1. Interventions for
Clients with
Colorectal Cancer

2. 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

3. What is Cancer? A group of 100 different diseases
The uncontrolled, abnormal growth of cells
Cancer may spread to other parts of the body

4. 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

5. Typical sites of incidence and sympoms of colon cancer

6. Colon cancers result from a series of pathologic changes that transform normal colonic
epithelium into invasive carcinoma. Specific genetic events, shown by vertical arrows,
accompany this multistep process. The various chemopreventive agents exert their
effects at different steps in this pathway, and this is depicted on the basis of the
available epidemiologic evidence, the results of studies in animals, and the known
mechanisms of action of the agents.

7. 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

8. Development of CRC result of interplay between environmental and
genetic factors
Central environmental factors:
diet and lifestyle
35% of all cancers are attributable to diet
50%-75% of CRC in the US may be preventable
through dietary modifications

9. Dietary factors implicated in colorectal carcinogenesis
consumption of red meat
animal and saturated fat
refined carbohydrates
alcohol
increased risk

10. Dietary factors implicated in colorectal carcinogenesis
dietary fiber
vegetables
fruits
antioxidant vitamins
calcium
folate (B Vitamin)
decreased risk

13. There is a solitary mass attached via a long stalk to the colonic mucosa. It is discreet and does not involve the wall of the colon. The surface is dark red (hemorrhagic). The stool guaiac was positive.

14. This is an adenocarcinoma of the cecum which demonstrates an exophytic growth pattern, as the bulk of the mass is within the bowel lumen. The patient had iron deficiency anemia.

15. The barium enema techniqu
instills the radiopaque barium
sulfate into the colon, producing
a contrast with the wall of the colon
that highlights any masses present.
In this case, the classic "apple core”
lesion is present, representing an
encircling adenocarcinoma that
constricts the lumen.

18. Symptoms associated with CRC
rectal bleeding
change in bowel habits
obstruction
abdominal pain & mass
iron-deficiency anemia
weight loss
loss of appetite
night sweats
fever

19. Staging of CRC TNM system Primary tumor (T) Regional lymph nodes (N)
Distant metastasis (M)
*Note: Tis includes cancer cells confined within the glandular basement membran
e (intraepithelial) or lamina propria (intramucosal) with no extension through the
muscularis mucosae into the submucosa.
**Note: Direct invasion in T4 includes invasion of other segments of the colorectum
by way of the serosa; for example, invasion of the sigmoid colon by a carcinoma of the
cecum.

20. 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

21. 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

22. 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

23. 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

24. 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

25. Staging of CRC Dukes staging system A Mucosa 80%
B Into or through M. propria 50%
C1 Into M. propria, + LN ! 40%
C2 Through M. propria, + LN! 12%
D distant metastatic spread <5%

26. Sites of metastasis Via blood Via lymphatics Per continuitatem Liver
Lung
Brain
Bones
Lymph nodes
Abdominal wall
Nerves
Vessels

27. This is an in-situ photograph of the
chest and abdominal contents. As
can be seen, the liver is the largest
parenchymal organ, lying just below
the diaphragm. The right lobe (at the
left in the photograph) is larger than
The left lobe. The falciform ligament is
the rough dividing line between the
two lobes.

29. The liver is filled with multiple masses of varying size
The liver is filled with multiple masses of varying size. The primary was a colonic adenocarcinoma. Some of the larger metastatic nodules have central necrosis.

30. 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

31. 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

32. Summary
CRC is a leading cause of death
Early stages are detectable
Screening can prevent CRC