Introduction
Colorectal cancer (CRC) is a disease that is characterized by abnormal cells in the rectum and colon that grow uncontrollably, resulting in malignant tumors. It is among the most common types of cancer in the United States, with a high incidence of 147,950 new cases and 53,200 deaths every year (Afifi et al., 2021). In 2020, the global number of new infections was 1.93 million (Yin et al., 2023).
The condition is chronic and affects senior citizens more, although people from other age groups are not exempt (Hashimoto et al., 2022). Factors such as age, diet, genetic predisposition, and ethnic background can influence the onset of the disease. Since 1990, there has been an exponential increase in the prevalence of CRC (Burnett-Hartman et al., 2021).
Colorectal cancer is especially significant in countries going through socioeconomic transitions. One of its impacts is that it is expensive to treat, potentially draining the finances of patients and their families. Furthermore, it reduces the quality of life and has a high mortality rate.
The Problem
Etiology/Pathophysiology of CRC
The exact cause of CRC remains a mystery in the clinical arena. Colon cancer could present as 10% inherited syndrome, 20% familial clustering, and 70% sporadic (Lotfollahzadeh et al., 2023). Notably, most colorectal cancers are sporadic and affect people whose diet has a low intake of fruits and vegetables (Barresi, 2022). Excessive consumption of highly processed food and the use of tobacco cause a poor prognosis.
Research indicates that there is some involvement of the gut microbiome in the etiopathogenesis of colorectal CRC (Chen et al., 2021). The dysbiosis changes a health-promoting microbiome of mutualists and commensals into a procarcinogenic and proinflammatory environment characterized by amensalism and parasitism (Chen et al., 2021). The microorganisms living in the colon can influence diet choices and obesity, thereby exacerbating the growth of tumor cells.
Clinical Presentation and Patient Assessment
The majority of patients do not experience any symptoms or signs during the early stages of the CRC. Most positive diagnoses result from screening and testing as part of a routine check-up or a visit to the hospital for an entirely different issue. Some of the symptoms show that clients may go to the hospital to pray. Rectal bleeding, iron deficiency, and abdominal pain are common signs that a person may present with initially (Barresi, 2022). If there is no apparent cause for the presenting symptoms, the healthcare provider may suggest some clinical tests to verify the possibility of cancer.
It is essential to do a comprehensive assessment, including social and drug history, family background, and operations. Colonoscopy screening and fecal-based testing provide reliable results in the diagnosis of the disease (Wolf et al., 2019). Computerized tomography (CT) colonography is utilized in tissue biopsy and has a high sensitivity of 94.7% (Lotfollahzadeh et al., 2023). The patient assessment, which rarely includes screening, may involve flexible sigmoidoscopy and an immunochemical test (De Klaver et al., 2021). The protective equipment (PPE) required when handling feces includes a full-face respirator for the laboratory technician.
Differential Diagnosis
The CRC has many symptoms that are similar to other conditions, which the physician should rule out. Some common clinical differential diagnoses include hamartomas, neuroendocrine tumors, lymphomas, mesenchymal tumors, and caudal-type homeobox 2 (Lotfollahzadeh et al., 2023). Crohn’s disease, ischemic bowel, ulcerative colitis, and carcinoid tumors should be ruled out before confirming CRC.
Young people are likely to have poorly displayed mucinous and signet-ring morphology (Chen et al., 2021). Moreover, CRC can imitate other diseases such as appendicitis, cystitis, endometriosis, and inflammatory bowel syndrome. The doctor should only confirm a diagnosis after the CT colonoscopy with tissue samples from the patient show the development of malignant tissue in the rectum or colon.
Clinical Management
Treatment Plan and Medication
The treatment plan should involve a multidisciplinary team that includes the surgeon, therapists, nurses, and other healthcare workers involved in the patient’s management. Simultaneous resection. Specifically, the source used is the national guidance for CRC published by the Health Commission, which requires the integration of other clinical information, such as the presence of suspicious lymph nodes, tumor size, and anal preservation decision (Health Commission of PRC, 2020). Surgical treatment of CRC through far-to-near abdominal exploration is a practical approach. Management of early CRC is possible when the team decides whether she should go for surgery.
Patients in advanced stages of cancer should start adjuvant chemotherapy, which is a standard of care. One evidence-based (EB) randomized control trial shows effectiveness for using medications such as oxaliplatin, bolus, Cetuximab, Panitumumab, Pembrolizumab, and Nivolumab (Lotfollahzadeh et al., 2023). These drugs work by sticking to the DNA of the tumor cells. The other EB clinical trial, which aimed to determine the effectiveness of cetuximab versus bevacizumab, found that the latter had more positive outcomes (Ciardiello et al., 2022). Primary research studies offer the possibility of systemic and neoadjuvant therapy in the management of the disease.
