CRC 101; Part One Julie Banahan, RN, BSN, OCN Gastrointestinal Oncology Nurse Navigator UC Health

Colon, Rectal and Anal Cancers

Statistics – 3rd most common cancer diagnosis in the US 2017 – projected 95,520 new cases of colon cancer and 39,910 new cases of rectal cancer Risk is 1/21 for men; 1/23 for women Approximately 50,260 deaths in 2016 Overall incidence is decreasing, especially in older adults over the age of 60. Incidence is increasing in younger populations though. Set footer with Insert > Header & Footer

Risk Factors: Personal or family history of polyps or cancer People over age 50 More common in African Americans; Native Americans; and Alaskan Natives Having Ulcerative Colitis or Crohn’s disease

Prevention Screening at age 50; or sooner if at higher risk Maintain a healthy weight and active lifestyle Eat a healthy diet Don’t use tobacco products Limit alcohol intake Source: 9-pt Arial; always comes first and always singular; punctuate using semicolons between references in the source and always end with a period. Note: Next in hierarchy; no callout in text. a. For footnotes with text callouts (third in hierarchy), use on-line lower-case letters starting with “a” on each slide. Set footer with Insert > Header & Footer

Screening a. Colonoscopy at age 50 for the general population b. Sooner than age 50 with the risk factors in slide # 4 c. Stigma of getting colonoscopy Set footer with Insert > Header & Footer

Symptoms of Colon Cancer A change in bowel habits Rectal bleeding, blood in stool, black stools Persistent abdominal discomfort (gas and bloating) Unexplained weight loss Nausea and vomiting Chronic fatigue Pain with bowel movements. Set footer with Insert > Header & Footer

Diagnosis and Treatment: How Colon Cancers form a. Definition of “cancer” – unregulated proliferation of cells; growth and division is abnormal CRC usually begins as a “polyp”, which is a growth on the inner surface of the colon There are two types of polyps: 1. Hyperplastic or inflammatory – usually do not carry a risk of developing into a cancer. 2. Adenoma or adenomatous - if left alone these have the potential of turning into a cancer. Set footer with Insert > Header & Footer

Local vs. Advanced Disease Set footer with Insert > Header & Footer

Aggressive Vs. Palliative Care Standard of care vs. Clinical Trials Naturopathic / non-conventional treatments Multi-modality treatments – Surgery + Radiation + Chemotherapy 5 year survival rates Set footer with Insert > Header & Footer

Patient Navigators / Role Implications of Diagnosis Physical (body changes / loss of function) Emotional – feeling overwhelmed; afraid Financial – insurance coverage? Religious - “why me?” Cultural Transportation Set footer with Insert > Header & Footer

Reinforce Education Adherence to prescribed treatment plan Who to call for help and when to call

Communication with the Nurse Navigator Definition of Oncology Nurse Navigator Increase Access to Care Coordinate Appointments Prevent hospitalizations Reporting Symptoms

Maintain contact with patient and family a. Identify any urgent needs Facilitate communication with the health care team Assist with transfer of records when possible. Set footer with Insert > Header & Footer

Make (or suggest) referrals Social Work Dietician Cancer Rehabilitation Complimentary treatments (massage; acupuncture)

Suggest reputable resources ACS Colon Cancer Alliance Chris4Life; Colontown (colontown.org) Fight Colorectal Cancer (FightCRC.org)

Where to get care? Community vs. academic Support services / cancer rehab Timeliness Need for MDC? Lodging and transportation

Never underestimate the power of listening and kindness.