1. Interventions for Clients with Colorectal Cancer

3. 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

4. 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

5. 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

6. 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 development of colorectal cancer

8. 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

11. 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

13. 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

15. Screening Methods for Colorectal Cancer
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

18. What Are the Symptoms of Colorectal Cancer?
A change in bowel habits: diarrhea, constipation, or a feeling that the bowel does not empty completely
Bright red or dark blood in the stool
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)

20. 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

24. Cancer Treatment: Surgery
Foundation of curative therapy
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)

25. Cancer Treatment: Chemotherapy
Drugs used to kill cancer cells
Typical medications include fluorouracil (5-FU), oxaliplatin (Eloxatin), irinotecan (Camptosar), and capecitabine (Xeloda)
A combination of medications is often used

26. Types of Chemotherapy
Adjuvant chemotherapy is given after surgery to maximize a patient’s chance for cure
Neoadjuvant chemotherapy is given before surgery
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

27. 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
Intraoperative: one dose during surgery

28. New Therapies: Antiangiogenesis Therapy
“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

29. New Therapies: Targeted Therapy
Treatment designed to target cancer cells while minimizing damage to healthy cells
Cetuximab (Erbitux) was approved by the FDA in 2004 for the treatment of advanced colorectal cancer

30. 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

32. 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

33. 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

34. 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 II rectal cancer is treated with surgery, radiation therapy, and chemotherapy

35. 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 III rectal cancer is treated with surgery, radiation therapy, and chemotherapy

36. 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

37. 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

38. 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