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 factors1.Dietary factors2.Environmental factors3.Lynch syndrome4.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

pathophysiology

Clinical features

Right side 1.abdominal pain 2.bleeding 3.weakness 4. Fatigue5. Palpable

abdominal mass6.Malena7.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.Pain2.Rectal bleeding3.Bloody stools4. Altered bowel pattern 5. Perineal and buttok pain

Management Medical management

1.chemotherapy 2.Bilogic or targeted therapy3.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

Loop stoma

Double-barreled stoma

Knock pouch

Colostomy care

Emotional support as the patient cope with a radical body change

Patient teaching about stoma care

Normal stoma

EquipmentsPouching system GlovesBed pan Plastic bagsTissue paper Wash clothCleansing solutionclamp

Explain the procedure to the patientScreen the patient Hand wasingWear 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.

Irrigation kit

Cone with sleeve

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.. CELECOXIB ANDCOMBINATION OF SULINADAC ,DIFLUROETHYL LORNITHINE REDUCE RISK OF POLYPS DEVELOPMENT