1. Colon Cancer
Jessica King, Erica Feil, Eli Rodriguez, Abbie Rademacher, & Chantal
Heathers

2. Pathophysiology
Cells divide through a tightly controlled cell cycle, controlled by the DNA in the nucleus,
producing new cells that allow for tissue growth and replace worn-out or damaged
cells.
If the DNA becomes damaged or mutated in some way, the cells can start growing
excessively, building the foundation for cancer (Kohler, et al., 2015).
The immune system has an important role in detecting abnormal cells, or cells with
damaged DNA, and destroying them. The failure of the immune system to detect these
altered cells is essence of all cancers (Key,Verkasalo, & Banks, 2010).
Most colorectal cancers begin as precancerous polyps in the rectum or colon. Polyps can
be neoplastic (with dysplasia) or non-neoplastic (without dysplasia). These abnormal
growths can be present for years before cancer develops and symptoms may not
appear.

4. Epidemiology
3rd most common cancer.
More likely to occur in developed countries.
Mortality is 50% of incidence. Mortality rate declining in the US.
Prognosis depends on stage at detection:
90% at localized stage
70% at regional stage
10% at metastatic stage
Determined largely by access to diagnostic and screening services.

5. Risk Factors: Modifiable vs. Non-Modifiable
Modifiable:
Low-fiber,high-fat diet
A sedentary lifestyle
Diabetes (Type 2)
Obesity
Alcohol
Smoking
Radiation therapy for cancer
Non-Modifiable:
Older age
African-American race
A personal history of colorectal
cancer or polyps
Inflammatory intestinal conditions
Inherited syndromes that increase
colon cancer
Family history of colon cancer and
colon
polyps

6. Screening Recommendations
❖ Should begin screening at age 50:
➢ Fecal occult blood testing
➢ Sigmoidoscopy
➢ Colonoscopy
❖ Get tested earlier if:
1. You or close relative have had colorectal polyps or cancer.
2. You have Inflammatory bowel disease, Crohn’s disease, or ulcerative colitis.
3. You have genetic syndrome like familial adenomatous polyposis or hereditary non-
polyposis colorectal cancer.

7. Signs and Symptoms
❖ A change in bowel habits
(diarrhea/constipation/narrowing of stool)
❖ Feeling of needing to have a bowel movement but not
relieved
❖ Rectal bleeding
❖ Blood in stool
❖ Cramping/abdominal pain
❖ Weakness/fatigue
❖ Unintended weight loss

8. Assessments and Diagnostic Tests
❖ Colon cancer is usually asymptomatic until advanced stages.
➢ Highly important to do screening tests.
1. Begin with medical history to find risk factors.
2. Physical Examination
a. Palpating abdomen for enlarged organs or masses.
b. Digital rectal exam for unusual masses
3. Fecal occult blood test
4. Blood Tests

9. Stool DNA Screening Test
Cologuard
Qualitative Detection of Neoplasia and Occult Hemoglobin
Expoliation of Cancer Cells in Stool
Noninvasive
Detects All Stages of Cancer

10. Diagnostic Criteria
❖Diagnosis is done via tissue biopsy.
❖General characteristics are noted during visualization of tissue under a
microscope.
❖Immunohistochemical stains and genetic testing help determine presence of
cancer.

11. Treatment
Surgery
Tumor Resection- Treatment of Choice
Laser Photocoagulation
For clients who can’t tolerate major
surgery
Palliative surgery to remove
obstructions
Destroys small tumors
Local Excision
During Endoscopy
Pharmacologic and Radiation Therapies
Chemotherapy
Decreases recurrence and lessens
the spread of tumor
Adjunctive
Radiation
Pre/Post-Operative
Shrink large tumors
Reduce Recurrence of Pelvic Tumors

