COLON CANCER

DEFINITION
● Colon cancer also known as colorectal cancer is a disease in which cells in the colon or
rectum grow out of control.
○ Abnormal growths like adenomatous ​“polyps” can advance into cancer.
○ Colon cancer starts in the inner lining (carcinoma) of the colon, slowly going
through some or all of its layers. It typically begins as a growth tissue called
polyp. A particular type of polyps, called an adenoma, can then develop cancer.
○ These are small growths that can develop on the inner lining of the colon and
rectum, which are considered “precancerous” because they can transform into
colorectal cancer if left untreated.

ANATOMY AND PHYSIOLOGY

Large intestine
● Absorbs water and salts from the material that has not been as digested as food.
● Get rid of any waste products left over.
Colon
● A long muscular tube called the large intestine is found in the lower part of the GI
digestive tract.
● Facilitates the absorption of food, water
and stores waste products.
● Turns food waste into stool and passes it
from the body when defecate.
Rectum
● The passageway that connect the colon to
the anus
● Move feces

ETIOLOGY
PREDISPOSING
 ● Age ( 50 years old above) - The immune system gradually declines over time as
people age.
○ The likelihood of accumulating genetic mutations as a person ages increases,
and these mutations can lead to a progression of existing polyps into cancerous
growths since the colon cancer typically develops over a long period of time.
○ They were more likely to have more advanced disease at the time of diagnosis.
Such cancers are largely left-sided cancers (i.e., more distal).
● Gender (Male) - Men typically have lower levels of estrogen, which might contribute to
their increased risk since women have estrogen as their sex hormone, which may have a
more protective effect against colorectal cancer.
● Family history/Genetics - A family history of colorectal cancer or specific genetic
mutations, such as those found in Lynch syndrome or familial adenomatous polyposis
(FAP), can significantly increase the risk of developing the disease.
○ Familial Adenomatous Polyposis (FAP)- A rare inherited genetic syndrome
caused by mutations in the APC (adenomatous polyposis coli) gene. Individuals
with FAP develop numerous polyps in their colon, and if these polyps are not
removed, they almost invariably progress to colon cancer.
○ Lynch syndrome- An inherited genetic condition caused by mutations in certain
DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2). People with Lynch
syndrome have an elevated risk of colorectal cancer, as well as other cancers,
such as endometrial, ovarian, and stomach cancers.

● Personal history of colon cancer or polys - Certain hereditary syndromes, such as

Lynch syndrome (hereditary nonpolyposis colorectal cancer or HNPCC) and familial
adenomatous polyposis (FAP), significantly increase the risk of developing multiple
colorectal cancers. In these cases, the genetic mutations that drive the first cancer may
also increase the risk of subsequent cancers.

PRECIPITATING
● Alcohol use- When a person consumes alcohol, it is metabolized in the liver to produce
a toxic substance called acetaldehyde. Acetaldehyde can damage DNA and proteins,
leading to mutations and disruptions in normal cellular processes. Over time, this
damage can contribute to the development of cancer.
 ● Smoking- Smoking introduces harmful chemicals into the body, including carcinogens
such as polycyclic aromatic hydrocarbons (PAHs) and nitrosamines. These chemicals
can be absorbed into the bloodstream and reach the colon and rectum, potentially
leading to DNA damage and the formation of cancerous cells.
● Diet- A high intake of red and processed meats and low consumption of fruits and
vegetables are associated with an increased risk of colorectal cancer
● Obesity- The body's cells become resistant to the effects of insulin, resulting in elevated
blood sugar levels. Insulin resistance can lead to increased levels of insulin in the body.
High insulin levels may promote the growth of cancer cells and the development of
tumors.
● Inactive lifestyle- An inactive lifestyle is a common contributor to obesity. Excess body
fat, especially around the abdomen, can lead to chronic inflammation, insulin resistance,
and elevated levels of certain hormones, all of which can promote the growth of cancer
cells.

