Colorectal Cancer, Constipation, Hernias, Obstruction, Diverticular Disease (1)

Cancer definition

Uncontrolled and unregulated growth of abnormal cells in the body

Leading cause of death related to cancer

Second leading cause of death in the U.S.

Normal cell characteristics

Specific morphology, tight adherence, orderly growth, apoptosis, and euploidy (normal chromosomes)

Cancer cell characteristics

Abnormal, nonfunctional, loose adherence, migratory, no contact inhibition, can metastasize

Carcinogenesis definition

Process of normal cell changing into cancer cell

Four stages of carcinogenesis

Initiation, Promotion, Progression, Metastasis

Initiation stage

Description: irreversible change caused by carcinogens; DNA damage occurs

Examples of carcinogens

Chemicals (smoking), radiation (UV light), viruses (HPV)

Promotion stage

Enhanced growth of altered cells; promoters like insulin and estrogen

Latency period

Time between cell initiation and tumor formation; can be months to years

Progression stage

Continued change of cancer cells; tumor develops its own blood supply

Metastasis stage

Cancer cells spread to distant organs via blood or lymph

Common metastasis sites

Breast → bone, lung, liver, brain; Colorectal → liver, lymph nodes

Risk factors for cancer

Genetic predisposition, age, lifestyle, chemical exposure, viral infection, radiation

Genetic mutations linked to cancer

BRCA1 and BRCA2 (breast, ovarian cancers)

Dietary habits to reduce cancer risk

Low fat, high fiber, limit red and processed meats, limit alcohol, eat fruits and vegetables

Vitamins that reduce cancer risk

Vitamin A (carrots, yellow veggies) and Vitamin C (citrus fruits)

7 warning signs of cancer

CAUTION (Change in bowel/bladder, A sore, Unusual bleeding, Thickening/lump, Indigestion, Obvious mole change, Nagging cough)

Cancer classification systems

Grading (G1-G4) and Staging (TNM)

Cancer grading scale

G1: well differentiated; G4: undifferentiated and most aggressive

Cancer staging system

T: tumor size, N: lymph nodes, M: metastasis

Primary prevention of cancer

Avoid carcinogens, limit alcohol, healthy diet, HPV vaccination, safe sex, regular exercise

Secondary prevention of cancer

Mammogram, colonoscopy, Pap smear, HPV testing, fecal occult blood test

Cancer management options

Surgery, radiation, chemotherapy, immunotherapy

Types of surgery for cancer

Prophylactic, diagnostic, curative, debulking, palliative, reconstructive

Radiation therapy types

Brachytherapy (internal) and teletherapy (external)

Radiation precautions

Protect skin, mark sites, avoid lotions on treatment area

Chemotherapy mechanism

Uses chemical agents to destroy rapidly dividing cells

Chemotherapy side effects

Bone marrow suppression, nausea, vomiting, mucositis, alopecia, cardiotoxicity, skin changes

Bone marrow suppression results

Anemia, neutropenia, thrombocytopenia

Neutropenia precautions

Monitor ANC, avoid crowds, use filgrastim (Neupogen)

Thrombocytopenia precautions

Avoid injury, use soft toothbrush, monitor for bleeding

Anemia treatment

Erythropoietin (Epogen), iron-rich foods, rest periods

Immunotherapy definition

Boosts immune system to fight cancer cells

Immunotherapy side effects

Fatigue, rash, infection risk

Constipation definition

Abnormal frequency or hard stool passage due to decreased motility

Constipation interventions

Increase fiber to 40 g/day, fluids to 2 L/day, and physical activity

Bulk-forming laxative prototype

Methylcellulose (Citrucel)

Surfactant laxative prototype

Docusate sodium (Colace)

Stimulant laxative prototype

Bisacodyl (Dulcolax)

Osmotic laxative prototype

Polyethylene glycol (Miralax)

