Colorectal Cancer Nursing Care Plan and Management

 Description of Colorectal Cancer

  • Adenocarcinoma is the most common type of colon cancer and may spread by direct extension through the walls of the intestine or through the lymphatic or circulatory system. Metastasis is most often to the liver.
Duke’s Classification of Colorectal Cancer
  • Stage A: confined to bowel mucosa, 80-90 % 5 years survival rate
  • Stage B: invading muscle wall
  • Stage C; Lymph node involvement
  • Stage D: Metastases or locally unresectable tumor, less than 5% , 5 years survival rate.
Causes/ Risk Factors


  • Diet: Whether diet plays a role in developing colon cancer remains under debate. The belief that a high-fiber, low-fat diet could help prevent colon cancer has been questioned. Studies do indicate that exercise and a diet rich in fruits and vegetables can help prevent colon cancer.
  • Obesity: Obesity has been identified as a risk factor for colon cancer.
  • Smoking: Cigarette smoking has been definitely linked to a higher risk for colon cancer.
  • Drug effects: Recent studies have suggested that estrogen replacement therapy and nonsteroidal anti-inflammatory drugs such as aspirin may reduce colorectal cancer risk.

Most colorectal cancers arise from adenomatous polyps-clusters of abnormal cells in the glands covering the inner wall of the colon. Over time, these abnormal growths enlarge and ultimately degenerate to become adenocarcinomas.

People with any of several conditions known as adenomatous polyposis syndromes have a greater-than-normal risk of     colorectal cancer.

  • In these conditions, numerous adenomatous polyps develop in the colon, ultimately leading to colon cancer.
  • The cancer usually occurs before age 40 years.
  • Adenomatous polyposis syndromes tend to run in families. Such cases are referred to as familial adenomatous polyposis (FAP). Celecoxib (Celebrex) has been FDA approved for FAP. After 6 months, celecoxib reduced the mean number of rectal and colon polyps by 28% compared to placebo (sugar pill) 5%.

Another group of colon cancer syndromes, termed hereditary nonpolyposis colorectal cancer (HNPCC) syndromes, also run in families. In these syndromes, colon cancer develops without the precursor polyps.

  • HNPCC syndromes are associated with a genetic abnormality. This abnormality has been identified, and a test is available. People at risk can be identified through genetic screening.
  • Once identified as carriers of the abnormal gene, these people require counseling and regular screening to detect precancerous and cancerous tumors.
  • HNPCC syndromes are sometimes linked to tumors in other parts of the body.

Also at high risk for developing colon cancers are people with any of the following:

  • Ulcerative colitis or Crohn colitis (Crohn disease)
  • Breast, uterine, or ovarian cancer now or in the past
  • A family history of colon cancer
  • The risk of colon cancer increases 2-3 times for people with a first-degree relative (parent or sibling) with colon cancer. The risk increases more if you have more than one affected family member, especially if the cancer was diagnosed at a young age.
Ascending (Right) Colon Cancer
  • Occult blood blood in stool
  • Anemia
  • Anorexia and weight loss
  • Abdominal pain above umbilicus
  • Palpable mass
Distal Colon/ Rectal Cancer
  • Rectal bleeding
  • Change bowel habits
  • Constipation or diarrhea
  • Pencil or ribbon shaped stool
  • Tenesmus
  • Sensation of incomplete
Diagnostic Evaluation
  • Fecal occult blood test (FOBT) – checks for hidden blood in the stool. Sometimes cancers or polyps can bleed and this test is used to pick up small amounts of bleeding. Have this test every year.
  • Flexible sigmoidoscopy – an exam where a health care provider looks at the rectum and the lower part of the colon using a sigmoidoscope, a tube with a light on the end. Have this test every 5 years.
  • Colonoscopy – an exam when a health care provider looks at the rectum and the entire colon using a colonoscope, an instrument with a light on the end. If polyps are found, they can be removed. Have this test every 5 to 10 years.
  • Double contrast barium enema (DCBE) – a series of x-rays of the colon and rectum. You are first given an enema with barium in it, which outlines the colon and rectum on the x-rays. Have this test every 5 to 10 years (only if not having a colonoscopy every 10 years).
  • Digital rectal exam – a health care provider inserts a lubricated, gloved finger into the rectum to feel for any problem areas. Have this test every 5 to 10 years at the time of other screening tests (flexible sigmoidoscopy, colonoscopy, or DCBE).