SYMPTOMATOLOGY
● Abdominal Pain: Because the cancerous cells in the colon can cause inflammation and
irritation in the digestive tract. As the cancer grows, it can cause a blockage or
obstruction in the colon, leading to cramping, abdominal pain, and discomfort.
● Hematochezia: Because the cancerous cells can cause bleeding in the colon. As the
cancer grows, it can cause damage to the lining of the colon, leading to bleeding that
can be seen in the stool.
● Anemia: Because the cancerous cells in the colon can cause bleeding in the digestive
tract, leading to a decrease in red blood cells.
● Weight loss: The obstruction in the colon affects the efficiency of nutrient absorption
and digestion. Substances that would normally be absorbed in the colon, contributing to
the body's nutritional status, may not be absorbed properly due to the blockage. This can
result in a decrease in appetite and a reduction in the intake of essential nutrients. As
the body continues to expend energy, coupled with the challenges in nutrient absorption,
weight loss becomes a noticeable symptom.
● Diarrhea: This can cause a change in bowel habits, leading to loose and watery stools.
Additionally, if the cancer causes an obstruction or blockage in the colon, it can lead to
diarrhea as the body tries to pass stool around the blockage.
 ● Changes in appetite: Due to the obstruction or blockage in the colon, it can lead to a
feeling of fullness or discomfort after eating, which can further decrease appetite.
● Fatigue: The body has to work harder to fight the cancer, leading to a feeling of
tiredness and weakness.
● Pencil/ribbon-shaped stool: Because the cancerous cells in the colon can cause a
narrowing of the stool as it passes through the colon. This can cause the stool to
become thin, pencil-like, or ribbon-shaped.

GENERAL PATHOPHYSIOLOGY
Narration:
The predisposing and precipitating factors interact and accumulate over time, leading to
the initiation of colon cancer. It begins with a series of genetic mutations that disrupt the normal
function of the epithelial cells and lead to the formation of abnormal cells that grow
uncontrollably. These mutations can be inherited or acquired over time due to exposure to
environmental factors such as toxins, radiation, or chronic inflammation. One of the earliest
genetic mutations that can occur in the epithelial cells of the colon is a mutation in the APC
(adenomatous polyposis coli) gene. This mutation disrupts the normal function of the APC
protein, which is involved in the regulation of cell growth and division. Due to the disruption of
cells in the colon it arises from the epithelial lining of the intestine, which is the layer of cells that
lines the inner surface of the colon and rectum. The epithelial lining of the intestine is composed
of different types of cells, including absorptive cells, goblet cells, and enteroendocrine cells,
among others. These cells play important roles in the absorption of nutrients, secretion of
mucus, and regulation of intestinal motility. Furthermore, The cells in the epithelial lining of the
colon will start to grow abnormally and form small, benign growths called polyps. Symptoms
include abdominal pain, hematochezia, diarrhea, constipation, and pencil shaped stool. Over
time, continuous proliferation of cells can occur in the polyps, leading to the increase in the size
of the polyps that lead to the development of malignant tumors. These mutations can affect
genes involved in cell division, DNA repair, and cell signaling, among others. As uncontrolled
growth of cells in the polyps continue to divide and grow, they eventually invade the surrounding
tissues and spread to other parts of the body, a process known as metastasis. With that, it will
result in colon cancer.
LABORATORY & DIAGNOSTIC
● Colonoscopy: used to evaluate the colon's lining, which determines polyps or tumors,
and collect tissue samples (biopsies) for further analysis.

○ This tool is recommended every 5 to 10 years

○ Camera is inserted to take pictures of polyps and get biopsy

Long explanation: Colonoscopy is a vital medical procedure used to evaluate the colon's
lining, enabling the identification of polyps or tumors. During the examination, a flexible tube
with a camera, known as a colonoscope, is inserted into the colon to capture detailed images.
This procedure serves both diagnostic and preventive purposes by allowing the removal of
precancerous polyps and the collection of tissue samples for analysis (biopsy). The frequency of
colonoscopies is typically recommended every 5 to 10 years, depending on individual risk
factors and medical history. Regular screenings are crucial for the early detection and
intervention of colorectal issues, contributing to effective prevention and management of
colorectal cancer.

● Fecal occult Blood test: Colorectal cancer and other gastrointestinal conditions can
cause bleeding, which may lead to the presence of blood in the stool detected by FOBT.
Elevated tumor markers called Carcinoembryonic Antigen (CEA) levels, associated with
cell adhesion (sticking together of cells), may suggest the presence of cancer cells,
especially colorectal cancer.

● CT (Computed Tomography) Scan: It ichecks for the presence of metastasis in the

brain. This tool provides detailed cross-sectional images of the colon and rectum. This
allows to detect the presence of tumors.

