults who develop certain
types ofcancer.
VII. Signs and SymptomsA. Worsening Constipation- the inability
to freely pass a bowel movement.B. Blood in the Stool- there is
bleeding somewhere in the large intestinesC. Weight Loss- is
associated loss of appetite. D. Fever- commonly associated with
types of cancer associated with blood but also common in person
whose cancer has spread.E. Loss of Appetite- this can be due to the
stress a person undergoing and medical treatment such as
medications, chemotherapy and radiation.F. Nausea and Vomiting- is
common in colon cancer because the tumor is causing bowel
obstruction. Depending on the severity of the blockage, solids,
liquids and even gas maybe prevented from passing through the
colon. This can lead to painful stomach cramps and constipation.G.
Dull Abdominal Pain- generally occurs when cancer spreads and
begins to affect the organ and nerves.H. Melena- refers to black
tarry feces that are associated with gastrointestinal
hemorrhage.
VIII. Clinical Manifestations:A. Large Bowel Obstruction- Colon
polyps are growths that form in the lining of the colon, and can
cause constipation and formation of large stools. The intestine is
blocked and causes pain, swelling, nausea, diarrhea, and more.B.
Distended Abdomen- this can occur if large bowel obstruction are
not removed and may cause pain and difficulty breathing.C. Visible
Loops of Large Bowel- IX. ComplicationsA. Partial or Complete Bowel
Obstruction- B. Hemorrhage- ulceration into the surrounding blood
vessels C. Perforation- is a serious and potentially fatal
complication of inflammatory bowel disease (IBD). A bowel
perforation is a surgical emergency, and needs immediate treatment
to prevent infection or death.D. Abscess Formation- is associated
with colon cancer.E. Peritonitis- aninflammationof theperitoneum,
the thin tissue that lines the inner wall of the abdomen and covers
most of the abdominal organs. Peritonitis may be localized or
generalized, and may result frominfection or from a non-infectious
process.F. Sepsis- is a potentially deadlymedicalcondition
characterized by a whole-bodyinflammatorystate (called asystemic
inflammatory response syndromeor SIRS) caused by severe
infection.G. Shock- is a life-threateningmedical condition that
occurs due to inadequatesubstrateforaerobic cellular respiration.
In the early stages this is generally an inadequate tissue level
ofoxygen.
X. Preventive MeasuresA. Lifestyle- increase consumption of
whole grains, fruits and vegetables, and reducing intake of red
meat. Physical activity can moderately reduce the risk of colon
cancer.B. Medication- early medication can prevent the occurrence
of disease.C. Screening- for early detection and prevention in the
occurrence of colon cancer.
XI. Medical Management:A. Surgical- For people with localized
cancer the preferred treatment is complete surgical removal with
the attempt of achieving a cure.A1. Colonoscopy- is the endoscopic
examination of the large bowel and the distal part of the small
bowel with CCD camera or a fiber optic camera on flexible tube
passed through the anus.A2. Cecostomy- new surgical procedure that
is used to clear bowels of fecal matter.A3. Colostomy- procedure in
which a stoma a formed by drawing the healthy end of the large
intestine or colon through an incision in the anterior abdominal
wall and suturing it into place.A4. Ileonal Anastomosis- is an
invasive procedure performed in patients who have not responded to
more conservative treatments.It allows people to have normal bowel
function even after theircolonand rectal lining are removed.
B. Chemotherapy- may be used in addition to surgery in certain
casesasadjuvant therapy. If cancer has entered thelymph nodesadding
the chemotherapy agentsfluorouracil, orcapecitabineincreases life
expectancy. If the lymph nodes do not contain cancer the benefits
of chemotherapy are controversial. If the cancer is widely
metastatic or unresectable, treatment is thenpalliative. Typically
in this case a couple of different chemotherapy medications are
used.Chemotherapy drugs may includecombinations of
agentsincludingfluorouracil,capecitabine,UFT,leucovorin,irinotecan,
oroxaliplatin.C. Radiation- While a combination ofradiationand
chemotherapy may be useful forrectal cancer,its use in colon cancer
is not routine due to the sensitivity of the bowels to radiationD.
Palliative Care- In people with incurable colorectal
cancer,palliative carecan be considered for improvingquality of
life. Surgical options may include non-curative surgical removal of
some of the cancer tissue, bypassing part of the intestines, or
stent placement. These procedures can be considered to improve
symptoms and reduce complications such as bleeding from the tumor,
abdominal pain and intestinal obstruction.Non-operative methods of
symptomatic treatment include radiation therapy to decrease tumor
size as well as pain medications.
