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Colorectal Cancer

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cdunbar4's version from 2016-10-22 21:40

Facts

Question Answer
___ most common form of cancer death & #_ cause of cancer related deaths in U.S.3rd, #2
Most prevalent over the age of 50
What is the survival rate?5-years: 90% for early, localized colorectal cancer & 64% for cancer that has spread to organs & lymph nodes
CausesGenetic predisposition; age (>40); men>women; high-calorie, high-fat western diet; etoh/tobacco
Why do tumors spread to the liver?venous blood flow from colorectal tumor is via portal vein
Most common type of tumor?adenocarcinoma-most arise from adenomatous polyps
Tumors spread through walls of intestine & into lymphatic system. % that start as polyps?85%!!! Can be detected and removed! Patient teaching!
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Manis

Question Answer
Ascending colonpain, mass, change in bowel habits, anemia, occult bleeding (or not blood): vague pain, usually no symptoms
Descending colonrectal bleeding; alternating constipation & diarrhea; narrow ribbon like stools; obstruction sx more likely
What is a textbook sign of colorectal cancer?alternating constipation & diarrhea
Harder to diagnose ascending or descending?ascending: diffuse pain, not as much blood → if dull, deep/vague pain be suspicious!
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Diagnostics

Question Answer
Depends onfamily hx & physical exam
flexible sigmoidoscopydetects 50% Q5 years
colonoscopyvisualizes entire colon Q10 years
Carcinoembryonic antigen (CEA)complex glycoprotein produced by 90% of all CRC's...used for monitoring after surgery or chemo
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Collaborative Care

Question Answer
Prognosis and treatment corelate withpathologic staging of the disease
Duke's classificationA, B1, B2, C, D See table 43-25
TNM classificationTumor size, node involvement and metastasis
endoscopic polypectomyremoval of polyps
surgical therapythe only curative treatment
chemo and radiation is recommended whena patient has positive lymph nodes at the time of surgery or has metastatic disease; adjuvant after colon resection; primary treatment for nonresectable CRC
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Nursing shit→ pun intended.

Question Answer
AssessmentHH: any previous cancer; familial polyposis; adenomatous polyps; IBD; Meds that ↓ immunity; weakness or fatigue; change in bowels; high-calore, high-fat, low-fiber diet
Planningnormal bowel elimination patterns; QOL APPROPRIATE to disease progression; relief of pain; feelings of comfort & well-being
Implementation at age 50fecal testing for occult blood done every year
Flexible sigmoidoscopy should be done every ___ to ___ years5-10
screening for high-risk patients should be done at ___ years45 years
The use of ________ or long term use of ______ may ↓ RF colorectal cancer (per epidemiologic studies)NSAIDs; aspirin
Acute intervention: preop careostomy care: inform about extent of procedure & amount of care needed to facilitate healing
Acute intervention: post op caredepends on type of wound-watch for skin breakdown!
Ambulatory & Home Carepsychologic support; chemo; perneal wound may not be completely healed before discharge
Evaluationminimal alterations in BM's; relief of pain; balanced nutritional intake; QOL appropriate to disease progression; feelings of comfort and well-being.
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