Your Actual or Potential Heath Conditions or Needs

Dear Colon,

We have learned about everything we need to know when you and/or your buddy, rectum become cancerous.  This week, I would like to learn about what a nurse would think I need when you have cancer.

Nursing Diagnosis #1- Constipation related to obstructive lesions.  This usually happens when my bowels are obstructed in you.

Nursing Diagnosis #2- Acute pain related to tissue compression secondary to obstruction.  I may experience excruciating pain because of feeling bloated.  I might later on experience post-surgical pain.

Nursing Diagnosis #3- Fatigue related to anemia or anorexia.  Feeling tired because you are bleeding in my bowel and I lost my appetite.

Nursing Diagnosis #4- Disturbed image related to colostomy.  Possible self-loathing because of stoma and colostomy.  Feeling disgusted by managing my bowel movement on my abdomen.  

Nursing Diagnosis #5- Knowledge deficit about diagnosis, surgical procedures, and self care.  Feeling really lost and not knowing anything about your condition.  This would freak me out!  

Nursing Diagnosis:  Knowledge deficit about diagnosis, surgical procedures, and self care.  

Actual Problems:  Unaware about the onset, course, pathophysiology of colorectal cancer.  Not knowing what to expect from the surgical procedures. 

Potential Problems:  At risk of improper self care. 

Plan:  Patient will be able to use teach back technique to demonstrate knowledge of colorectal caner, his/her surgical procedures, and ways of proper self care after surgery or when discharge home.  

Outcome:  Patient and family will be knowledgeable about the diagnosis of colorectal cancer, surgical procedures (knowing what to expect and consequences), and will be able to provide proper self care after the surgery.    

Nursing Intervention:  RN will provide verbal and written education for patient and family about colorectal cancer, the surgical procedures of it, and ways of proper self care after the surgery.  

Yours sincerely,

Jumbo

What can a nurse do?

Dear Colon,

How are you?  This week, we'll learn about how the nurses can take care of me while you have cancer.  There's a lot the nurses can do to take care of us; it all depends on the treatment options I elect.  If I choose to have part of you or all of you surgically removed, the nurse would have to provide pre-operative care like the following as suggested by :
1) Preparing the patient for the surgery by offering guidelines about what an be expected from general anesthesia, intubation, and post-operative care management.
2) After surgery, the nurse will monitor my vital signs while I regain my consciousness from anesthesia.
3) The nurse will closely monitor my orientation, my post-operative pain, and my intake and output every 30 minutes.
4) The nurse would also closely monitor the lab results to ensure good blood count and possible infection (Hct, Hb, Leuk), and electrolyte balanced.
5) If there's a stoma as a result of the surgery, the nurse would use aseptic procedures to care for it to prevent infection.
6) Respiration would be closely monitored to see if I can breath on my own.
7) If the catheter is no longer necessary, the nurse would have to remove it from me as soon as possible to prevent hospital acquired infections.

These pictures illustrate how I can change the ostomy bag independently.

This video shows us what a stoma is.

This video shows how a nurse providing ostomy care.

According Pereira (2014), with the increased number of colorectal cancer survivors worldwide, nursing interventions are crucial to enable autonomy and promote independence for the patients.  Effective nursing interventions include multimedia education program, a structured telephone follow-up conducted by an experienced nurse specialist, and a 17-item patient completed continuity assessment with feedback to clinical nurse specialist and actions to address the needs identified.  More research needs to be done in this area to promote post-cancer care for the patients and their families.  I hope I will benefit from these research in the future.

Yours sincerely,

Jumbo

Reference:
Colon Cancer Care Plan. (2013, June 16). Retrieved May 13, 2015, from http://www.istudentnurse.com/care-plans/crc/
Pereira, N. (2014). Educating and empowering colorectal cancer survivors. Gastointestinal Nursing, 12(9), 33-40.

To Treat or Not to Treat?

Dear Colon,

If one day you are diagnosed with cancer, I will no doubt pursue treatment.  Treatment options varies depending on the stage of cancer that's invading you, and the location of it.  It might not be a 100% cure. I will pursue treatment aiming for remission, preventing metastasis and relapse, and hopefully a cure eventually.  Cancer treatment is not easy physically and mentally; nevertheless, with the advanced medical technology, we have hope.

I actually found some detailed staging information about your colorectal cancer on the American Cancer Society's website.  Here is the link:  http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-staged
I think I was only describing your progression in general in my last letter.  However, this website gives you extensive description of your cancer's staging.  After I learn about the stage of the cancer, I will talk to my doctor about the type of treatment I want to undergo.

