Cancer colon rectal sign symptom

A malignancy deep within, it may require complex treatment.

Learn how to guide your patient through each step.

BEVERLY BOWEN, 63, IS A CREATURE of habit. Every morning as far back as she can remember, she's eaten a breakfast of bacon, eggs, toast, and coffee; within an hour, she's always had a bowel movement. Until recently, that is.

For the past month or so, Mrs. Bowen's routine has ended with an episode of diarrhea, and on days when it hasn't, she's been unable to move her bowels at all. But she didn't become alarmed until she noticed blood in her stool.

Mrs. Bowen's signs-alternating diarrhea and constipation and blood in the stools-are common in colon cancer, the fourth most prevalent cancer type. In this article, I'll discuss the risk factors, detection methods, treatments, and nursing measures you need to know to help a patient with colon cancer.

Assessing the risk

Accounting for 15% of new malignancies, colon cancer strikes men and women equally, typically after age 40. Growing slowly, the tumor may at first cause signs and symptoms that the patient can shrug off. For example, she may interpret blood in her stool as a sign of hemorrhoids or respond to a change in bowel habits by simply modifying her diet. But Mrs. Bowen knew that blood can indicate something serious, so she made an appointment with her physician.

While performing a complete assessment, the physician asks Mrs. Bowen if she has any of the following risk factors for colon cancer:

a high-fat, low-fiber diet including large amounts of meat. Mrs. Bowen's intake fits this category: Her breakfasts are laden with fat, she eats beef several times a week, and she consumes few fruits and vegetables. Researchers believe that animal fat may increase bile salt production, which alters colon epithelial cell reproduction and may trigger cancer. Fiber, on the other hand, may reduce exposure to carcinogens by speeding stool transit through the colon. Fatty meat doesn't contain fiber and may slow digestion.

ulcerative colitis or Crohn's disease. These inflammatory bowel diseases promote the development of dysplasia, which may lead to malignancy. genetic factors. Genetic diseases, such as familial adenomatous polyposis (FAP) and Gardner's syndrome, cause the development of colon polyps with a malignant predisposition.

personal or family history of colon cancer. Mrs. Bowen's father died of colon cancer.

environmental exposure to carcinogens. The incidence of colon cancer is higher in people who live in cities and industrialized countries.

Mrs. Bowen's physician performs a digital rectal examination and fecal occult-blood testing, which reveals a large amount of blood. He draws blood for liver function tests, a complete blood cell (CBC) count, coagulation studies, and carcinoembryonic antigen (CEA, a tumor marker) and blood urea nitrogen (BUN) levels.

Although most of Mrs. Bowen's lab results are within the normal range, her hemoglobin level is slightly decreased at 11.5 grams/dl (normal, 12 to 16 grams/dl) and her CEA level is elevated at 13 ng/ml (normal, 0 to 2.5 ng/ml in a nonsmoker; up to 5 ng/ml or higher in a smoker). Because her signs may indicate a tumor, the physician refers her to a gastroenterologist for a colonoscopy.

The day before the procedure, Mrs. Bowen begins a bowel prep by drinking only clear fluids. In the evening, she drinks 4 liters of polyethylene glycol-electrolyte solution (GOLYTELY) over 3 hours to evacuate her colon.

During the colonoscopy, the gastroenterologist detects a mass in the left side (descending colon) and performs a biopsy, which reveals malignant cells.

To help determine the stage of Mrs. Bowen's cancer and evaluate her for metastasis, the physician orders a chest X-ray (which is normal) and an abdominal computed tomography (CT) scan. The CT scan shows the colon tumor and several questionable lymph nodes nearby but no indication of metastasis. The physician schedules Mrs. Bowen for a left hemicolectomy.

Getting to know your patient Mrs. Bowen is admitted to the hospital on the morning of surgery. During your nursing assessment, you ask her about her normal gastrointestinal function: What were the color, consistency, and frequency of her bowel movements before she noticed a change? What changes occurred and when? Has she had abdominal pain, rectal bleeding, weight loss, vomiting, or abdominal distension?

