MALIGNANT NEOPLASM OF THE COLON

Colon cancer is a growth of cells that begins in a part of the large

intestine called the colon.
The colon is the first and longest part of the large intestine. The large
intestine is the last part of the digestive system. The digestive system
breaks down food for the body to use.

Colon cancer typically affects older adults, though it can happen at

any age. It usually begins as small clumps of cells called polyps that
form inside the colon. Polyps generally aren't cancerous, but some
can turn into colon cancers over time. Colon cancer is sometimes
called colorectal cancer. This term combines colon cancer and rectal
cancer, which begins in the rectum.

CLINICAL MANIFESTATION
Many people with colon cancer don't have symptoms at first. When symptoms appear,
they'll likely depend on the cancer's size and where it is in the large intestine.
Symptoms of colon cancer can include:

 A change in bowel habits, such as more frequent diarrhea or constipation.

 Rectal bleeding or blood in the stool.
 Ongoing discomfort in the belly area, such as cramps, gas or pain.
 A feeling that the bowel doesn't empty all the way during a bowel movement.
 Weakness or tiredness.
 Losing weight without trying.

CAUSES

 Colon cancer happens when cells in the colon develop changes in their DNA. A
cells' DNA holds the instructions that tell the cell what to do. The changes tell the
cells to multiply quickly. The changes let the cells continue living when healthy cells
die as part of their natural lifecycle.This causes too many cells. The cells might
form a mass called a tumor. The cells can invade and destroy healthy body tissue.
In time, the cells can break away and spread to other parts of the body. When
cancer spreads, it's called metastatic cancer.
Risk factors
Factors that may increase the risk of colon cancer include:

 Older age. Colon cancer can happen at any age. But most people with colon
cancer are older than 50. The numbers of people younger than 50 who have colon
cancer has been growing. Doctors don't know why.
 Black race. Black people in the United States have a greater risk of colon cancer
than do people of other races.
 A personal history of colorectal cancer or polyps. Having had colon cancer or
colon polyps increases the risk of colon cancer.
 Inflammatory bowel diseases. Conditions that cause pain and swelling of the
intestines, called inflammatory bowel diseases, can increase the risk of colon
cancer. These conditions include ulcerative colitis and Crohn's disease.
 Inherited syndromes that increase colon cancer risk. Some DNA changes that
increase the risk of colon cancer run in families. The most common inherited
syndromes that increase colon cancer risk are familial adenomatous polyposis and
Lynch syndrome.
 Family history of colon cancer. Having a blood relative who has colon cancer
increases the risk of getting colon cancer. Having more than one family member
who has colon cancer or rectal cancer increases the risk more.
 Low-fiber, high-fat diet. Colon cancer and rectal cancer might be linked with a
typical Western diet. This type of diet tends to be low in fiber and high in fat and
calories. Research in this area has had mixed results. Some studies have found an
increased risk of colon cancer in people who eat a lot of red meat and processed
meat.
 Not exercising regularly. People who are not active are more likely to develop
colon cancer. Getting regular physical activity might help lower the risk.
 Diabetes. People with diabetes or insulin resistance have an increased risk of
colon cancer.
 Obesity. People who are obese have an increased risk of colon cancer. Obesity
also increases the risk of dying of colon cancer.
 Smoking. People who smoke can have an increased risk of colon cancer.
 Drinking alcohol. Drinking too much alcohol can increase the risk of colon cancer.
 Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat
previous cancers increases the risk of colon cancer.

DIAGNOSTIC EVALUATION
 Imaging tests: CT, MRI or other imaging tests can capture important details, including a
tumor’s size or location.
 Blood tests: Your doctor may order blood tests to evaluate your overall health. A blood test
may also check for substances (called tumor markers) that colon cancer cells make.
 Stool-based tests: Doctors may use stool-based tests for colon cancer screening or diagnosis.
For some tests, a lab checks a stool sample for signs of colon cancer, such as blood. Other
tests analyze the DNA in stool for possible cancer.
 Pathology tests: If your doctor removes abnormal tissue during a colonoscopy, a pathologist
will analyze cells under a microscope, looking for telltale signs of cancer. Pathology tests can
confirm or rule out a cancer diagnosis. Our pathologists are experts in GI cancer diagnosis.