Complication of constipation

Fecal impaction

Bowel obstruction definition

Complete or partial blockage of the intestines

Mechanical vs nonmechanical obstruction

Mechanical = physical blockage; Nonmechanical = decreased peristalsis

Common causes of mechanical obstruction

Adhesions, tumors, hernias, impaction, volvulus, intussusception

Signs of bowel obstruction

Nausea, vomiting, distention, pain, hyperactive bowel sounds

Complication of bowel obstruction

Ischemia, necrosis, perforation

Treatment for partial obstruction

NPO, IV fluids, nasogastric tube to low suction

Treatment for complete obstruction

Surgery (exploratory laparotomy)

Hernia definition

Protrusion of bowel or abdominal structure through muscle wall weakness

Types of hernias

Indirect, direct, femoral, umbilical, incisional

Reducible vs irreducible hernia

Reducible can be pushed back; Irreducible (incarcerated) cannot

Strangulated hernia

Emergency due to impaired blood flow to bowel

Post-hernia repair care

Avoid coughing, use incentive spirometer, ambulate early, monitor incision, avoid heavy lifting

Diverticular disease definition

Pouchlike herniations of intestinal mucosa through muscle wall

Diverticulosis vs diverticulitis

Diverticulosis = no inflammation; Diverticulitis = inflammation/infection

Diverticulitis symptoms

Abdominal pain, fever, tachycardia, nausea, distention

Diverticular disease teaching

High-fiber diet (25-35 g/day), avoid seeds, nuts, laxatives, and high fiber during flare-ups

Colorectal cancer definition

Malignant tumor of the colon or rectum; highly curable if detected early

Most common sites of colorectal cancer

Rectosigmoid region and liver (metastasis site)

Common metastasis sites

Liver, lungs, brain, bone, adrenal glands

Colorectal cancer risk factors

Age >50, family history, ulcerative colitis, Crohn's, diet high in fat/low in fiber, smoking, obesity

Genetic colorectal cancer syndromes

Familial adenomatous polyposis (FAP) and Lynch syndrome

Screening recommendations

Colonoscopy at age 45, every 10 years; annual fecal occult blood test

Pre-colonoscopy care

NPO 24 hrs, bowel prep, IV start, left-side positioning, sedation

Post-colonoscopy care

Vitals q15min, encourage flatulence, monitor for bleeding or perforation

Early signs of colorectal cancer

Rectal bleeding, anemia, change in stool shape

Advanced signs of colorectal cancer

Vomiting, abdominal pain, weight loss, fatigue

Diagnostic tests for colorectal cancer

Colonoscopy, CT, sigmoidoscopy, CEA blood test

Normal CEA value

Less than 5 ng/mL

Primary treatment for colorectal cancer

Surgery (colon resection or colectomy)

Nonsurgical treatments

Radiation and chemotherapy (5-FU, leucovorin, capecitabine)

Common chemotherapy side effects

Bone marrow suppression, nausea, diarrhea, alopecia

Neutropenia definition

Low neutrophil count after chemo; monitor infection risk

Thrombocytopenia definition

Low platelet count; bleeding risk

Anemia definition

Low RBC; fatigue; treat with erythropoietin

Chemotherapy cycle advantage

Decreases resistance, kills more cancer cells, spares normal cells

Routes of chemotherapy

IV (CVAD/port), oral, intraarterial, intrathecal, intraperitoneal

Colon resection types

Partial colectomy, total colectomy, abdominoperineal resection

Pre-op education for colectomy

Turn, cough, deep breathe, pain control, bowel prep, antibiotics

Post-op colon resection care

Monitor for pain, NGT care, advance diet when bowel sounds return

Healthy stoma appearance

Reddish pink, moist, protrudes 1-3 cm from abdomen

Unhealthy stoma signs

Dark, dry, pale, or black indicates poor perfusion

Post-op stoma care

Clear pouch visible, empty when 1/3-1/2 full, check skin for irritation

Colostomy stool consistency

Ascending: liquid; Transverse: pasty; Descending: solid

Colostomy teaching

Empty frequently, avoid gas-causing foods, monitor skin, body image support

Psychosocial considerations for ostomy

Body image changes, sexuality concerns, encourage support groups

Diet after colon surgery

Normal diet when tolerated; avoid foods causing odor or gas

When to call provider after surgery

Fever, severe pain, bleeding, dark stoma, no output