The signs and symptoms of colon cancer depend on the location of the mass. Because the ascending or right portion of the colon is distensible, a tumor there may become large and palpable before the patient develops symptoms. Her first symptom may be crampy or achy abdominal pain. If the tumor bleeds, she may pass dark reddish brown stools and become anemic. Eventually, the tumor may obstruct her bowel. Because the stool in this part of the colon is liquid, the patient's bowel habits typically don't change.

Cancer in the transverse portion of the colon may cause the patient to have diarrhea, constipation, or bloody stools. An obstruction is more likely to occur here because the stool is thicker and a tumor in the narrow areas of the transverse colon or the hepatic or splenic flexures can prevent the stool from passing through.

Cancer in the left portion of the colon, where Mrs. Bowen's tumor is located, may cause a sense of fullness or cramps. The patient may become constipated or have diarrhea; if the tumor bleeds, her stools may contain bright red blood.

Benign diseases, such as polyps, irritable bowel disease, or inflammatory bowel disease, may cause signs and symptoms similar to those of colon cancer. Diagnosis and intervention are important to pinpoint the source and monitor benign conditions that may become malignant.

Regardless of the tumor site, progressing colon cancer may cause the patient to develop a fever and lose weight. Cancer may invade her urinary tract, liver, or lungs, the most common sites of metastatic colon cancer.

During your physical assessment, you inspect Mrs. Bowen's abdomen for distension, asymmetry, and distended veins, which may indicate portal hypertension secondary to liver metastasis. You listen for bowel sounds in all four quadrants. Palpating for ascites and masses, you ask if the pressure causes her pain. You should be able to feel the edge of her liver; if it's enlarged, note how far below the costal margin it extends.

You ask Mrs. Bowen if she understands her diagnosis. Encouraging her to express her feelings, you listen to her concerns. Then you tell her about a support group in her areafor example, after her discharge, a group sponsored by the American Cancer Society may help her cope with her cancer diagnosis.

Preparing for surgery

Surgery is the primary treatment for colon cancer. Typically, the surgeon removes in one piece the colon section with the cancer and its surrounding lymph nodes, blood supply, and mesentery.

In rare cases, the patient requires a colostomy. Advances in surgical techniques have reduced the number of colostomies performed to treat colon cancer; most colostomies are used for rectal cancer occurring within 8 cm of the anal verge. However, a temporary or permanent colostomy may be needed if:

an obstruction with extensive abdominal disease prevents performing a colectomy

the anastomosis created after extensive surgery requires a temporary colostomy for appropriate healing

a distal sigmoid colon resection requires a descending colostomy to allow for complete tumor resection.

To evacuate her colon and reduce its bacterial content, Mrs. Bowen underwent a bowel prep and took three doses of neomycin (an antibiotic) at home yesterday. This morning, you administer enemas to complete the cleaning.

During preoperative teaching, you reinforce the surgeon's explanation of Mrs. Bowen's planned surgical procedure and expected outcome.

You describe the type of dressing she'll have. Telling her that participating in her own care will give her a sense of accomplishment and help her recover, you teach her how to cough, breathe deeply using incentive spirometry, splint her incision, and move in bed. You explain how her pain will be managed and tell her that she'll have intermittent compression stockings to help prevent deep vein thrombosis (DVT).

You tell Mrs. Bowen that after surgery, she'll have a nasogastric (NG) tube and an indwelling urinary catheter. She'll receive intravenous (I.V.) fluids until the NG tube is removed and her bowel sounds return. Then she'll start taking ice chips and noncarbonated, clear liquids. The day after surgery, she'll get out of bed with assistance and sit in a chair. During the hemicolectomy, the surgeon takes care to avoid contaminating Mrs. Bowen's abdominal cavity with the opened bowel ends and spilling residual feces, which would increase the risk of infection. She sends the tissue to the lab for pathologic examination.