XII. Nursing Process: Nursing Interventions1. Assessment-
complete a health history to obtain information about fatigue,
abdominal or rectal pain (eg, location, frequency, duration,
association with eating or defecation), past and present
elimination patterns, and characteristics of stool (eg, color,
odor, consistency, presence of blood or mucus).2. Planning and
Goals- The major goals for the patient may include attainment of
optimal level of nutrition; maintenance of fluid and electrolyte
balance; reduction of anxiety; learning about the diagnosis,
surgical procedure, and self-care after discharge; maintenance of
optimal tissue healing; protection of peristomal skin; learning how
to irrigate the colostomy and change the appliance; expressing
feelings and concerns about the colostomy and the impact on himself
or herself; and avoidance of complications.3. Peparing a Patient
for Surgery- The patient anticipating surgery for colorectal cancer
has many concerns, needs, and fears. He or she may be physically
debilitated and emotionally distraught with concern about lifestyle
changes after surgery, prognosis, ability to perform in established
roles, and finances. 4. Providing Emotional Support- All members of
the health care team, including the enterostomal therapy nurse,
should be available for assistance and support. The nurses role is
to assess the patients anxiety level and coping mechanisms and
suggest methods for reducing anxiety such as deep-breathing
exercises and visualizing a successful recovery from surgery and
cancer.5. Providing Post Operative Care- Postoperative nursing care
for patients undergoing colon resection or colostomy is similar to
nursing care for any abdominal surgery patient (see Chap. 20),
including pain management during the immediate postoperative
period. The nurse also monitors the patient for complications such
as leakage from the site of the anastomosis, prolapse of the stoma,
perforation, stoma retraction, fecal impaction, skin irritation,
and pulmonary complications associated with abdominal surgery.6.
Maintaining Optimal Nutrition- The nurse teaches all patients
undergoing surgery for colorectal cancer about the health benefits
to be derived from consuming a healthy diet. The diet is
individualized as long as it is well balanced and does not cause
diarrhea or constipation. The return to normal diet is rapid.7.
Providing Wound Care- The nurse frequently examines the abdominal
dressing during the first 24 hours after surgery to detect signs of
hemorrhage. It is important to help the patient splint the
abdominal incision during coughing and deep breathing to lessen
tension on the edges of the incision. The nurse monitors
temperature, pulse, and respiratory rate for elevations, which may
indicate an infectious process.8. Monitoring and Managing
Complications- It is important to frequently assess the abdomen,
including decreasing or changing bowel sounds and increasing
abdominal girth, to detect bowel obstruction. The nurse monitors
vital signs for increased temperature, pulse, and respirations and
for de decreased blood pressure, which may indicate an
intra-abdominal infectious process. It is important to report
rectal bleeding immediately because it indicates hemorrhage.XIII.
Promoting Home and Community Based Care
Teaching Patients Self-Care- Patient education and discharge
planning require the combined efforts of the physician, nurse,
enterostomal therapist, social worker, and dietitian. Patients are
given specific information, individualized to their needs, about
ostomy care and signs and symptoms of potential complications.
Dietary instructions are essential to help patients identify and
eliminate irritating foods that can cause diarrhea or constipation.
It is important to teach patients about their prescribed
medications (ie, action, purpose, and possible side effects).5
minutes
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10 minutes
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15 minutes
Socialized discussion.
Concept Mapping
Concept Mapping
Concept Mapping with Visual Aid
Concept Mapping
Socialized Discussion
Socialized Discussion / Concept Mapping
Socialized Discussion / Concept Mapping
Interactive discussion.
Let the listeners identify Colorectal Cancer, its Cell Type and
its causes.
The listeners will be able to list down at least 5 Assessment
and Diagnostic Findings for Colorectal Cancer
The learners will be able to answer questions given by the
reporter at a 75% competency.
The learners will be able to answer questions given by the
reporter at a 75% competency.
The learners will be able to answer questions given by the
reporter at a 75% competency.
Question and answer.
Sources:
Smeltzer, S. C. & Bare B.C. (2006) Mediacal Surgical
Nursing: 11th ed. Philadelphia, Lippicott Williamns and Wilkins
Black J. & Jacobs E. (1997). Medial Surgial Nursing:
Clinical management for continuity of care. PA. USA: W.B. Saunders
Company
Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl
J Med. 2003;348:919932.
Meyerhardt JA, Giovannucci EL, Ogino S, et al. Physical activity
and male colorectal cancersurvival. Arch Intern Med.
2009;169:21022108.
National Cancer Institute. Physician Data Query (PDQ). Rectal
Cancer Treatment.10/12/2011. Accessed
atwww.cancer.gov/cancertopics/pdq/treatment/rectal/healthprofessional
on January 20, 2013.
National Comprehensive Cancer Network. NCCN Clinical Practice
Guidelines in Oncology:Colon Cancer. V.3.2012. Accessed at
www.nccn.org on January 20, 2013
COLLEGE OF NURSINGSilliman UniversityDumaguete City
SYLLABUS ON COLON/COLORECTAL CANCER
SUBMITTED BY: Roma, Charimae S.
SUBMITTED TO: Asst. Prof. Venus F. Monroy01-22-13
COLLEGE OF NURSINGSilliman UniversityDumaguete City
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