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Helping Patients Combat Colon Cancer. By Janice C. Colwell, RN, CWOCN, MS, FAAN, and Barbara Gordon, RN, OCN, MSN Nursing2009, April 2009 2.3 ANCC contact hours Online: www.nursingcenter.com © 2009 by Lippincott Williams & Wilkins. All world rights reserved.

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helping patients combat colon cancer

Helping Patients Combat Colon Cancer

By Janice C. Colwell, RN, CWOCN, MS, FAAN,

and Barbara Gordon, RN, OCN, MSN

Nursing2009, April 2009

2.3 ANCC contact hours

Online: www.nursingcenter.com

© 2009 by Lippincott Williams & Wilkins. All world rights reserved.

statistics regarding colon cancer
Statistics regarding colon cancer
  • 148,810 people in the U.S. received diagnosis of colon cancer in 2008
  • Estimated 49,960 died of the disease
  • Third most frequently diagnosed cancer in the U.S.
cancer of the gi tract defined
Cancer of the GI tract defined
  • Cancers of colon and rectum are colorectal cancer
  • Cancer below small intestine and above rectum is colon cancer (includes ascending, transverse, descending, sigmoid colon)
  • Rectal cancer affects last 6 inches of GI tract
a look at the colon and rectum
A look at the colon and rectum

The colon has four sections:

  • The ascending colonstarts with the cecum, where the small bowel attaches to the colon on the right side of the lower abdomen and moves upward
  • The transverse coloncrosses from the right to the left side in the upper abdomen
a look at the colon and rectum5
A look at the colon and rectum
  • The descending coloncontinues downward on the left side of the abdomen
  • The sigmoid colonhas an “S” shape
  • The highest incidence of colon cancer is in the sigmoid and ascending colon. The rectumis the final 6 inches of the digestive tract
focus on colon cancer
Focus on colon cancer
  • Deaths from colon cancer have decreased over the last 30 years
  • Possibly due to earlier diagnosis, thorough screening
  • Better treatments
who s at risk
Who’s at risk?
  • Equal among men and women
  • Increases with age; 90% of people diagnosed are over age 50
  • Additional risks include family history of adenoma polyps or colorectal cancer, inflammatory bowel disease
modifiable risk factors
Cigarette smoking

Diet high in red and processed meats, low in fruits and vegetables

Obesity

Adult-onset diabetes

Limited physical activity

Modifiable risk factors
how colon cancer develops
How colon cancer develops
  • A series of events leads to colon cancer
  • Changes in DNA oncogenes speed up cell division and turn off tumor suppressor genes
  • Adenomatous polyps cause most colon cancers; early polyp removal via colonoscopy is recommended
location and stage determine symptoms
Location and stage determine symptoms
  • Ascending colon

- tumors can be large before obstructing flow

- anemia may be first sign of tumor

  • Transverse or descending colon

- tumor may cause obstruction of solid stool

- patient may have cramping and constipation

  • Sigmoidcolon

- blood through the rectum, bowel changes, narrow stool

screening for trouble
Screening for trouble
  • Highly curable with early detection
  • 5-year survival rate is 90% if detected early
  • U. S. Preventive Service Task Force (USPSTF) screening guidelines suggest that adults age 50 to 75 at average risk with no signs and symptoms can choose one of the following options
uspstf guidelines
USPSTF guidelines
  • Average risk patients may choose:

- colonoscopy every 10 years

- sigmoidoscopy every 5 years with high

sensitivity fecal occult blood test every 3 years

- FOBT annually

  • People with known risk factors should have a colonoscopy at age 40 or earlier
uspstf screening guidelines
USPSTF screening guidelines
  • If high risk, should have colonoscopy earlier
  • No routine screening for adults age 76 to 85 except in special circumstances; mortality benefit declines after age 75
  • Screening adults over age 85 isn’t recommended; risks outweigh benefits
additional tests
Additional tests
  • Complete blood cell count can identify anemia
  • Chemistry panel to determine advanced disease; elevated liver enzymes may indicate metastasis to the liver
  • Carcinoembryonic antigen (CEA) can detect tumor recurrence after resection
  • CT can screen for metastasis to other organs
surgery
Surgery
  • Best possible chance for cure
  • Aims at resecting tumor and preventing recurrence
  • 80% of patients have potentially curative surgery
surgery16
Surgery
  • Standard surgical treatment is colectomy
  • Lymph nodes will be removed for biopsy
staging for colon cancer
Staging for colon cancer

TNM staging system

  • T (tumor): extent of the primary tumor through the colon layers
  • N (nodes): the absence or presence of metastasis to lymph nodes and number of nodes involved
  • M (metastasis): absence or presence of distant metastasis
adjuvant therapy
Adjuvant therapy
  • Systematic treatment to help reduce risk of recurrence and increase chance of cure
  • Chemotherapy is principal method; generally started 6 to 7 weeks after surgery
  • Adjuvant chemotherapy in stage III improves long-term survival
recommended therapies
Recommended therapies
  • National Comprehensive Cancer Network recommends one of the following therapies:

- 5-FU/leucovorin/oxaliplatin

- capecitabine

- 5FU/leucovorin

- participation in a clinical trial

or

- observation for resected stage III and IV disease

targeted therapy
Targeted therapy
  • Also known as biological therapy
  • Designed to stop cancer cell growth
  • May be used alone or with chemotherapy
targeted therapy21
Targeted therapy
  • Monoclonal antibodies are a type of targeted therapy
  • Antibodies - cetuximab and panitumumab (target epidermal growth factor) and bevacizumab (targets vascular endothelial growth factor) have been effective against metastatic disease
long term follow up
Long-term follow-up
  • So far, no standard for surveillance in patients who have surgically resected colon cancer
  • Follow-up care most likely includes:

- history and physical every 3 to 6 months for 2 years, then every 6 months for 5 years

- stage II or higher may have serum CEA

every 3 to 6 months for 5 years

- annual CT of chest, abdomen, pelvis for 3 years if patient has high risk of recurrence

teaching your patient what to expect
Teaching your patient what to expect
  • Offer support for diagnosis and treatments the patient will undergo
  • Encourage patient in managing the disease and adhering to treatment plan
  • Educate patient regarding what to expect
teaching your patient what to expect24
Teaching your patient what to expect
  • Advise patient to follow a low-residue diet for 6 weeks after surgery
  • Instruct patient that he may need to use fiber supplements
managing the effects of chemotherapy
Managing the effects of chemotherapy
  • Appetite changes

- suggest drinking fluids between meals

- eat food at room temperature

- light exercise to stimulate appetite

- eat nutritious snacks high in calories and protein

managing the effects of chemotherapy26
Managing the effects of chemotherapy
  • Mucositis

- swish ice chips in mouth 5 minutes prior and for 30 minutes with chemotherapy treatments

- remove dentures

- gently brush teeth

- rinse with salt water/baking soda solution

- avoid spicy foods and foods requiring excessive chewing

managing the effects of chemotherapy27
Managing the effects of chemotherapy
  • Fatigue

- plan naps if possible

- some fatigue is normal

- alert healthcare provider if symptoms of fatigue persist despite rest or experiences shortness of breath

managing the effects of chemotherapy28
Managing the effects of chemotherapy
  • Finger and toe numbness

- hand-foot syndrome: skin on hands and feet appears red and peels

- can be painful

- advise patient not to handle cold items (iced beverages/frozen foods)