Transcript 16. Interventions for Clients with Colorectal Cancer

Interventions for Clients with
Colorectal Cancer
What is Colorectal Cancer?

Third most common type of cancer
and second most frequent cause of
cancer-related death

A disease in which normal cells in
the lining of the colon or rectum
begin to change, grow without
control, and no longer die

Usually begins as a noncancerous
polyp that can, over time, become a
cancerous tumor
What is the Function of the Colon
and Rectum?

The colon and
rectum comprise the
large intestine (large
bowel)

The primary function
of the large bowel is
to turn liquid stool
into formed fecal
matter
What Are the Risk Factors
for Colorectal Cancer?
Polyps (a noncancerous or precancerous
growth associated with aging)
 Age
 Inflammatory bowel disease (IBD)
 Diet high in saturated fats, such as red meat
 Personal or family history of cancer
 Obesity
 Smoking
 Other

Hereditary Colorectal Cancer
Syndromes: HNPCC
Hereditary non-polyposis colorectal cancer (HNPCC),
sometimes called Lynch syndrome, accounts for
approximately 5% to 10% of all colorectal cancer
cases
 The risk of colorectal cancer in families with HNPCC is
70% to 90%, which is several times the risk of the
general population
 People with HNPCC are diagnosed with colorectal
cancer at an average age of 45
 Genetic testing for the most common HNPCC genes is
available; measures can be taken to prevent

Hereditary Colorectal Cancer
Syndromes: FAP
Familial adenomatous polyposis (FAP) accounts for 1% of
colorectal cancer cases
 People with FAP typically develop hundreds to thousands of
colon polyps (small growths); the polyps are initially benign
(noncancerous), but there is nearly a 100% chance that the
polyps will develop into cancer if left untreated
 Colorectal cancer usually occurs by age 40 in people with FAP
 Mutations (changes) in the APC gene cause FAP; genetic
testing is available
 Yearly screening for polyps is recommended
 Attenuated familial adenomatous polyposis
(AFAP) is related to FAP; people have fewer
polyps

Hereditary Colorectal Cancer
Syndromes

Several other less common
syndromes can increase a
person’s risk of colorectal cancer

Talk with your doctor about
finding a genetic counselor if
you have a history of colorectal
cancer in your family and family
members developed cancer
before age 50
Colorectal Cancer and Early
Detection

Colorectal cancer can be prevented through
regular screening and the removal of polyps

Early diagnosis means a better chance of
successful treatment

Screening should begin at age 50 for all
“average risk” individuals or sooner if you have a
family history of colorectal cancer, symptoms, or
a personal history of inflammatory bowel disease
Screening Methods for Colorectal
Cancer
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Colonoscopy (currently the best way to prevent
and detect colorectal cancer)
Virtual colonography
Sigmoidoscopy
Fcal occult blood test
Double contrast barium enema
Digital rectal examination
What Are the Symptoms of
Colorectal Cancer?

A change in bowel habits: diarrhea, constipation, or a
feeling that the bowel does not empty completely
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Bright red or dark blood in the stool
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Stools that appear narrower or thinner than usual

Discomfort in the abdomen, including frequent gas
pains, bloating, fullness, and cramps

Unexplained weight loss, constant tiredness, or
unexplained anemia (iron deficiency)
How is Colorectal Cancer
Evaluated?

Diagnosis is confirmed with a biopsy

Stage of disease is confirmed by
pathologists and imaging tests, such
as computerized tomography (CT or
CAT) scans

Endoscopic ultrasound and magnetic
resonance imaging (MRI) may also be
used to stage rectal cancer
Cancer Treatment: Surgery
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Foundation of curative therapy
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The tumor, along with the adjacent
healthy colon or rectum and lymph
nodes, is typically removed to offer
the best chance for cure

May require temporary or (rarely)
permanent colostomy (surgical
opening in abdomen that provides
a place for waste to exit the body)
Cancer Treatment: Chemotherapy
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Drugs used to kill cancer cells
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Typical medications include
fluorouracil (5-FU), oxaliplatin
(Eloxatin), irinotecan
(Camptosar), and capecitabine
(Xeloda)

A combination of medications is
often used
Types of Chemotherapy
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Adjuvant chemotherapy is given after
surgery to maximize a patient’s chance for
cure
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Neoadjuvant chemotherapy is given
before surgery
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Palliative chemotherapy is given to
patients whose cancer cannot be removed
to delay or reverse cancer-related
symptoms and substantially improve
quality and length of life
Cancer Treatment: Radiation
Therapy

The use of high-energy x-rays or other particles
to destroy cancer cell

Used to treat rectal cancer, either before or after
surgery

Different methods of delivery

External-beam: outside the body
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Intraoperative: one dose during surgery
New Therapies: Antiangiogenesis
Therapy
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“Starves” the tumor by disrupting its blood
supply

This therapy is given along with
chemotherapy

Bevacizumab (Avastin) was approved by
the U.S. Food and Drug Administration
(FDA) in 2004 for the treatment of stage
IV colorectal cancer
New Therapies: Targeted Therapy

Treatment designed to target cancer cells
while minimizing damage to healthy cells
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Cetuximab (Erbitux) was approved by the
FDA in 2004 for the treatment of
advanced colorectal cancer
Colorectal Cancer Staging
Staging is a way of describing a cancer, such as
the depth of the tumor and where it has spread
 Staging is the most important tool doctors have
to determine a patient’s prognosis
 Staging is described by the TNM system: the
size (the depth of penetration of the Tumor into
the wall of the bowel), whether cancer has
spread to nearby lymph Nodes, and whether the
cancer has Metastasized (spread to organs such
as the liver or lung)
 The type of treatment a person receives
depends on the stage of the cancer
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Stage 0 Colorectal Cancer

Known as “cancer in
situ,” meaning the
cancer is located in
the mucosa (moist
tissue lining the
colon or rectum)

Removal of the polyp
(polypectomy) is the
usual treatment
Stage I Colorectal Cancer

The cancer has
grown through the
mucosa and invaded
the muscularis
(muscular coat)

Treatment is surgery
to remove the tumor
and some
surrounding lymph
nodes
Stage II Colorectal Cancer
 The
cancer has grown
beyond the muscularis
of the colon or rectum
but has not spread to
the lymph nodes
 Stage
II colon cancer
is treated with surgery
and, in some cases,
chemotherapy after
surgery
Stage III Colorectal Cancer

The cancer has
spread to the
regional lymph nodes
(lymph nodes near
the colon and
rectum)

Stage III colon
cancer is treated with
surgery and
chemotherapy
Stage IV Colorectal Cancer
 The
cancer has spread
outside of the colon or
rectum to other areas of
the body
 Stage IV cancer is treated
with chemotherapy.
Surgery to remove the
colon or rectal tumor may
or may not be done
 Additional surgery to
remove metastases may
also be done in carefully
selected patients
Coping With the Side Effects of
Cancer
and its Treatment
Side effects are treatable; talk with the
doctor or nurse
 Fatigue is a common, treatable side effect
 Pain is treatable; non-narcotic pain
relievers are available
 Antiemetic drugs can reduce or prevent
nausea and vomiting

Follow-Up Care
Doctor’s visits
 Serial carcinoembryonic antigen (CEA)
measurements are recommended
 Colonoscopy one year after removal of
colorectal cancer
 Surveillance colonoscopy every three to
five years to identify new polyps and/or
cancers
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