According to the American Cancer Societ, there are four treatment options:  surgery, radiation therapy, chemotherapy, and targeted therapy.  The diagram on the letter head is showing one of the surgery options, colectomy (partial or complete removal of colon) for your cancer.  It can be done through open surgery, one incision in the abdomen, or a laparoscope-assisted colectomy.  A laparoscope is a thin tube with light and a camera at the end of it.  Some lymph nodes would be removed while undergoing a partial colectomy.  After the surgery, you will need two to three days of pain medication to manage the pain and you won't be able to return to your regular diet until a few days later.  We have to give you time to heal.  Side effects of colectomy are like any other surgeries.  However, if you undergo a total colectomy, you may have a temporary or permanent colostomy.  In that case, I will need to adjust my lifestyle to manage it.

Radiation is another treatment option.  People with colon cancer that has attached to an internal organ or the lining of the abdomen would need radiation for treatment (ACS, 2015).  It can also be used when the cancer has spread to the bones or brain.  If you buddy, rectum, has cancer, radiation will be needed before and after surgery to prevent the return of cancer at it.  There are four types of radiation therapy, but external beam radiation therapy is the most common kind of radiation for colorectal cancer.  Radiation is focused on the cancer given outside of the body.  Radiation therapy is usually given five days a week for several weeks depending on your stage and location.  Length of time it is given can be shorten before surgery.  Side effects of radiation include:  skin irritation, nausea, rectal irritation, bowel incontinence, bladder irritation, fatigue and sexual problems.

Chemotherapy is giving anticancer drugs to treat cancer.  It can be given systemically or regionally.  Systemic chemotherapy will be injected into a vein or given orally.  Regional chemotherapy will be injected into an artery directly leading to the part of the body containing the tumor (ACS, 2015).  For colorectal cancer, chemotherapy are usually given in multiple cycles.  Each cycle of it last for two to four weeks.  Here are some common chemotherapy drugs for you:  5-Fluorouracil (5-FU), Capecitabine (Xeloda), Irinotacan (Campotosar), and Oxaliplatin (Eloxatin).  Side effects of chemotherapy include:  hairloss (alopecia), mouth sore (mucositis), loss of appetite, nausea/vomiting, low blood counts, and low blood counts.

Type of cancer treatment will be stopped depending on the effectiveness, patients's reaction to the side effects, and whether the cancer metastasize or not.  Doctors would definitely stop your treatment if you or I have an allergic reaction to any of the treatment.  Just remember, you may not die from colorectal cancer; however, you can die from a allergic reaction if it's severe enough.  Don't take the chance.

This is a treatment pathway given by the Bowel Cancer Australia,which is an Australian national charity that educate, raise awareness, fund raise, research, and advocate for people with colorectal cancer.  Here is the link,   https://www.bowelcanceraustralia.org/

This week's research article is one of my favorite areas of cancer research, emotional resistance of family members of loved ones undergoing chemotherapy.  How would my family and friends react if I have to undergo chemotherapy?  I can imagine.  According to MacCarthy, Andrews, & Hegarty, 2015), emotional collapse was the fear for all the family members who participated in their study.  This fear would lead to the Emotional Resistance Building process, which includes "Figuring it out", "Getting on with it", and "Uncertainty adjustment".  They are basic social processes that are interrelated.  The study concludes that health care providers may use this theory to provide support for the family members of loved ones undergoing chemotherapy.  Unfortunately, their emotions are always neglected during cancer treatment for the patients.  I believe more research is needed to look into this area.  Maybe effective ways to provide emotional support?    

Reference:
Chemotherapy for colorectal cancer. (n.d.). Retrieved May 6, 2015, from
http://http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-treating-chemotherapy

McCarthy, B., Andrews, T., & Hegarty, J. (2015). Emotional Resistance Building: How family members of loved ones undergoing chemotherapy treatment process their fear of emotional collapse. Journal of Advanced Nursing, 71(4), 837-848. doi:10.1111/jan.12549

Radiation therapy for colorectal cancer. (n.d.). Retrieved May 6, 2015, from http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-treating-radiation-therapy

Surgery for colorectal cancer. (n.d.).  Retrieved May 6, 2015, from
http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-treating-colon-surgery
    

How would I feel?

