Colorectal Cancer: Symptoms, Nursing Management & Complete Nursing Care Plan

 Colorectal Cancer: 

IRODUCTION :

Colorectal cancer is a common and life-threatening disease that affects the colon and rectum. Early detection and proper nursing management significantly improve patient outcomes. This comprehensive guide explains colorectal cancer in detail, including causes, symptoms, diagnostics, medical management, nursing management, and a complete nursing care plan (NCP) in table format. It is especially useful for nursing students, healthcare professionals, and educators preparing assignments or presentations.

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Definition  of Colorectal Cancer :

Colorectal cancer is a malignant growth of epithelial cells in the colon or rectum, commonly originating from adenomatous polyps through a progression called the adenoma-carcinoma sequence.

Epidemiology of Colorectal Cancer :

• One of the leading causes of cancer-related death.

• More common in individuals >50 years.

• High prevalence in Western countries but rising in India due to lifestyle changes.

Risk Factors of Colorectal Cancer :

Modifiable

• Diet high in fat, red meat, low fiber

• Obesity

• Physical inactivity

• Smoking

• Heavy alcohol use

• Type 2 diabetes

Non-modifiable

• Age >50 years

• Family history of CRC

• Genetic disorders: FAP, Lynch syndrome

• Personal history of IBD (ulcerative colitis, Crohn’s)

Pathophysiology of Colorectal Cancer :

Colorectal cancer follows a slow progression:

1. Mutation in the colon lining

2. Formation of polyps

3. Dysplasia (abnormal cell growth)

4. Carcinoma in situ

5. Invasive cancer

6. Local spread and metastasis

This progression often occurs silently, making screening essential.

Common Symptoms of Colorectal Cancer :

Symptoms vary depending on the location of the tumor.

Early Symptoms

• Change in bowel habits

• Occult or visible blood in stool

• Fatigue or weakness

• Persistent abdominal discomfort

Advanced Symptoms

• Severe anemia

• Weight loss

• Bowel obstruction

• Rectal bleeding or painful defecation

If symptoms persist for more than two weeks, medical evaluation is recommended.

Diagnostic Evaluation of Colorectal Cancer :

A timely diagnosis improves recovery and survival.

Most Common Diagnostic Tests:

• Colonoscopy (gold standard)

• Fecal Occult Blood Test (FOBT)/FIT

• Biopsy for confirmation

• CT and MRI scan for staging

• CEA levels to monitor treatment response

Medical & Surgical Management of Colorectal Cancer :

Treatment depends on the cancer stage, location, and patient’s overall health.

1. Surgical Treatment

• Hemicolectomy

• Low anterior resection

• Abdominoperineal resection

• Colostomy creation (temporary or permanent)

2. Chemotherapy

• FOLFOX

• FOLFIRI

3. Radiation Therapy

Often used for rectal cancer to reduce tumor size before surgery.

4. Targeted & Immunotherapy

• Bevacizumab (anti-angiogenic)

• Cetuximab (EGFR inhibitor)

• Pembrolizumab (for MSI-H tumors)

Nursing Management of Colorectal Cancer

Nurses play a vital role in caring for patients with colorectal cancer—from pre-operative preparation to post-operative rehabilitation.

Pre-Operative Nursing Care

• Assess bowel habits, bleeding, and nutritional status

• Provide bowel preparation instructions

• Maintain NPO status

• Educate patient on the surgical procedure

• Provide psychological support

• Teach basic stoma care if colostomy is planned

Post-Operative Nursing Care

• Monitor vital signs and surgical incision

• Manage drains, IV fluids, and analgesics

• Promote early ambulation to prevent DVT

• Assess bowel sounds and elimination

• Provide colostomy care and skin protection

• Monitor for complications such as infection or obstruction

Nutritional Management

• Gradually reintroduce diet

• High-protein, high-calorie meals

• Encourage hydration

• Avoid gas-producing foods in early recovery

Psychosocial Support

• Allow patients to express fears

• Provide emotional counseling

• Support body image changes after colostomy

• Encourage participation in cancer support groups

Nursing Care Plan (NCP) for Colorectal Cancer

Nursing Diagnosis	Goals / Expected Outcomes	Nursing Interventions	Rationale	Evaluation
Acute Pain related to surgical incision/tumor	Pain reduces to ≤ 3/10	Assess pain, administer analgesics, provide comfort measures	Adequate pain control promotes healing	Patient reports reduced pain
Risk for Infection due to surgery or immunosuppression	No signs of infection	Monitor temperature, WBC, incision site; maintain aseptic technique	Prevent early postoperative complications	Wound remains clean and intact
Imbalanced Nutrition: Less than body requirements	Weight maintained or improved	Provide high-calorie meals, monitor intake, refer to dietician	Adequate nutrition aids recovery	Weight and labs stabilize
Risk for Impaired Skin Integrity around stoma	Stoma site remains intact	Inspect stoma daily, apply skin barriers, teach proper care	Prevents irritation and infection	Skin remains free from breakdown
Anxiety related to diagnosis and surgery	Patient verbalizes reduced anxiety	Provide emotional support, explain procedures, encourage questions	Reduces fear and improves coping	Patient demonstrates coping strategies
Knowledge Deficit regarding disease and self-care	Patient demonstrates correct self-care	Provide education materials, demonstrate stoma care, allow return demo	Enhances independence and compliance	Patient performs care properly

Prevention and Lifestyle Tips :

To prevent colorectal cancer or avoid recurrence:

• Eat a high-fiber diet

• Reduce red and processed meats

• Exercise regularly

• Maintain a healthy weight

• Avoid smoking and alcohol

• Go for routine screenings after age 50 or earlier if high-risk