Colon cancer is a disease that involves the large intestine (colon), which is the last portion of the gastrointestinal (GI) tract. Polyps or small, benign groups of cells can form inside the colon.
Some of these colon polyps can become cancerous. Colon cancer usually affect people of old age but has been recently seen as affecting even young people.
The treatment of colon cancer depends on its severity (grading). These may include systemic anti-cancer therapies (such as chemotherapy and immunotherapy), radiotherapy, and/or colorectal surgery.
Prevention of colon cancer includes colorectal screening and healthy lifestyle habits.
Signs and Symptoms of Colorectal Cancer
The formation of polyps and early stages of colon cancer may not manifest in any kind of symptoms at all.
The warning signs of colon cancer include:
- Blood in the stool or rectal bleeding
- Persistent abdominal cramping, pain, or gas
- Poor bowel emptying, or passing “skinny” stools
- Myalgia and body weakness
- Bloating
- Severe or persistent constipation
- Fatigue
- Unexplained weight loss
Causes and Risk Factors of Colorectal Cancer
Colon cancer happens when the healthy cells undergo mutations, or changes in the DNA, causing them to divide abnormally.
Once the abnormal cells accumulate, it forms a clump of abnormal or undifferentiated cells, called a tumor.
It is still unknown what exactly causes the mutations that give rise to benign polyps and cancerous tumors, but some risk factors have been identified to cause the likelihood of developing colon cancer.
People aged 50 years and above of any race, African-Americans, and having a family history of colon cancer are some of the risk factors related to colon cancer.
Following the Western diet (low fiber and high fat diet), having a history of intestinal disorders such as Crohn’s disease and colitis, smoking, alcohol abuse, obesity, diabetes, and physical inactivity can increase the risk of colon cancer.
Complications of Colorectal Cancer
- Metastasis. The cancerous cells can cause invasion and destruction of the normal cells and tissues. They can also travel and invade other parts of the body, such as the lungs or liver.
- Bowel obstruction. The tumor can obstruct the passageway, making it difficult for the stool to be eliminated from the colon. This increases the risk for infection, or perforation of the intestine.
Diagnosis of Colorectal Cancer
- Digital rectal examination (DRE) – physical examination wherein the doctor inserts his lubricated and gloved finger into the anus to check for any abnormalities and presence of blood
- Blood tests – the doctor may order a blood test to check for the chemical released by colon tumor, called the carcinoembryonic antigen (CEA), which is also sometimes referred to as a “tumor marker”
- Imaging:
- Colonoscopy – insertion of a long, thin tube with a video camera to visualize the entire colon
- Flexible sigmoidoscopy – similar to colonoscopy but only views the distal part of the colon (sigmoid colon and rectum)
- CT colonography – also known as virtual colonography; used to produce detailed images of the bowel
Staging of Colorectal Cancer
Staging of Colon Cancer: Staging is done to determine which treatments may be needed to help the patient:
- Stage 0: very early cancer found on the innermost layer of the intestine
- Stage 1: cancer has grown through the mucosa of the colon but has not spread any further.
- Stage 2: Cancer has now grown into the wall of the colon. There is no lymph node involvement.
- Stage 3: Lymph node involvement is now seen, however, there is no metastasis to other parts of the body.
- Stage 4: Cancer has metastasis to other organs of the body.
Treatment of Colorectal Cancer
- Surgery. Early stage colon cancer can benefit from surgical interventions such as:
- Polypectomy -removal of polyps during colonoscopy
- Laparoscopic surgery -making small incisions in the abdomen to perform laparoscopy and removing the polyps
- Endoscopic mucosal resection – removal of large polyps and a small section of the colon’s inner lining (mucosa)
Advanced colon cancer may require the following surgeries:
- Partial colectomy – removal of the diseased section of the colon and reconnecting the healthy parts to the rectum, using laparoscopy
- Ostomy placing a part of the colon out from the created opening in the abdominal wall (stoma) and attaching a bag on its top, where the stool can be eliminated; can be temporary or permanent
- Lymph node removal – removal of regional lymph nodes near the colon and testing them for presence of cancerous cells
- Systemic Anti-Cancer Therapies (SACT). These medications are administered to the body through a vein, in order to destroy cancer cells or shrink the tumor. These may include single treatments, or a combination of medications. They can be chemotherapy drugs, immunotherapy, targeted therapy, or a combination of these.