Dear Colon,

How have you been?  I feel fine; my bowel movement has been normal looking and regular.  How did you feel about the video I posted here?  Did it give you goose bumps?  My dad had similar experience.  He told me that my grandmother passed away shortly after she was diagnosed with colorectal cancer forty years ago.  She passed away before I was born so I didn't know any of her signs and symptoms.  However, I understand Alyson's pain of losing a loved one.  Unfortunately, I don't pay much attention to your health until I realized I belong to the high risk group.  I should get a colonoscopy when I turn 50.  The following clip shows a few classic symptoms of colorectal cancer.

Since polyps are the classic sign of possible development of colorectal cancer, the following picture shows the progression of polyp growth in you.

This picture from the society of digestive health shows the progression of carcinoma in you.

The bottom line is, as long as we can catch and remove the polyps in you as early as possible (hopefully before you experience any signs or symptoms).  You can be cancer free.  Nevertheless, cancer can move around in the body.  According to the current publication, the global rate of mutation for the twelve known recurrent mutations of colorectal cancer between primary and metastatic tumors jumped from 78% to 90% (Vignot, et al., 2015).  This study concludes during the metastatic progression, that the primary tumor profiles can identify key alterations existing in the colorectal cancer metastases.  We can use analysis of gene expression to determine the conserved pathways between primary tumor and matched liver metastases (Vignot, et al., 2015).   It seems like when your cancer spread, you can invade other organs in the digestive system.

Reference:
Vignot, S., Lefebvre, C., Frampton, G., Meurice, G., Yelensky, R., Palmer, G., . . . Spano, J. (2015). Comparative analysis of primary tumour and metastases in colorectal cancer patients: Evaluation of concordance between genomic and transcriptional profiles. European Journal of Cancer, 51(7), 791-799. Retrieved April 29, 2015, from http://www.sciencedirect.com.offcampus.lib.washington.edu/science/article/pii/S0959804915002129

Let's Check Things Out!

Dear Colon,

I have been thinking about our future.  I am not going to put you at further risk.  I will undergo necessary screening and check up when appropriate to figure out whether you have polyps or not.  Although it's still early for my age, I just want to think ahead.  The first step for general cancer treatment is to focus on prevention.  According to the American Cancer Society, more than one million colorectal cancer survivors in our country because of improved prevention, early detection, and treatment.  You can develop into cancer unnoticed (without any pain); therefore, I will share with you some insights about how to check things out!

According to the National Cancer Institute, I should have you screen for colorectal cancer starting at 50 years of age and continue through 75 years of age as long as the result has been negative.  Anyone in the highest risk group should be screened at a younger age.  Since I don't think you belong to that category, you should be fine until I turn 50.  The recommended screening tests include:  checking for blood in stool (high sensitivity fecal occult blood test), or using an instrument to look at yours and rectum's linings (sigmoidscopy and colonoscopy).  Virtual colonoscopy and tests that analyze my DNA in the stool or my blood sample would be the new methods for screening.  I should check and see what the insurance coverage is before checking you out with the new methods.  The American Cancer Society also shared some interesting information about diagnosis of colorectal cancer. It is very descriptive so I will summarize it for you.

First, we would begin with a blood sample to test my complete blood count (CBC), because I would have fewer red blood cells (anemia) if you have cancer.  It will also look into my liver enzymes to see how my liver is doing.  It is possible for your cancer to spread it to my liver.  And then, they will look for some tumor markers (carcinoembryonic antigen and CA 19-9).  When analyzing my blood is completed, I may need a colonoscope, a long, lighted tube with a camera at the end, to see what's going on inside you and rectum.  The examination takes about 30 minutes.  If any polyps is detected, it would be removed immediately during the procedure.  By the way, you won't feel anything during the colonoscopy because you will be under sedation.  For any polyps removed, they would be sent to the lab for a biopsy test to see if it's benign or cancerous.  Sometimes CT scans, ultrasound and or MRI would be used to see the whole picture of you and rectum such as the picture of the mass in you and to see whether the cancer has infected other parts of the body.  Before taking any tests, I should discuss in details about the purpose and the pros and cons of each test with my doctor.  Don't worry, Colon, I will take good care of you!

Yours sincerely,

Jumbo

             
Reference:
How is colorectal cancer diagnosed? (n.d.). Retrieved April 22, 2015, from http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-diagnosed

Tests to Detect Colorectal Cancer and Polyps. (n.d.). Retrieved April 23, 2015, from http://www.cancer.gov/cancertopics/types/colorectal/screening-fact-sheet

Colon, how you turn into cancerous?