MEDICAL MANAGEMENT

 1. Surgery :The main treatment for colon cancer involves surgical removal of the tumor and
nearby lymph nodes. This procedure may involve a partial colectomy (removal of a portion of
the colon) or a total colectomy (removal of the entire colon). In some cases, a colostomy or
ileostomy may be necessary to divert stool from the remaining portion of the colon to an
opening in the abdomen.

 2. Chemotherapy :Chemotherapy involves the use of drugs to kill cancer cells or prevent their
growth. It is commonly used before or after surgery to shrink tumors, reduce the risk of
recurrence, or treat metastatic disease. Common chemotherapy drugs used for colon cancer
include fluorouracil (5-FU), oxaliplatin, irinotecan, capecitabine, and others.

 3. Targeted Therapy: Targeted therapy drugs specifically target cancer cells by interfering with
specific molecules involved in tumor growth and progression. For colon cancer, targeted
therapies such as bevacizumab, cetuximab, panitumumab, and regorafenib may be used,
particularly in cases where the cancer has specific genetic mutations, such as KRAS or BRAF
mutations.

 4. Immunotherapy :Immunotherapy drugs work by stimulating the body's immune system to

recognize and attack cancer cells. Pembrolizumab and nivolumab are immunotherapy drugs that
may be used for certain types of advanced colon cancer, particularly those with microsatellite
instability-high (MSI-H) or mismatch repair deficiency (dMMR).

 5. Radiation Therapy : Radiation therapy uses high-energy beams to target and destroy cancer
cells. It may be used before surgery to shrink tumors, after surgery to destroy any remaining
cancer cells, or to relieve symptoms in cases of advanced disease. Radiation therapy is not as
commonly used for colon cancer as it is for some other types of cancer, but it may be
recommended in certain situations.

 6. **Supportive Care**: Supportive care plays a crucial role in managing colon cancer and
includes pain management, nutritional support, management of treatment side effects, and
psychosocial support for patients and their families. This may involve working with a
multidisciplinary team of healthcare professionals, including oncologists, surgeons, nurses,
dietitians, and social workers, to address the individual needs of each patient.

 It's important for patients to discuss their treatment options with their healthcare team to
develop a personalized treatment plan tailored to their specific diagnosis and preferences.
NURSING MANAGEMENT

 1. **Assessment and Monitoring**: Nurses play a crucial role in assessing patients' symptoms,
monitoring their vital signs, and evaluating their response to treatment. This involves regular
physical assessments, including monitoring for signs of complications such as infection, bleeding,
or bowel obstruction.

 2. **Education and Support**: Nurses provide education to patients and their families about
colon cancer, its treatment options, potential side effects, and self-care strategies. This may
include guidance on managing dietary changes, coping with emotional distress, and recognizing
signs of complications.

 3. **Symptom Management**: Nurses assist patients in managing symptoms related to colon

cancer and its treatment, such as pain, nausea, fatigue, and diarrhea. This may involve
administering medications, providing comfort measures, and teaching patients relaxation
techniques or distraction methods.

 4. **Nutritional Support**: Nurses collaborate with dietitians to assess patients' nutritional

needs and develop personalized dietary plans. They provide guidance on maintaining adequate
nutrition during treatment, managing side effects such as appetite loss or digestive issues, and
adapting to any dietary restrictions or modifications.

 5. **Pain Management**: Nurses play a key role in assessing and managing pain in patients with
colon cancer. This involves administering pain medications as prescribed, monitoring their
effectiveness, and implementing non-pharmacological pain management strategies such as
positioning, relaxation techniques, or heat therapy.

 6. **Psychosocial Support**: Nurses address the psychosocial needs of patients and their
families by offering emotional support, counseling, and referrals to support services such as
social work, counseling, or support groups. They help patients cope with anxiety, fear,
depression, and other emotional challenges associated with a cancer diagnosis.

 7. **Wound Care**: In cases where patients undergo surgery for colon cancer, nurses provide
wound care and monitor for signs of infection or other complications. They educate patients on
proper wound care techniques, monitor healing progress, and collaborate with other healthcare
professionals to promote optimal recovery.

 8. **Prevention and Early Detection**: Nurses play a role in promoting colon cancer prevention
and early detection through patient education, advocacy for screening programs such as
colonoscopies, and raising awareness about risk factors and warning signs of the disease.

