colorectal cancer

Colorectal cancer
Presented by .
LIKHILA ABRAHAM

DEFINITION
 Colorectal cancer is a disease in which
cancer cells grow either colon or in rectum
.the colon are the parts of digestive system
,normally the cells of colon and rectum
divide in a regular manner .,if cells keep on
dividing a mass of tissue forms called tumor,
that may b benign or malignant.(medical
encyclopedia)

Colorectal cancer commonly known as colon
cancer or bowel cancer ;which is a cancer
from uncontrolled cell growth in the colon or
rectum ,genetic analysis shown that
essentially colon and rectum tumors are the
same type of carcinomas..national cancer
institute)

etiology
 1.inflammatory bowel disease
 2.genetic mutations
 3.polyps
Risk factors
1.Dietary factors
2.Environmental factors
3.Lynch syndrome
4.Familial adenomatous polyposis

Cancer distribution
15%
5%
9%
20%
50%

Classifications(duke’s )
 Duke A:the tumor penetrates into the mucosa of
bowel wall no further
 DukeB :B1:tumor penetrates into but not through
the muscular layer
 B2;tumor penetrates into through the
muscular layer
 Duke C:C1:tumor penetrates into but not through
the muscular layer there is pathogenic evidence
of colon cancer in the lymph nodes


C2;tumor penetrates into the muscular layer with
pathological evidence of colon cancer in the lymph
nodes
Modified duke D:the tumor spread beyond the
confines ..metastasis to other organs

TNM STAGING
 T;TUMOR
 T1:tumor invades submucosa
 T2:tumor invades muscular layer
 T3:tumor invades to muscular and peri rectal
tissues
 T4:tumor perforates the organ and other
structures

Node (N)
 N0: No regional lymph node metastasis
 N1:metastasis to 1 to 3 regional lymph nodes
 N2: Metastasis in 4 or more regional lymph
nodes
 Metastasis (m)
 M0:no metastasis
 M1 :distant metastasis

Stages
 Stage1:T1N0M0;T2N0M0(cancer has begun
to spread but still in the inner linig
 Stage2:T3N0M0 ,T4N0M0(cancer has spread
to other organs near colon and rectum
 Stage3:T4N1 M0 (cancer has spread to lymph
nodes .
 Stage 4(cancer spread through lymph nodes
to other distant parts of the body

Clinical features
 Right side
 1.abdominal pain
 2.bleeding
 3.weakness
4. Fatigue
5. Palpable abdominal
mass
6.Malena
7.Bowel obstruction
 Left side
 1.coliky pain
 2.bleeding
 3.obstruction
 4.weakness and
fatigue
 5 ribbon like stools
 6.nausea and
vomitting

Rectum
1.Pain
2.Rectal bleeding
3.Bloody stools
4. Altered bowel pattern
5. Perineal and buttok
pain

Management
Medical management
1.chemotherapy
2.Bilogic or targeted therapy
3.Radiation therapy

Surgical management
 1.colectomy (right hemicolectomy-asending
colon
 Left hemi colectomy(decending colon)
 Extended hemicolectomy(transeverse colon)
 Sigmoidectomy
 Tottal colectomy
 Subtottal colectomy
 Colostomy

Colostomy
 A colostomy is a surgical procedure in which a
stoma is formed by drawing the healthy end of
the large intestine though the abdominal wall
and suturing in to place (medical encyclopedia)
 Colostomy is a surgical procedure that allows
intestinal contents to pass from the bowel
through an opening is called STOMA .the stoma
created when the intestine is brought through
the abdominal wall and sutured to the
skin.(colostomy nursing care)

Types of ostomies
 End stoma

Colostomy care
 Emotional support as the patient cope with a
radical body change
 Patient teaching about stoma care

Equipments
Pouching system
Gloves
Bed pan
Plastic bags
Tissue paper
Wash cloth
Cleansing solution
clamp

Explain the procedure to the
patient
Screen the patient
Hand wasing
Wear gloves
Arrange all the article near to
the patient

Remove contents from the pouch

Remove all the content to a bed pan by
opening the clamp ,after procedure
return the clamp and remove the pouch
from the skin wipe the stoma with wash
cloth.if physian approves cleansing
solution use that.dry the area
Select flange size 1or 2cm larger than
the stoma,trace the size.make the strter
hole.attach the pouch on skin
barrier.remove pouch when it is 1/3rd
filled

colostomy irrigation
Gather Necessary Materials Needed -You will
need the following materials: a colostomy
irrigation water bag with tubing and cone .
This is good because it has a very
handy temperature indicator to prevent any
stomach cramping and has a flowmeter to
control water flow. Another thing is
your Irrigation drainage bag with belt (ask
about the variant from hollister 7724) this is a
reusable bag which comes very handy. Of course
you also need your paper towels.

Fill the colostomy irrigation bag -
can always use mineral water. Just make sure the
temperature is a variant of your body temperature
and not on any extremes.(normal body temp is 37.5
degree celsius).The amount of water still varies per
individual; some use 750ml and some use 1.5 Liters
of water. can start with 750mL (again, your doctor's
advise is important)
Attach irrigation sleeve - your irrigation drainage
bag can now be attached using your belt placing
your stoma on the middle of the ring.

Insert the cone of the irrigation water bag to
stoma - . Just make sure you insert the cone
firm enough to avoid water leaks.
Infuse the water to your stoma - Start at a
slower rate and gradually increase water flow.
The infusion will last from 3-5 minutes.You dont
have to fill in the whole 1,000mL in. (Remember:
if you encounter any discomfort at this stage,
stop the water infusing, remove the cone for a
while, then continue again and start at a slower
rate of infusion)

Let the stool exit - After infused, remove the
cone and let the stool exit to the sleeve or the
collection bag with belt that you have attached
earlier.This process will take around 45 to 60
minutes. . If you see enough stool has collected in
the bag, go back to the bathroom, deposit the
contents to the bowl and close the sleeve again.
Repeat this process until everything has
evacuated from the bowel.

Remove the sleeves and Put on regular
pouching system - After the bowel is empty,
remove the sleeves, wash it with soap and
water, rinse and dry them.You may way to
use disinfectant to make it odorfree and
clean.After this, you can now freely use a
patch or your regular pouching system.

Nursing management
 Accute pain related to inflammatory process
 Deficient fluid volume related to vomiting
 Imbalanced nutrition less than body
requirement related to dietary restriction
 Disturbed body image related to fecal
diversion
 Anxiety related to the loss of bowel control
 Risk for impaired skin integrity related to
discharge in the peristomal area

Complication
 Liver cancer
 Lung cancer
 Intestinal obstruction
 Intestinal perforation
Prevention
 Colonoscopy
 Polyps removal
 NSAID

ADVANCEMENTS
NANOTECHNOLOGY
 DMFO.. CELECOXIBANDCOMBINATION
OF SULINADAC ,DIFLUROETHYL
LORNITHINE REDUCE RISK OF POLYPS
DEVELOPMENT

colorectal cancer

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