Dear Colon,

This week I have been learning a little more about different types of cancer such as, breast cancer and prostate cancer.  The common resolutions to cancer seems to be early detection and treatment during early stage.  Oh colon, my goal is to keep you cancer free as long as I can.  I looked up a few peer reviewed articles and also checked out the American Cancer Association website to learn more about the causes of colorectal cancer and physiological and biological changes of the body if you develop cancer.  

The exact cause of most colon cancers is still unknown.  Many research is undergoing to target this topic.  However, we know for sure that the biological and physiological changes of the colon involves the appearance of an adenomatous polyp to develop into colorectal cancer (Bronner, et al., 2013).  It is usually a long progression.  Unfortunately, a family history of colorectal cancer is the most prominent factor of cancer growth without any signs or symptoms. Colon, I hate to remind you, but my grandma died of colorectal cancer before I was born.  Therefore, you belong to the high risk population.  It's all about my DNA, when it mutates, the genes (oncogenes) that were supposed to protect us from developing cancer would proliferate and won't stop growing.  I can inherit the DNA mutation from my grandma, since it can pass from generation to generation.

Fortunately, only a small portion of colorectal cancers are caused by inherited gene mutations (American Cancer Association).  Genetic testings can detect mutations associated with inherited genes.  I either can inherit genes that cause multiple polyps to develop in you or cause DNA error.  Most cases of colorectal cancer are caused by acquired genes mutations.  A major gene that is involved in both types of genes mutation is called APC genes.  However, the exact cause is unknown.

I cannot undertake the risk of ignoring the fact that you are at risk of developing cancer due to my genetic background.  Although it is only a small chance, it cannot be overlooked.  Early detection and early treatment is still my motto for you.

Yours sincerely,

Jumbo

Reference:
Bronner, K., Mesters, I., Weiss-Meilik, A., Geva, R., Rozner, G., Strul, H., . . . Kariv, R. (2013). Determinants of adherence to screening by colonoscopy in individuals with a family history of colorectal cancer. Patient Education and Counseling, 93(2), 272-281.

Do we know what causes colorectal cancer? (n.d.). Retrieved April 16, 2015, from http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-what-causes

Scary Facts

Dear Colon,

How are you doing?  I thought you would have a higher chance of developing colorectal cancer when you get older because of my ethnic background and family history.  However, I was not absolutely correct.  According to the Standford geriatrics website, there is limited direct correlation between family history and actual diagnosis of colorectal cancer between the Chinese American and Western populations.  Nevertheless, your fate is still on a roller coaster ride according to the cancer facts.

As described in Haggar's 2002 article, colorectal cancer accounts for 9% of all cancer incidence globally.  It is the major cause of morbidity and mortality around the world.  The risk factors and prevalence of men and women getting this cancer are about the same.  Colorectal cancer is the third most common cancer in the United States.  And, we are not alone.  Countries such as, Australia, New Zealand, Canada, and parts of Europe also have high incidence of this type of cancer.  On the other hand, it is not much of a concern in China, India, parts of Africa, and South America.  Half of the incidence of global colorectal cancer would lead to mortality.  I wonder why there is a geographic difference?  Could it be their diet?  Exercise?  Lack of access to diagnosis or treatment, maybe?   Well, I still have to keep you and your buddy, rectum, in good shape since you and I live in a red flag country.

According to the American Cancer Association in 2015, about 93,090 new cases of colon cancer, about 39,610 new cases of rectal cancer, and about 49,700 deaths from colorectal cancer.  In general, the lifetime risk of developing colorectal cancer is 1 in 20.  Although these data are scary, there is a silver lining.  People's chance of dying from colorectal cancer has been going down for more than 20 years.  There are more than one million survivors Thank you for the early diagnosis and medical treatments Maybe by the time as we age to a point, there would be a cure for colorectal cancer around the world.

   

Yours sincerely,

Jumbo

References:
Deshpande, PhD MPH, A., Shootman, PhD, M., & Mayer, MPH, A. (2015). Development of a claims-based algorithm to identify colorectal cancer recurrence. Annals of Epidemiology, 25(4), 297-300. Retrieved April 9, 2015, from http://www.sciencedirect.com.offcampus.lib.washington.edu/science/article/pii/S1047279715000277

Haggar, F. A., & Boushey, R. P. (2009). Colorectal Cancer Epidemiology: Incidence, Mortality, Survival, and Risk Factors. Clinics in Colon and Rectal Surgery, 22(4), 191–197. doi:10.1055/s-0029-1242458

(n.d.). Retrieved April 2, 2015, from https://geriatrics.stanford.edu/ethnomed/chinese/health_risk_patterns/cancer/colon.html