Colorectal tumors are generally adenocarcinomas that develop from adenoma polyp.
Cause of Colorectal Cancer is not known for certain, but there are predisposing factors consisting of:
- Age over 40 years
- Family history
- History of cancer in other parts of the body
- Benign polyps, colorectal polyps, adenomatous polyps, or adenomas villus
- Ulcerative colitis is more than 20 years
- Sedentary Life style, smoking, obesity.
- Eating habits of high cholesterol / fat and protein (meat) and low in fiber / Refined Carbohydrates that cause changes in faecal flora and the change of bile salts degradation or breakdown products of protein and fat which are carcinogenic.
The clinical manifestations are varied and nonspecific. Can be found without complaint until the complaint and depends heavily on the location / size of the tumor. In the right colon carcinoma, clients present with no future in the right abdomen, obstruction will occur when the tumor is large. Left colon tumors occur more quickly obstipation and the signs of obstruction.
In patients with Colorectal Cancer generally Asymptomatis, or relatively mild symptoms while the disease was found. Symptoms that may arise related to the gastrointestinal tract. Signs and symptoms are determined by the location of the cancer, the stage of disease and the function of intestinal segments where the cancer is located. Discomfort in the stomach or abdominal pain is the most frequent complaints presented patients. However, this complaint is not associated with colon cancer with rectum cancer.
Peranal bleeding as the first complaint of patients with symptoms such as bleeding or without mixed fresh feces. Changes in bowel habit can be; diarrhea / constipation, stool shape like a pencil, and my stomach still feels full despite defecation. The other symptoms are: anemia idiopathic, Nausea, malaisea, Haemoroid, anorexia, and weight change (B decreases) due to irritation and reflux response.
Complication
- Partial or complete intestinal obstruction followed by narrowing of the lumen due to lesions.
- Hemorrhage / bleeding
- Perforation abscess formation due to the intestinal wall by tumor contamination of the peritoneal cavity followed by intestinal contents.
- Shock due to peritonitis and sepsis
- Mestatase adjacent to other organs. Fistula occur in the bladder, vagina / intestine..
Management
Precautions need to be done and include education about the diet that individuals increase intake of fruits, vegetables, and coarse food grain to increase lower-fat food future and provide antioxidants.
Diagnostic and laboratory:
- Diagnostic approach in patients with colorectal cancer depends on the clinical symptoms appear. Small proportion of patients who come in a serious condition that requires immediate surgery so that a diagnosis can be made immediately, or sometimes a diagnosis can be made through a digital rectal examination.
- On digital rectal examination period may be palpable. Fecal occult blood test can indicate the presence of cancer. Early identification of polyps with digital rectal examination, prokto-sigmoidoscopy / colonoscopy and surgical removal of all polyps can prevent cancer formation. Blood tests for specific antigens associated with Colorectal Cancer, especially carsino-embrionic antigen (CEA).
The laboratory tests are recommended as follows:
- The number of blood cells for evaluation of anemia. Microcytic anemia, characterized by red blood cells are small, with no visible cause is a common indication for further diagnostic tests to find the certainty of colorectal cancer.
- Guaiac test on stool to detect blood clots in the stool, because all colorectal cancers bleed remitten.
- CEA (carcinogens Embrioniogenic Antigen) is a glycoprotein found on cell membranes in many tissues, including colorectal cancer. This antigen can be detected by radioimmunoassay of serum or other body fluids and secretions.
- Phospatase alkaline blood chemistry and levels of bilirubin can be elevated, an indication has on the liver. Other laboratory tests only include serum protein, calcium, and creatinine.
- Barium enema is often used for the detection or confirmation of the existence and location of the tumor.
- Chest X-ray to detect tumor metastases to the lungs.
- CT (computed tomography) - Scan, Magnetic Resonance Imaging (MRI) or ultrasonic examination can be used to assess whether there is metastasis.
- Endoscopy (sigmoidoscopy or Colonoskophy) is the primary diagnostic test used to detect and see the tumor. All tissue biopsy done. Endoscopic examination of the recommended colonoscopy and biopsy to determine the location of the lesion on the client with bleeding rectum.
Nursing Management of Colorectal Cancer
Client care with bowel surgery:
A. Pre-Operative of Colorectal Cancer
- Ensure valid signs for the procedure. This is useful for patients and family members to understand the procedures and possible risks and advantages, should alternatives to the preparation procedure. Format signing consent for procedures especially as documentation that the client and the family agreed.
- Assess the client and family understanding about the procedure, clarification and interpret as needed. Give instructions on what to expect during the postoperative period, covering pain management, hose fitting NGT / IVFD, breathing exercises, reintroduction of oral intake of food and fluids. Clients are well prepared for preoperative usually not anxious and better able to support the post-operative care. Adequate preparation also reduced the need for narcotic analgesics and enhance client recovery.
- NGT installation. Although the installation is often done in an operating room just for surgery, preoperative NGT can be fitted to throw secretion and gastric emptying.
- Bowel preparation procedure. Antibiotic should kathartik oral and parenteral and enema / swallow can be given preoperatively to cleanse the colon and reduce the risk of peritoneal contamination by intestinal contents during surgery.
Pre-operative treatment goals:
- Relief of pain
- Increase activity tolerance
- Provide nutritional measures
- Maintain fluid and electrolyte balance
- Lowers Anxiety
- Prevent Infection
- Client Pre-operative education
B. Post-Operative of Colorectal Cancer
- Routine care for the surgical client. Monitor vital signs and intake and output, including gastric and other drainage from the wound drain. Assess bleeding from abdominal and perineal incision, colostomy, or anus. Evaluation of the other wound complications and maintain the integrity of psychology.
- Monitor bowel sounds and abdominal distension degrees. Surgical manipulation of the intestinal peristaltic manghentikan, cause ileus. Absence of bowel sounds and passage of flatus indication of the return of peristaltic.
- Drugs reduce pain and provide a sense of comfort as checking the position change
- Assess respiratory status, prop abdomen with a blanket or pillow to help cough
- Assess the position and patency of NGT, linkage suction. When folded hoses, irrigation with sterile saline carefully.
- Assess the color, number, and the smell of drainage and colostomy (if any) noted various changes or clot or bleeding bright red.
- Avoid mounting rectal temperature, rectal suppository or other procedure might damage the anal suture line, causing bleeding, infection or impaired healing.
- Maintain intravenous fluids when they do naso gastric suction
- Giving antacid, histamine 2 receptor antagonists and antibiotic therapy is recommended. Depending on the procedure performed. Antibiotic therapy to prevent infection due to contamination of the abdominal cavity with bowel contents.
- Encourage ambulation to stimulate peristaltic
- Began teaching and discharge planning. Consult with a nutritionist for diet instructions and menus, give reinforcement teaching.
The purpose of post-operative care:
- Wound care
- Client education and home care considerations
- Positive body image
- Monitoring and management of complications
