Colorectal Cancer

Colorectal Cancer Nursing Diagnosis Interventions and Care Plans

Colorectal Cancer NCLEX Review Care Plans

Nursing Study Guide on Colorectal Cancer

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

  1. 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.
  2. 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

  1. 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.
https://youtu.be/OJ5UhiiXEpc

Nursing Care Plans for Colorectal Cancer

  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.

InterventionsRationales
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.
  • 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.

InterventionRationale
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.

Other nursing diagnoses:

  • Acute Pain
  • Anticipatory Grieving
  • 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. (2017). 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. (2018). 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 facilities guidelines and 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. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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One comment

  1. CHINFAI

    Dear Dr.Anna,

    I am nursing student in Hong Kong. I would to have the references about “Colon Cancer – Pathophysiology, Podcast, and Nursing Care Plan”. Can you offer me the references?

    Thankyou

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