POLYPS CHOLORECTAL CANCER M. DuBois Fennal, PhD, RN, CNS

POLYPS  DEFINITION: A BENIGN TUMOR OF THE BOWEL. THE MOST COMMONLY OCCURING TYPE OR BENIGN TUMOR OF THE LARGE INTESTINES.

ETIOLOGY: BASICALLY UNKNOWN; A MASS OF TISSUE THAT PROTRUDES FROM THE BOWEL WALL AND PROTRUDES INTO THE LUMEN.

RISK FACTORS –AGE OVER 50 –POLYPS –PREVIOUS CANCER –FAMILY HISTORY –ULCERATIVE COLITIS –CHRON’S DISEASE

 EXPOSURE TO RADATION  *IMMUNODEFICIENCY DISEASE  *DIETARY INFLUENCES; HIGH FAT, LOW CALCIUM AND FIBER.

 OCCUR MOST OFTEN IN THE SIGMOID COLON AND RECTUM  MORE PREVELENT IN THE FIFTH DECADE  Cancerous type (adenomatous) more common in men INCIDENCE

Pathophysiology  A mass of tissue protrudes into the lumen of the large intestine. Benign growths are made of epithelial cells

Clinical Manifestations  Depend on the size and location of the polyp  Rectal Bleeding  Lower abdominal pain

DIAGNOSIS  History  Digital Rectum examination  BARIUM ENEMA  SIGMOIDOSCOPY  COLONOSCOPY

MEDICAL MANAGEMENT  SURGERY  DEPENDS ON THE FINDING  BENIGN = FOLLOW UP  MALIGNANT = FOLLOW UP DEPENDING ON THE TISSUE TYPE AND THE DEGREE OF INVASION

Nursing Management  Prepare the patient for test  Enemas  Medication as ordered  Psychological support  Safety  Patient teaching

COLORECTAL CANCER  DEFINITION:A MALIGNANT TUMOR ARISING FROM THE EPITHELIAL TISSUES OF THE COLON OR THE RECTUM

Etiology  Unknown

Risk Factors  Age  Family History  Previous colon cancer or adenomatous polyps  Hx inflamitory bowel disease  High protein, high fat diet, low fiber  Genital or breast cancer

Incidence  Third leading cause of cancer deaths in the US  73,182 men & 70,763 diagnosed  27, 990 men and 27,793 women died from colorectal cancer CDC (2006)  American Cancer Society (2006), 150,000 new cases and 56, 000 deaths

Pathophysiology  Adenocarcinoma arising from epithelial cells, or a polyp that invades and destroys normal tissue. Will usually migrate to other tissues.

Clinical Manifestations  Change in bowel habits  Bloody stools  Anemia  Anorexia  Weight loss  Fatigue

Medical Management  IV Fluids  NG Suction  Blood Transfusion  Surgery  Supportive Therapy  Adjuvant (chemo)  Laser Therapy

Dukes Staging  Class A  Class B1  Class B2  Class C1  Class C2  Class D

Grading System

Nursing Management  Assessment  Prevention of complications  Nutritional support  Reduction of anxiety  Patient and family support  Preparation for surgery  Post operative care

Nursing Diagnosis  Fear  Anxiety  Inappropriate Coping  Impaired skin integrity  Imbalance nutrition less than body requirement  Disturbed body image