- Radiotherapy. Radiation using protons and X-rays are used to kill colon cancer cells and shrink the tumor.
- Palliative care. Supportive medications and therapies can be provided to improve the quality of life of colon cancer patients and their families. These may include pain relief and complementary therapies.
Nursing Diagnosis for Colon Cancer
Colon Cancer Nursing Care Plan 1
Nursing Diagnosis: Deficient Knowledge related to new diagnosis of colon cancer as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”
Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of colon cancer and its management.
| Nursing Interventions for Colorectal Cancer | Rationales |
| Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. denial of diagnosis or poor lifestyle habits)To address the patient’s cognition and mental status towards the new diagnosis and to help the patient overcome blocks to learning. | |
| Explain what colon cancer is and its symptoms. Avoid using medical jargons and explain in layman’s terms. | To provide information on colon cancer and its pathophysiology in the simplest way possible. |
| Educate the patient about his/her colon cancer treatment plan. If patient is for systemic anti-cancer therapy (SACT) and/or radiotherapy, explain the treatment protocol that will be administered, its purpose, risks, and possible side effects. If the patient is for surgery, explain the procedure to the patient. | To give the patient enough information on the treatment plan, so that he/she can provide or deny an informed consent. |
| Demonstrate how to perform blood sugar monitoring. | To empower patient to monitor his/her blood sugar levels at home. |
| Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) for supportive care, such as pain medications, anti-emetics and bowel medications. Explain how to properly self-administer each of them. Ask the patient to repeat or demonstrate the self-administration details to you. | To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details. |
| Use open-ended questions to explore the patient’s lifestyle choices and behaviors that can be linked to the development of colon cancer. Teach the patient on how to modify these risk factors (e.g. smoking, excessive alcohol intake, low fiber and high fat diet, obesity, sedentary lifestyle, etc). | To assist the patient in identifying and managing modifiable risk factors related to colon cancer. |
Colon Cancer Nursing Care Plan 2
Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to abdominal pain and cramping secondary to colon cancer, as evidenced by abdominal cramping, stomach pain, bloating, weight loss, nausea and vomiting, and loss of appetite
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
| Nursing Interventions For Colon Cancer | Rationale |
| Explore the patient’s daily nutritional intake and food habits (e.g. meal times, duration of each meal session, snacking, etc.) | To create a baseline of the patient’s nutritional status and preferences. |
| Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals. | To effectively monitory the patient’s daily nutritional intake and progress in weight goals. |
| Help the patient to select appropriate dietary choices to increase dietary fiber, caloric intake and alcohol and coffee intake. | To promote nutrition and healthy food habits, as well as to boost the energy levels of the patient. Dietary fiber can help reduce stool transit time, thus promoting regular bowel movement. |
| Refer the patient to the dietitian. | To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed colon cancer. |
| Symptom control: Administer the prescribed medications for abdominal cramping and pain, such as antispasmodics. Promote bowel emptying using laxatives as prescribed. | To reduce cramping, relieving the stomach pain and helping the patient to have a better appetite. To treat persistent and/or severe constipation, which is a common symptom of colon cancer. |
Colon Cancer Nursing Care Plan 3
Risk for Constipation/Diarrhea
Nursing Diagnosis: Risk for Constipation/Diarrhea related to chemotherapy treatment secondary to colon cancer.