● Magnetic Resonance Imaging (MRI): This provides a more detailed view of the rectum
and surrounding structures, particularly for assessing rectal cancer.

MEDICAL MANAGEMENT
● Systemic Anti-Cancer Therapies (SACT): medications administered to destroy cancer
cells that may include a single or combination of medications.
● Radiation Therapy: uses protons and X-rays to kill colon cancer cells
 ● Chemotherapy: uses special drugs to kill and target cells that grow and divide quickly in
order to destroy cancer cells or shrink the tumor. Capecitabine
○ Theophylline Capecitabine
○ Oxaliplatin
○ Trifluridine and tipiracil
○ Flourouracil (Xeloda)- stops cancer cells and repair DNA
● Immunotherapy: uses the immune system to fight cancer. The body's disease-fighting
immune system may not attack the tumor because the cancer cells produce proteins that
blind the immune system cells from recognizing the cancer cells.
● Corticosteroids reduce inflammation, and relieve bowel stiffness by switching off
activated inflammatory genes.
● Palliative care: to improve quality of life and reduce pain.

SURGICAL MANAGEMENT
● Colostomy: surgical creation of an opening( ie, stoma) into the colon. It can be created
as a temporary or permanent fecal diversion.
● Polypectomy: removal of polyps during colonoscopy
● Partial colectomy: removal of the diseased section of the colon and reconnecting the
healthy parts to the rectum using laparoscopy.
● Permanent colostomy or ileostomy: involves creating an opening (stoma) in the
abdominal wall using a portion of the colon

NURSING DIAGNOSIS
Nursing Diagnosis 1: Acute Pain related to surgical procedure or tumor
compression
● Assess the patient's pain level using a pain scale at regular intervals.
● Administer prescribed pain medications as ordered and evaluate their
effectiveness.
● Implement non-pharmacological pain management techniques, such as guided
imagery or relaxation exercises.
● Educate the patient on the importance of reporting pain promptly and any
breakthrough pain.
● Collaborate with the healthcare team to adjust pain management strategies
based on the patient's response and side effects.
Nursing Diagnosis 2: Imbalanced Nutrition: Less Than Body Requirements related
to nausea, vomiting, and changes in appetite
● Assess the patient's nutritional status and dietary habits.
● Encourage small, frequent meals and snacks to enhance nutrient intake.
● Collaborate with a dietitian to develop a nutrition plan tailored to the patient's
needs and preferences.
● Monitor for signs of malnutrition and intervene promptly with nutritional support if
needed.
● Provide oral care before and after meals to enhance taste and reduce the risk of
oral complications.
Nursing Diagnosis 3: Risk for Infection related to compromised immune function
and surgical wounds
● Monitor vital signs and laboratory values, such as white blood cell count, for signs
of infection.
● Follow strict aseptic techniques during wound care and other procedures.
● Educate the patient and caregivers on the importance of hand hygiene and
infection prevention measures.
● Administer prescribed antibiotics promptly and assess for any signs of adverse
reactions.
● Collaborate with the healthcare team to implement strategies for preventing
healthcare-associated infections.
Nursing Diagnosis 4: Disturbed Body Image related to surgical changes,
colostomy, or other alterations
● Assess the patient's feelings and perceptions about changes in body image.
● Provide emotional support and encourage open communication about body
image concerns.
● Offer information about reconstructive options or strategies to enhance body
image.
● Collaborate with a stoma nurse specialist to provide education and support for
patients with a colostomy.
● Facilitate the involvement of the patient in decisions regarding appearance and
self-care.
Nursing Diagnosis 5: Anxiety related to cancer diagnosis, treatment uncertainties,
and lifestyle changes
 ● Establish a therapeutic nurse-patient relationship to foster trust and open
communication.
● Encourage the patient to express feelings and concerns about the cancer
diagnosis and treatment.
● Provide information about the disease, treatment options, and potential outcomes
to address uncertainties.
● Teach relaxation techniques and coping mechanisms to manage anxiety.
● Collaborate with the interdisciplinary team to involve a mental health professional
if needed for counseling or additional support.

PROGNOSIS
If treated = Fair prognosis results in patients only having a short life expectancy even after
treatment.
If untreated =Poor prognosis results Metastasis to other organs can lead to eventual death