12. Which fast track elements predict early recovery
after colon cancer surgery?
❖ Overview: To determine what factors enhance the recovery of colon cancer patients who have
underwent resection surgery, six baseline variables were entered in a multivariable, linear regression
analysis, along with numerous fast track elements (postop care). There were 400 patients involved
that underwent either laparoscopic or open surgery to remove the cancer. The care provided to
each patient was documented and analyzed.
❖ Conclusion: The study found that the female sex, laparoscopic resection, advancement of oral
intake and a regular diet, and early mobilization were independent factors that enhanced recovery.
❖ Nursing Role: Nurses involved in the postoperative care of a patient should evaluate the patient's’
ability to swallow and encourage the advancement of diet to gain optimal nutrition for healing.
Nurses also should educate the patients about the importance of mobilization to prevent further
complications and to promote recovery.Vlug, M. S., Bartels, S. L., Wind, J., Ubbink, D. T., Hollmann, M. W., & Bemelman, W. A. (2012). Which fast track
elements predict early recovery after colon cancer surgery? Colorectal Disease, 35-47.

13. Effectiveness of Interventions to Increase
Screening
❖ Overview: Systematic review of literature regarding interventions to increase screening for colon
cancer.
❖ Conclusion: One-on-one client education and client reminders are shown to increase likelihood that
a client will do a FOBT. Reducing structural barriers to colorectal screening is also recommended.
Mass media and group education show insufficient evidence that they improve screening rates.
❖ Nursing roles: Nurses can play a role in both one-on-one client education and client reminders.
Nurses, having close relationships with clients are in a perfect position to improve screening rates.
Sabatino, S., Lawrence, B., Elder, R., Mercer, S.L., Wilson, K., DeVinney, B., Melillo, S.,
Carvalho, M., Taplin, S., Bastani, R., Rimer, B., Vernon, S., Melvin, C., Taylor, V., Fernandez,
M., Glanze, K. (2012). Effectiveness of Interventions to Increase Screening for Breast, Cervical,
and Colorectal Cancers. American Journal of Preventative Medicine. 43(1): 97-118.

14. Patient Education and Resources
❖ Education
➢ Disease Process
■ Polyps, Metastasize to Other Organs
■ Dx Tests (Colonoscopy, Labs, etc.)
➢ Signs and Symptoms of Colorectal Cancer
➢ Diet high in plant foods, whole grains, and
legumes.
■ Referrals to Nutritionists if necessary.
➢ Importance of Screening
➢ Postoperative Care after Surgery
❖ Resources
➢ Local Healthcare Facilities
■ Regional West Physicians Clinic-
Oncology
■ Regional West Surgery Center
➢ Credible Websites
■ American Cancer Society
● www.cancer.org
■ National Cancer Institute
● www.cancer.gov

15. References
American Cancer Society. (2015). Signs and symptoms of colorectal cancer.
http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-symptoms-of-crc
American Cancer Society. (2015). Testing biopsy and cytology specimens for cancer. http://www.cancer.org/acs/groups/cid/documents/webcontent/003185-pdf.pdf
American Cancer Society. (2014). Colorectal cancer: How is colorectal cancer diagnosed.
http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-diagnosed
Center for Disease Control and Prevention. (2014). What Should I Know About Screening? http://www.cdc.gov/cancer/colorectal/basic_info/screening/
Colon cancer: Patient education (2015). In Baylor Scott & White Health.
http://www.sw.org/cancer-institute/gastrointestinal/colon/colon-cancer-patient-education
Haggar, F., Boushey, R. (2009). Colorectal Cancer Epidemiology: Incidence, mortality, survival and risk factors. Clinics in Colol and Rectal Surgery. 22(4): 191-197.
Key, T., Verkasalo, P. K., & Banks, E. (2010). Epidemiology of breast cancer. The Lancet Oncology, 2.
Kohler, B., Sherman, R.L., Howlader, N., Jenal, A., Ryerson, B., Henry, K., Boscoe, F.P., Cronin, K.A., Lake, A. Noone, A., Henley, S. Eheman, C., Anderson, R. Penberthy, L. (2015). Annual
Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. Journal of the
National Cancer
Institute. 107 (6).
Mayo Clinic. (2013).Colon Cancer Risk Factors. http://www.mayoclinic.org/diseases-conditions/colon-cancer/basics/risk-factors/con-20031877
Vlug, M. S., Bartels, S. L., Wind, J., Ubbink, D. T., Hollmann, M. W., & Bemelman, W. A. (2012). Which fast track elements predict early recovery after colon cancer surgery? Colorectal
Disease, 35-47.