Desired Outcome: The patient will establish bowel movement patterns within normal limits as evidenced by type 4 or 5 stools in the Bristol chart at least once every 3 days.
| Nursing Interventions For Colon Cancer | Rationale |
| Assess the patient’s bowel movement daily, including the frequency, color, and type of stools. | To acquire baseline data that will show evidence of constipation or diarrhea as a probable side effect of chemotherapeutic agent/s for the treatment of colon cancer. |
| Assess and observe any presence of abdominal pain or blood in the stool. Note for any abnormalities or discomfort, notify the physician immediately | To establish a baseline for bowel function.. Accurate and thorough documentation or monitoring provides systematic and appropriate intervention. |
| Conduct a daily monitoring of input and output of fluid and body weight. | To ensure proper hydration to prevent constipation. Proper hydration prevents complications of diarrhea such as weight loss, fluid and electrolytes imbalance. |
| Promote adequate intake of fluid of 2,000cc/ml per day, regular exercise, and increased intake of fiber diet. | To prevent constipation, improve bowel consistency and frequency, stimulate peristaltic movement, and promote proper hydration. |
| Promote and maintain the required amount of proteins, carbohydrates, and low dietary fiber as directed by the dietitian. Take small, frequent meals if not contraindicated. | Small frequent meals help alleviate gastric irritation and promote bowel rest. They can also promote patient’s comfort and security. |
| Modify diet intake as needed. Avoid high fatty food (e.g., butter, fried food, and nuts); high fiber diet; gas forming diet (e.g., chilies, beans/legumes, and cabbage); caffeinated beverages; or excessively hot or cold drinks or food. | Avoiding gastric stimulants helps prevent or lessen gastric/bowel motility. Modifying the patient’s diet facilitates recovery process. |
| Assess for fecal impaction if no bowel movement is noted in a three-day period. Note for abdominal distension, cramping, and headache. | Performing a comprehensive physical assessment can help determine and monitor any discomfort, trauma, infection, and etc. |
| Monitor laboratory studies as indicated: Electrolytes Administer IV fluids Antidiarrheal agents Use of prophylactics (e.g., stool softeners, rectal laxatives, enemas as indicated) | Fluid and electrolyte imbalance may alter the patient’s gastrointestinal function. Promote hydration as it helps in diluting agents found in chemotherapy and reduces its side effects. Proper hydration also alleviates bowel discomfort or severe diarrhea. The use of these prophylactic drugs helps prevent further complications for a patient who is specifically prescribed vinca-alkaloid agents, such as poor/decreased bowel motility, or poor bowel movement pattern before treatment. |
| Implement a strict stool monitoring chart. | To ensure proper monitoring of the amount, color, type of stool passed, elimination pattern, and frequency of bowel movement. |
| Monitor skin integrity. | To ensure adequate hydration through monitoring skin temperature, texture, turgor, mobility, color, and moisture. Maintaining the patient’s overall hydration is crucial. Lack of fluid or any fluid imbalance can contribute to organ failure, and muscle damage, and may also affect mental function and changes in behaviour. |
| Administer enema as ordered. | To ensure that the patient is clear of fecal matter, an enema is usually given three (3) consecutive times to avoid fluid and electrolyte imbalance. There are two different types of enema: cleansing enema and retention enema. Both are helpful to promote defecation or treat constipation and to aid in the expulsion of flatus. More importantly, an enema can cleanse or empty the bowel prior diagnostic procedures. |
| Prepare the patient for colonoscopy as ordered. | A colonoscopy can help determine if there are changes such as polyp/s, swelling, tissue irritation, or obstruction in the large intestines and rectum. In this procedure, a long flexible tube is inserted into the patient’s rectum and intestine to get a better visualization. |
| Assess the patient’s level of understanding of the prescribed procedure (e.g., enema, colonoscopy, etc.) Educate the patient about the indicated procedure before obtaining consent. | This allows the nurse to plan appropriate health teaching measures. Proper education promotes cooperation and reduces patients’ anxiety. Ensures smooth procedure. |
| Assist the patient to the bathroom or help to position patient on bedpan. | To promote proper hygiene, comfort, and safety as well as to prevent the risk for injury or fall. |
Colon Cancer Nursing Care Plan 4
Nursing Diagnosis: Risk for Infection related to immunosuppressed status secondary to chemotherapy treatment for colon cancer.
