Transcript 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

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

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
The colon has four sections:
 The ascending colon starts with the cecum,
where the small bowel attaches to the colon
on the right side of the lower abdomen and
moves upward

The transverse colon crosses from the right
to the left side in the upper abdomen
A look at the colon and rectum

The descending colon continues downward
on the left side of the abdomen

The sigmoid colon has an “S” shape

The highest incidence of colon cancer is in the
sigmoid and ascending colon. The rectum is
the final 6 inches of the digestive tract
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?

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

Obesity

Diet high in red and
processed meats,
low in fruits and
vegetables

Adult-onset diabetes

Limited physical
activity
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



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
Sigmoid colon
- blood through the rectum, bowel changes,
narrow stool
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

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

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

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

Best possible chance for cure

Aims at resecting tumor and preventing
recurrence

80% of patients have potentially curative
surgery
Surgery

Standard surgical treatment is colectomy

Lymph nodes will be removed for biopsy
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

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

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

Also known as biological therapy

Designed to stop cancer cell growth

May be used alone or with chemotherapy
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

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

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 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

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 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 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 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)