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

2. Colon, Rectal and Anal Cancers

3. 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.
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4. 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

5. 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.
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6. 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
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7. 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.
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8. 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 Adenoma or adenomatous - if left alone these have the potential of turning into a cancer.
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9. Local vs. Advanced Disease
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14. Aggressive Vs. Palliative Care
Standard of care vs. Clinical Trials
Naturopathic / non-conventional treatments
Multi-modality treatments – Surgery + Radiation + Chemotherapy
5 year survival rates
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16. Patient Navigators / Role Implications of Diagnosis
Physical (body changes / loss of function)
Emotional – feeling overwhelmed; afraid
Financial – insurance coverage?
Religious - “why me?”
Cultural
Transportation
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17. Reinforce Education Adherence to prescribed treatment plan
Who to call for help and when to call

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

19. 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.
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20. Make (or suggest) referrals
Social Work
Dietician
Cancer Rehabilitation
Complimentary treatments (massage; acupuncture)

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

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

23. Never underestimate the power of listening and kindness.