Desired Outcome: The patient will be free from any signs and symptoms of infection while he/she is undergoing chemotherapy treatment for colon cancer.
| Nursing Interventions For Colon Cancer | Rationale |
| 1. Promote good hand washing procedures and practices amongst staff and visitors. | To prevent transmission of microorganisms to the patient and vice-versa. |
| 2. Reduce the number of visits and screen each visitor for any signs and symptoms of respiratory infection. | To prevent transmission of communicable diseases such as respiratory problems transmitted via coughing or sneezing. |
| 3. Promote proper hygiene by encouraging daily showers and change of clothes and bed linen. | To lessen the growth and spread of infection and promotes patient’s comfort and cleanliness. |
| 4. Monitor the patient’s body temperature. Regulate the temperature in the patient’s room. | Any changes in body temperature could indicate either viral or bacterial infection. Early detection could provide immediate and appropriate intervention for suspected infection. Microorganisms thrive in warm and dark environments. |
| 5. Perform a head-to-toe physical examination and check for signs and symptoms of infection. Report to the attending physician for any changes noted. | To monitor and ensure no presence of infection or changes noted in the patient. This helps determine the patient’s current risk for infection. |
| 6. Promote frequent and proper turning and positioning for bedbound patients or those with poor mobility. | This prevents the patient from having bed sores (decubitus ulcer), redness, poor circulation, thrombus formation, and pneumonia |
| 7. Maintain wrinkle-free and dry linen at all times. | To prevent the growth and spread of microorganisms. To promote patient’s comfort and cleanliness. |
| 8. Promote regular exercise and adequate rest or sleep. | To maintain good blood circulation, muscle movements, and mental function. |
| 9. Practice good oral hygiene and regular dental check-up. | To prevent the occurrence tooth decay/s. To reduce the risk for oral infection such as thrush which is common in immunosuppressed states. |
| 10. If the patient is for an invasive procedure, use aseptic techniques at all times. | To avoid cross-contamination and to reduce the risk of infection. |
| 11. Monitor complete blood count (CBC) specifically white blood cells, platelets, and granulocyte count. | Chemotherapy can cause myelosuppression for cancer patients. This can affect bone marrow activity, causing possible anemia, hemorrhage, and infection. |
| 12. If the patient has a fever, consider stopping the chemotherapy and secure culture and sensitivity test as ordered. | This helps to determine the causative factor/s for possible infection to facilitate appropriate management and intervention can be carried out. |
| 13. Administer broad-spectrum antibiotics as prescribed if the patient has a fever. | To inhibit the growth and spread of microorganisms, especially amongst immuno-compromised patient/s. Educate the patient about the drug’s mechanism of action, dosage, timing, and side effects. |
| 14. Advise the patient to maintain a healthy diet and take immune booster food to strengthen immune system. | A healthy and well-balanced diet, especially food rich in vitamins and minerals can help boost the immune system to fight off infection. Opt for food rich in vitamin C and Zinc to strengthen immune system. |
| 15. Encourage the patient to maintain a healthy lifestyle. | Maintaining a positive and healthy holistic approach to oneself would lessen the level of stress, and strengthen the immune system. A healthy lifestyle includes smoking cessation, limiting alcohol intake, and having adequate fluid intake, exercise, healthy eating habits, good hygiene, as well as maintaining a positive outlook in life, acceptance/self-actualization, and etc. |
Colon Cancer Nursing Care Plan 5
Nursing Diagnosis: Anticipatory Grieving related to situational crisis secondary to learning about the diagnosis of colon cancer.
