Colorectal Cancer
Risk Factors?
No single risk factor
Highest risk—first-degree relatives with CRC and people with IBD
-Family history of CRC or familial adenomatous polyposis (FAP)
-Hereditary form
-Abnormal KRAS gene (oncogene)
Other: obesity, smoking, more than 7 servings red meat/wk, more than 4 alcohol drinks/wk, diabetes
Stage 1 Tumor Treatment
Stage I tumors
Removal of tumor and at least 5 cm of surrounding intestine and nearby lymph nodes
Cancer-free ends are anastomosed
May be done laparoscopically
What are diverticula?
Diverticula—saccular dilations or outpouchings of the mucosa in the colon
What is a fistula?
Abnormal tract between two hollow organs or a hollow organ and the skin
What is a malabsorption syndrome & the various types?
Impaired absorption of fats, carbohydrates, proteins, minerals, and vitamins
Most common—lactose intolerance
Other common—IBD, celiac disease, and cystic fibrosis
Factors that decrease the risk of CRC:
Healthy weight
Physically active
Limit alcohol
No smoking
Diet high in fruits, vegetables, and grains
Stage 2 Tumor Treatment
Low-risk stage II tumors
-Wide resection and reanastomosis
High-risk stage II tumors
-Same as for low-risk stage II tumors, plus chemotherapy
What is diverticulitis and diverticulosis?
Diverticulosis—multiple, noninflamed diverticula
Diverticulitis—one or more inflamed diverticula
Manifestations of Fistulas?
Complication—increased morbidity and mortality, extended length of stay, and increased costs
Simple—1 short direct tract
Complex—multiple organs, abscess, opens into base of wound
Output: low less than 200 mL/day; moderate 200 to 500 mL/day; high greater than 500 mL/day
Early signs: fever and abdominal pain
Common S/S?
Most common—weight loss, diarrhea, steatorrhea
Manifestations?
Symptoms often do not appear until disease is in advanced stages
Common: iron-deficiency anemia, rectal bleeding, abdominal pain, change in bowel habits
Early: none or nonspecific; fatigue, weight loss
Advanced: abdominal tenderness, palpable mass, hepatomegaly, ascites
Right-sided CRC
-Bleeding more common; unrecognized and early sign of anemia
-Diarrhea
Left-sided CRC
-Hematochezia (fresh blood in stool)
-Bowel obstruction
Complications: obstruction, bleeding, perforation, peritonitis, fistula formation
Stage 3 Tumor Treatment
Stage III tumors
Surgery and chemotherapy
May have chemotherapy and radiation preoperatively to reduce tumor size
Manifestations of Diverticulosis?
Diverticulosis—most asymptomatic
Abdominal pain, bloating, flatulence, changes in bowel habits; Serious: bleeding or diverticulitis
Fistula Management?
Fistula management:
Identify tract
Maintain fluid and electrolytes: IV replacement
Control infection
Protect surrounding skin: WOCN consult
Manage output: Monitor I & O; drainage
Nutritional support: dietician; high-calorie, high-protein enteral or parenteral nutrition
Most heal spontaneously; some require surgery
Treatment?
Depends on cause
Gold Standard Diagnostic?
Colonoscopy
Nonresectable tumors or mestasis
Nonresectable tumors or metastasis:
Surgery is palliative; relieves obstruction or controls bleeding
Chemotherapy and radiation—control the spread and provide pain relief
Manifestations of Diverticulitis?
Acute pain in LLQ, distention, decreased or absent bowel sounds, nausea, vomiting, systemic symptoms of infection; Older adults—afebrile, normal WBC, possible abdominal tenderness
What is a hernia & types?
Protrusion of intestine through an opening or weakened area in the cavity wall
Most occur in abdomen; men more than women
Reducible—easily return to abdominal cavity
Irreducible or incarcerated—cannot be placed back into abdominal cavity; abdominal contents are trapped
Strangulated—blood supply compromised
Results in intestinal obstruction; gangrene and necrosis are concerns
Inguinal
Umbilical
Femoral
Incisional
Interprofessional Care for this?
Decision for surgery considers staging, location, and ability to restore bowel function and continence
Overall Treatment
APR, LAR, chemotherapy, targeted therapy, radiation therapy, etc.
Treatment?
Prevention:
High-fiber diet; decreased fat and red meat
Physical activity
Acute diverticulitis:
-Goal: bowel rest to reduce inflammation
• Clear liquids, bed rest, analgesia
• Severe symptoms, systemic infection, comorbidities: hospitalization: NPO, NGT, bed rest, IV fluid and antibiotics; observe for signs of abscess, bleeding and peritonitis; advance diet as tolerated
Reoccurring diverticulitis or complications:
-Surgical resection with anastomosis or temporary colostomy
Patient education:
-Explain condition and prescribed regimen
-High-fiber diet
-Fluids: at least 2 L/day
-Avoid increased intraabdominal pressure
Manifestations & Treatment of a hernia?
Manifestations:
Pain; increases with activities that increase intraabdominal pressure
May be visible
Strangulated—severe pain, vomiting, cramping, abdominal pain, distention
Treatment:
Herniorrhaphy—surgical repair; laparoscopic
Hernioplasty—reinforce weak are with wire, fascia or mesh
Strangulated—emergency surgery; temporary colostomy