Cancer

3. Colon and rectal cancer
1. Risk factors:
   1. Men, middle age, personal or family history of colon and rectal cancer, personal or family history of polyps in the rectum or colon, ulcerative colitis.
   2. Diet high in beef and low in fiber.
   3. Gardners syndrome (multiple colonic adenomatous polyps, osteomas of the mandible or skull, multiple epidermoid cysts, or softtissue tumors of the skin).
2. Annual incidence: 131,200 new cases, 56,600 estimated deaths.
3. Assessment:
   1. Subjective data:
      • Change in bowel habits.
      • Anorexia.
      • Weakness.
      • Abdominal cramping or vague discomfort with or without pain.
      • Chills.
   2. Objective data:
      • Diarrhea (pencil-like or ribbon-shaped feces) or constipation.
      • Weight loss.
      • Rectal bleeding; anemia.
      • Fever.
      • Digital exam reveals palpable mass if lesion is in ascending or descending colon.
      • Signs of intestinal obstruction: constipation, distention, pain, vomiting, fecal oozing.
      • Diagnostic tests:
        1. Digital examination.
        2. Slides of stool specimen, for occult blood.
        3. Proctoscopy.
        4. Sigmoidoscopy, colonoscopy.
        5. Barium enema.
      • Lab data: occult blood, blood serotonin increased, carcinoembryonic antigen (CEA); positive radioimmunoassay of serum or plasma indicates presence of carcinoma or adenocarcinoma of colon; positive result after resection indicates return of tumor.
4. Analysis/nursing diagnosis:
   1. Constipation or diarrhea related to presence of mass.
   2. Altered health maintenance related to care of stoma.
   3. Sexual dysfunction related to possible nerve damage during radical surgery.
   4. Body image disturbance related to colostomy.
5. Nursing care plan/implementation:
   1. Radiation: to reduce tumor or for palliation.
   2. Chemotherapy: to reduce tumor mass and metastatic lesions.
      • Antitumor antibiotics - mitomycin C, doxorubicin hydrochloride (Adriamycin).
      • Alkylating agents - methyl-CCNU.
      • Antimetabolites - 5-fluorouracil (5-FU).
      • Steroids and analgesics for symptomatic relief.
   3. Prepare patient for surgery (colostomy) if necessary.
6. Evaluation/outcome criteria:
   1. Return of peristalsis and formed stool following resection and anastomosis.
   2. Adjusts to alteration in bowel elimination route following abdominoperineal resection (e.g., no depression, resumes lifestyle).
   3. Demonstrates self-care skills with colostomy.
   4. Makes dietary adjustments that affect elimination as indicated.
   5. Identifies alternative methods of expressing sexuality, if needed.