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Rock Street 34, San Francisco State

What percentage of deaths are due to CRC?
9%
What gender is CRC most common in?
Men
What race doe CRC have the highest mortality?
African Americans
What is the most common unmodifiable risk factor for CRC?
Age
What are risk factors for CRC?
Genetic conditions such as Familiar Adenomatous Polypsis (which accounts for 5-10% of cases)

Personal Hx of IBD

Individual or Family HX of CRC

Colorectal polyps

What is the most common type of CRC?
Adenocarcinoma (85%)
How does CRC metastasize?
Tumor spread through the walls of the colon into musculature and into the lymphatic and vascular systems
What are modifiable risk factors for CRC?
Diet (High in red meat, low in fruits and veggies)

Obesity

Sedentary

ETOH

Smoking

What is initial screening for CRC?
Colonoscopy
When should people start getting colonoscopies?
Age 50-75
Except for African Americans who should start when they are 45
How often should you get a colonoscopy?
Every 10 years
How often should you get a sigmoidoscopy?
Every 5 years
Who is at the highest risk for CRC?
People with first degree relative in whom CC was diagnosed before age 60

People with two first degree relatives with CRC

What are two types of screening tests for CRC?
Fecal Occult Blood Test (FOBT)

Fecal Immunochemical Test (FIT)

When and how often should someone get a FOBT?
Every year from age 50-75
When how often should someone get a FIT?
Every year from are 50-75
Clinical Manifestations of CRC?
Iron deficiency anemia
Rectal bleeding
Abdominal pain
Change in bowel habits
Intestinal obstructions
Intestinal perforations

Advanced:

Tenderness
Palpable abdominal mass
Hepatomegaly
Ascites

S/S of CRC in the Ascending Colon
Pain
Mass
Change in bowel habits
Anemia
S/S of CRC in Transverse Colon
Pain
Obstruction
Change in bowel habits
Anemia
S/S of CRC in Descending Colon
Pain
Change in bowel habits
Bright red blood in stool
Obstruction
S/S of CRC in Rectum
Blood in stool
Change in bowel habits
Rectal discomfort
Stage 0 CRC
Cancer has not grown beyond inner layer of colon wall
Stage 1 CRC
Cancer has grown to out layer of colon wall
Stage 2 CRC
Tumor is through the colon wall, but has not spread to lymph nodes
Stage 3 CRC
Cancer has spread to lymph nodes
Stage 4 CRC
Cancer has spread to distant sites in the body (liver, lungs)
Most common sites of CRC metastasis?
Regional nodes
Liver
Lungs
Bones
Brain
What is needed to confirm a diagnosis of CRC?
Colonoscopy and tissue biopsy
What additional lab studies must be done when CRC is suspected?
CBC to check for anemia
Coagulation studies
Liver function tests
Why is a CT Scan/CT guided colonoscopy performed?
To visualize the lesion because it more accurate than a CT
What is a CEA?
Carcinoembryonic antigen
Denotes malignancy, but is not specific for just CRC
What staging system does CRC use?
TNM
What causes the prognosis of CRC to worsen?
Greater size/depth of tumor
Node involvement
Metastasis
Surgical goals R/T CRC?
Complete resection
Thorough exploration
Removal of all nodes that drain the area
Restoration of bowel continuity
Prevention of complications
What is polypectomy used for?
To resect CRC in situ
When is a polypectomy successful?
When the resected margin of the polyp is free of cancer

When the cancer is well differentiated

When there is no lymphatic or blood vessel involvement

What is important to do before surgery?
Decrease colonic bacteria

This helps prevent infection and prevent abscess formation

What is chemo used for in CRC?
Used to shrink a tumor before surgery

Used as an adjuvant treatment following colon resection

For palliative treatment

When is radiation therapy used for CRC?
Post operatively as adjuvant to surgery and chemo

As palliative therapy for metastasis to reduce tumor size and provide symptomatic relief

Objective data R/T CRC?
CBC
Guaiac-positive stools
Palpable mass upon DRE
Sigmoidoscopy/Colonscopy with biopsy
Barium Enema
CT Scan
Nursing diagnoses R/T CRC?
Diarrhea/constipation R/T altered bowel elimination patterns

Fear/anxiety R/T Dx of CRC, surgical or therapeutic interventions, and possible terminal illness

Ineffective coping R/T Dx of Cancer and side effects of Tx

What is important to teach R/T Colonoscopy?
Colonoscopy only detects polyps when the bowel has been adequately prepared!
Post-op Care R/T CRC?
Sterile dressing change
Care of drains
Stoma education
Regular examination of wound
Monitor suture for infection
Provide sexual dysfunction education

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Post Author: Arnold

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