Desired Outcome: The patient will be able to go through the grieving process with a sturdy support system.
| Nursing Interventions For Colon Cancer | Rationale |
| Before encountering the patient, the nurse must prepare herself/himself emotionally and have an expectation of disbelief, shock, denial, anger, and other overwhelming flow of negative emotions from the patient. Prepare to discuss appropriate referrals to various cancer health services for the patient and family. | A lot of patients would undergo this emotional phase upon hearing the physician’s diagnosis of cancer. The mind and heart would be flooded with major concerns such as major changes in life, medical expenses, laboratory procedures, the prognosis of the disease, possible surgeries, emergence of disabilities, chemotherapy, radiotherapy, going in and out of hospitals, and the remaining concerns a patient and the support system can possibly go through. Proper counselling, family meeting, and psychiatric support would help the patient and the family cope better at the reality at hand. |
| 2. Assess the patient’s stage of grief that he or she is experiencing at the moment. Facilitate the patient during the process and allow the patient express his or her feelings freely without any judgement. | Providing psychological or psychiatric support through providing knowledge about grief, how to process and reinforce the patient’s feeling would provide a better understanding of the patient’s mental and emotional state and how to gradually cope effectively and positively. |
| 3.Provide and practice appropriate therapeutic forms of communication. Be an active listener and always acknowledge the patient whenever he or she relays concerns and emotions. Maintaining a non-judgmental environment is essential. | Therapeutic form of communication would help the patient put at ease. Avoid using a journalistic question ‘Why’ when talking or conducting a counselling or therapy session as it can provoke or trigger the patient. A calm and therapeutic approach would help the patient cope effectively. In addtion, it allows the patient to be more open to talk freely. |
| 4.Allow and acknowledge the normality of negative feelings such as, anger, sadness, denial, rejection, betrayal and etc. Always encourage the patient to express his or her feelings and emotions freely. | Expressing one’s emotions or feelings to a trusted person or professional can make the patient feel acknowledged, respected, important, and lighter. Providing emotional support and understanding helps the patient to lessen the burden and to cope effectively. |
| 5. Be mindful of mood changes, inappropriate behaviour, acting-out, hostility or any challenges behaviour/s Always set boundaries or limits and always redirect any forms of negative behaviour or thinking. | Stay vigilant and cautious. Setting rules and limits puts the patient in right perspective. Thus, helps maintain self-control, and promotes positive self-esteem. Ineffective coping behaviours can cause harm to both self and others. |
| 6. Be mindful of ‘crippling’ or ‘debilitating’ form of depression. Asking direct question/s about the patient’s mental state is an important nursing skill. | Debilitating depression puts colon cancer patients at high risk for suicide. It is commonly found amongst the most vulnerable patients such as newly diagnosed colon cancer patient/s. |
| 7. Discuss with the patient the need for a health care provider or care support to speak or accompany him/her as deemed necessary. | Frequent visitation and phone sessions with a a health care provider may decrease feelings of abandonment and isolation. |
| 8. For a patient with terminal colon cancer, reinforce structured health teaching on the disease process and treatments, and provide appropriate information on the topic of death and dying. Avoid giving false hope while giving emotional support. | Asking direct questions about death or dying and providing truthful and genuine answers promote trust and establish rapport. Avoidance of false hope can help the patient go through the grieving process successfully. |
| 9. Discuss with the patient and family the things that spark the interest of the patient such as hobbies and activities that the patient enjoys. Explore previous experiences that show the patient’s coping strategies and how these can help him/her in the present situation. | To assist individuals and their families to effectively cope with grief. |
| 10. Document expression of anger, statements of despair, hopelessness, guilt, regret, ‘will to live’. | Challenging behaviors such as anger and interpersonal conflicts may be considered the patient’s way of dealing and expressing his or her feelings of spiritual distress, despair, and possibly an indication of suicidal ideation. These data can help the team to guide the patient through the grieiving process. |
| 11. Gather and determine the patient’s response to death and dying, such as cultural expectations, religious beliefs, learned or acquired behaviors, and death experience of family member/s, loved ones, close friends. Ask about the patient’s beliefs about life after death, or any faith in a higher power. | To help the patient explore personal feelings and belief systems regarding death and dying as appropriate. |
| 14. Refer the patient to a hospice program as deemed appropriate by the whole multidisciplinary team. | Colon cancer patients who are deemed terminally ill may benefit tremendously from the expert services of a hospice. |
More Colon Cancer Nursing Diagnosis
- Acute Pain
- Impaired Bowel Elimination
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
Disclaimer:
Please follow your facility’s guidelines, policies, and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. It is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.