COMPLICATIONS
1. **Bowel Obstruction**: As the tumor grows, it can partially or completely obstruct the colon, leading
to symptoms such as abdominal pain, bloating, constipation, and vomiting.

2. **Bowel Perforation**: In some cases, the tumor can erode through the wall of the colon, causing a
perforation. This can lead to peritonitis, a serious infection of the abdominal cavity, which requires
prompt medical attention.

3. **Bleeding**: Colon cancer can cause bleeding from the tumor site, which may result in symptoms
such as rectal bleeding, blood in the stool, anemia, and weakness.

4. **Anemia**: Chronic bleeding from the tumor can lead to iron deficiency anemia, resulting in
symptoms such as fatigue, weakness, and shortness of breath.

5. **Metastasis**: Colon cancer can spread (metastasize) to other organs, such as the liver, lungs, or
bones, leading to additional complications associated with metastatic disease.

6. **Liver Dysfunction**: If colon cancer metastasizes to the liver, it can impair liver function and lead to
symptoms such as jaundice (yellowing of the skin and eyes), abdominal pain, and fluid accumulation in
the abdomen (ascites).

7. **Infection**: Infections can occur as a result of complications such as bowel perforation, surgical site
infections following surgery, or immunosuppression due to cancer treatments.

8. **Side Effects of Treatment**: Chemotherapy, targeted therapy, immunotherapy, and radiation

therapy can all cause side effects such as nausea, vomiting, diarrhea, hair loss, fatigue, and increased
susceptibility to infections.

9. **Lymphedema**: Removal of lymph nodes during surgery for colon cancer can sometimes lead to
lymphedema, a swelling of the limbs due to impaired lymphatic drainage.

10. **Psychological and Emotional Impact**: Dealing with a diagnosis of colon cancer and undergoing
treatment can have a significant psychological and emotional toll on patients and their families, leading
to anxiety, depression, and other mental health challenges
 PREVENTION

1. **Screening**: Regular screening for colon cancer is one of the most effective ways to prevent the
disease or detect it at an early stage when it's most treatable. Screening tests include colonoscopy,
sigmoidoscopy, fecal occult blood tests (FOBT), fecal immunochemical tests (FIT), and stool DNA tests
(such as Cologuard). The recommended screening schedule may vary depending on individual risk
factors and guidelines from healthcare organizations.

2. **Healthy Diet**: A diet rich in fruits, vegetables, whole grains, and lean proteins, and low in red and
processed meats, saturated fats, and refined sugars may help lower the risk of colon cancer. Eating a
high-fiber diet and consuming adequate calcium and vitamin D may also be beneficial.

3. **Regular Physical Activity**: Engaging in regular physical activity, such as brisk walking, jogging,
cycling, or swimming, can help reduce the risk of colon cancer. Aim for at least 150 minutes of
moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week, along with strength
training exercises at least twice a week.

4. **Maintain a Healthy Weight**: Being overweight or obese is associated with an increased risk of
colon cancer. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce
this risk.

5. **Limit Alcohol Consumption**: Alcohol consumption, especially heavy drinking, has been linked to
an increased risk of colon cancer. Limit alcohol intake to no more than moderate amounts, which is up
to one drink per day for women and up to two drinks per day for men.

6. **Avoid Tobacco**: Smoking has been linked to an increased risk of colon cancer, as well as other
types of cancer and numerous health problems. If you smoke, quitting can significantly reduce your risk
of developing colon cancer and improve your overall health.

7. **Screening for and Treatment of Precancerous Polyps**: Removing precancerous polyps during a
colonoscopy can prevent them from developing into cancer. Regular screening allows for the detection
and removal of polyps before they become cancerous.
8. **Medications**: Some medications, such as aspirin and nonsteroidal anti-inflammatory drugs
(NSAIDs), may help reduce the risk of colon cancer in certain individuals. However, these medications
can have side effects and should only be used under the guidance of a healthcare professional.

9. **Genetic Counseling and Testing**: Individuals with a family history of colon cancer or certain
genetic conditions, such as Lynch syndrome or familial adenomatous polyposis (FAP), may benefit from
genetic counseling and testing. Identifying individuals at higher risk can help tailor screening and
prevention strategies accordingly.