colorectal cancer

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Introduction :

Introduction Colorectal cancer , commonly known as bowel cancer, includes cancerous growths in the colon , rectum , appendix . Colorectal cancer is the third most commonly diagnosed cancer in the world. Colorectal cancers arise from adenomatous polyps in the colon. These mushroom-shaped growths are usually benign . Definition :- A malignant tumor arising from the inner wall of the large intestine.

Risk factors :

Risk factors Age – most patients are older than 50 Polyps or inflammatory bowel disease Family history of colorectal cancer History of ovarian or breast cancer Diet high in red, processed, or heavily cooked meats Smoking or drinking alcohol Genetic mutations NSAIDS-aspirin Long term consumption of red meat. Increase dietary intake of fat.

Warning signs :

Warning signs blood in the stool, abdominal pain, a change in bowel habits (such as constipation or diarrhea), unexplained weight loss, or fatigue Screening :- > 50 yrs. FOBT Digital rectal examination Sigmoidoscopy Colonoscopy Barium enema

Pathophysiology :

Pathophysiology 95% from adenomatous polyps occurs( tubular,tubovillous,villous ) grows for 5 t0 10 yrs increase in size with in the lumen and bowel Increase in growth necrosis occurs Malignant tumour ( spreads tostomach,liver,peritoneal cavity,urinarybladder,ureter Involve the lungs,kidneysand bones)

Diagnosis :

Diagnosis Digital rectal exam (DRE) The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. Fecal occult blood test (FOBT) Endoscopy Sigmoidoscopy : A lighted probe ( sigmoidoscope ) is inserted into the rectum and lower colon to check for polyps and other abnormalities Colonoscopy : Double contrast barium enema (DCBE): An enema containing barium sulfate is administered, then air is insufflated into the colon, distending it. Blood tests Positron emission tomography (PET) Stool DNA testing

Clinical symptoms:

Clinical symptoms Tumors in rightcolon and small bowel -Rectal bleeding Change in bowel habits Abdominal pain Weight loss Anaemia Anorexia Nausea/ vomitting Reddish brown stools Tumors in descending colon- Ribbon like stools Stool contain bright red with mucus. dyspepsia


staging AJCC stage TNM stage Stage for Colorectal cancer Stage 0 Tis N0 M0 Tis : Tumor confined to mucosa ; cancer- in - situ Stage I T1 N0 M0 T1: Tumor invades submucosa Stage I T2 N0 M0 T2: Tumor invades muscularis propria Stage II-A T3 N0 M0 T3: Tumor invades subserosa or beyond (without other organs involved) Stage II-B T4 N0 M0 T4: Tumor invades adjacent organs or perforates the visceral peritoneum Stage III-A T1-2 N1 M0 N1: Metastasis to 1 to 3 regional lymph nodes . T1 or T2. Stage III-B T3-4 N1 M0 N1: Metastasis to 1 to 3 regional lymph nodes. T3 or T4.


Staging Stage III-C any T, N2 M0 N2: Metastasis to 4 or more regional lymph nodes. Any T. Stage IV any T, any N, M1 M1: Distant metastases present. Any T, any N.











Management :

Management The treatment depends on the stage of the cancer. Decrease tumour growth-by surgery Radiation therapy Chemotherapy- leucovorinand 5 flurouracil -Stage-III Irinotecan,5 fluro,,leucovorin -IFL for metasis . Eloxatin,5FLu,leucovorin can be given. antiangiogenic drug- bevacizumab or epidermal growth factor- erbitux can be given.

Surgical management:

Surgical management Very early cancer that develops within a polyp can often be cured by removing the polyp (i.e., polypectomy ) at the time of colonoscopy Colectomy - surgical removal of the section of colon containing the tumor with sufficient margins, and radical en-bloc resection of mesentery and lymph nodes to reduce local recurrence

PowerPoint Presentation:

Colon cancer surgery with colostomy. Part of the colon containing the cancer and nearby healthy tissue is removed, a stoma is created, and a colostomy bag is attached to the stoma ostomy – Colostomy –creating an opening between the colonand abdominal wall.

Types of colostomies:

Types of colostomies Single barrel colostomy- Double barrel colostomy Loop colostomy- Complications :- Haemorrhage Stomal necrosis Prolapse Stenosis .

PowerPoint Presentation:

Radiofrequency ablation : Cryosurgery : Chemotherapy :- When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy ) When chemotherapy is placed directly into the cerebrospinal fluid , an organ , or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas ( regional chemotherapy ).

PowerPoint Presentation:

Chemoembolization of the hepatic artery - This involves blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver. Radiation therapy:- External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , wires, or catheters that are placed directly into or near the cancer.

PowerPoint Presentation:

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of targeted therapy used in the treatment of colon cancer.

Nursing management :

Nursing management 1)Teach recording the diet- avoid bowel irritating foods. Avoid eating of non vegetarian. Add fiber rich diet. Take frequent food at regular intervals. 2)Care of colostomy site 3) Check for stromal ischaemia . 4) Check for complications. 5) Follow aseptic technique to prevent infection.

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