COLORECTAL CANCER

DEFINITION

Colorectal cancer, commonly known as bowel cancer, is a cancer from uncontrolled cell growth in the colon, rectum, or appendix. Symptom typically include rectal bleeding and anemia which are sometimes associated with weight loss and changes in bowel habits.

RISK FACTORS Increasing age and male gender Alcohol consumption Smoking Family history of colon cancer or polyps Previous colon cancer History of Inflammatory Bowel Disease

(Ulcerative colitis/ Regional enteritis) High fat and low fiber diet and red meat Hereditary Obesity Lack of physical exercise

PATHOPHYSIOLOGY

CLINICAL MANIFESTATIONS Change in bowel habits Worsening constipation Blood in stool Rectal bleeding Dull abdominal pain and malena Abdominal cramps Narrowing stools Rectal lesions Tenesmus Diarrhea Incomplete evacuation of bowel Rectal pain Weight loss Pyrexia Loss of appetite Nausea and vomiting Unexplained Anemia Anorexia and fatigue

ASSESSMENT AND DIAGNOSIS Abdominal and rectal examination Fecal Occult Blood Testing (FOBT) Barium enema Proctosigmoidoscopy Carcino Embryonic Antigen(CEA) Studies Colonoscopy

MEDICAL MANAGEMENT

MANAGEMENT IV Fluids Nasogastric Suction Adjuvant Therapy

Duke’s class C – 5-Fluorouracil +Levamisole Regimen

Duke’s class B or C – 5-Fluorouracil and high doses of pelvic irradiation

Mitomycin Radiation Therapy – Before, during and

after surgery to reduce tumor size

Surgical Management (curative/palliative) Laparoscopic colotomy with polypectomy Segmental resection with anastomosis –

removal of tumor and portions of the bowel on either side of the growth, as well as the blood vessels and lymphatic nodes

Temporary colostomy with segmental resection and anastomosis and reanastomosis of colostomy

Permanent colostomy or ileostomy for palliation

Temporary loop ileostomy

Segmental Resection with Anastomosis

Abdominoperineal Resection with Colostomy

Ostomy Surgeries

Numerous medical conditions, including congenital defects, trauma, inflammatory bowel disease (IBD),and bowel and bladder cancer, can be treated by ostomy surgeries

These surgeries close the normal route of elimination of bodily wastes and create a new opening (stoma)

Ostomy Surgeries

GI Stomas Jejunosto

my Ileostomy Cecostom

y Colostomy

Colostomy Colostomy: A surgically

created opening in the abdominal wall through which digested food passes. Temporary colostomy Permanent

colostomy Reasons for surgery:

Cancer, diverticultis trauma, imperforate anus

Vocational impact – restrict heavy lifting

Ileostomy A surgically created

opening in the abdominal wall through which digested food passes. The Ileum (the lowest part of the small intestine) is brought through the abdominal wall to form a stoma. A Ileostomy is performed when a disease or injured colon cannot be treated successfully.

Vocational implication – restrict heavy lifting.

Jejunostomy Can be used for either feeding or removal

of stool, depending on if the stoma is at the beginning or end of the Jejunum. Feeding: A tube is placed into the jejunum

versus the stomach (gastrostomy). People with a jejunostomy can eat and drink by mouth. The device is an “insurance” mechanism for nutrition. It can be temporary or permanent.

Stool removal: in certain instances a jejunostomy is conducted similarly to the Ileostomy. Again, this usually temporary.

Cecostomy

A tube that goes through the skin into the beginning of the large intestine to help remove gas or feces by injecting a solution (antegrade enema) that flushes the gas and stool out of the rectum.

Can be temporary or permanent.

COMPLICATIONS Paralytic Ileus Mechanical Obstruction Peritonitis Abscess Formation Wound Disruption Intraperitoneal and Abdominal Wound

Infection Dehiscence of Anastomosis Fistulas