Patient Teaching
The patient should be advised to maintain a healthy weight by following a balanced diet that includes a variety of vegetables, fruits, and water. The patient should be educated about the medication they are using, including its side effects and dosage (Barresi, 2022). For instance, they should understand the components of the drugs that they are using. The rationale is to make it easier for them to understand the components causing adverse reactions and allergies. They can then report if they notice any problems after taking a drug.
Wound cleaning and overall hygiene are crucial in the recovery process of individuals with CRC. Therefore, it is crucial to instruct the client and their family members on how to clean the surgical wound, keeping it dry and aerated. The lesson on how to help the person start exercising and prepare food is vital. Ideally, the patient should be informed about the entire treatment plan and their role in the recovery process.
Preventive Measures
One of the ways of preventing colorectal cancer is through community workshops that teach the public about the risk factors for CRC and ways of healthy living. It is essential to encourage the inclusion of food that contains fiber in the diet. It is crucial to engage the public in precision screening that takes into account family history, genetics, lifestyle, and other relevant factors (Burnett-Hartman et al., 2021). Population-based testing for individuals at higher risk of developing CRC is vital for early detection and timely treatment to prevent complications.
Artificial intelligence provides precision screening, which individuals can undergo annually to aid in the early detection of CRC and prevent other complications (Yin et al., 2023). Therefore, healthcare organizations should invest in medical technologies that make work much more manageable. The protection of the environment by removing plastic and pollutants from significant water bodies can help prevent CRC. The food that people eat needs to be free from all kinds of contaminants.
Expected Patient Outcome
Treatment Outcomes, Timeframe, and Success Factors
The improvement in the treatment of cancer and landmark innovations such as the integration of AI in screening and management mean that many people can live long and healthy lives after CRC. For a patient who had adjuvant treatment, they should follow with chemotherapy for another 3 to 6 months to kill all the traces of the tumor (Health Commission of PRC, 2020). During this time, it is essential to monitor the patient for side effects, such as vomiting, and provide relief medications as needed. After the surgery, the clinical guidelines recommend that patients stay for 2 to 3 months while receiving care for lung and liver metastasis (Health Commission of PRC, 2020). Colon cancer can try to spread to other organs, so the nurse practitioner should assess for any other problems and inform the multidisciplinary team.
Success for a patient includes a total recovery, which is evident in an improved quality of life. It is essential to view the patient holistically and care for their physical, psychological, and spiritual well-being during treatment. Additionally, it is essential to prevent postoperative complications, which are crucial for the patient’s survival after surgery (Wu et al., 2019).
It would be an excellent achievement for the patient not to experience complications with other parts of the body. They should be completely free of pain even without medications. The only thing left in their surgical area should be a scar without the risk of reinfection. Moreover, given that chemotherapy negatively impacts immunity and hair growth, it would be great if the client regrows their hair and their body builds up sufficient antibodies.
Point to Stop Managing the Patient
Given the chronic nature of CRC, it is vital to manage the patient for any resulting complications or regrowth of tumors even after their surgery is complete. The average follow-up period for patients following their operation and discharge from the hospital is 30.3 months (Wu et al., 2019). The time for follow-up treatment will continue to increase as the patient’s health improves.
For example, during their hospitalization, management will be ongoing several times a day. The patient can then go home after they have stabilized, provided they have a family member to care for them. However, they should come to the hospital for a check-up regularly until it is inevitable that they are completely cured of the CRC and other complications.
Depending on the patient’s condition, clinical management can last for several years. Patient education on adherence to a proper diet, following the prescription, proper wound hygiene, and other specific instructions is vital for the gradual improvement of quality of life. If the patient experiences regrowth of the tumor, it is vital to refer them to a gastroenterologist and a surgical oncologist for further evaluation. Additionally, the patient requires a referral to organizations that offer financial assistance to individuals with cancer. The other professions that are important for the client include psychologists and a cancer support group.
Conclusion
The incidence of colorectal cancer across the United States and the globe is on the rise, especially among geriatric patients. The disease often develops when a malignant tumor forms in the regions around the rectum and colon. In most cases, an individual will come to the hospital for a different reason, and then, after testing, the doctor discovers colorectal cancer.
Colonoscopy and fecal-based screening provide reliable results on a person’s health status. Some risk factors for developing colorectal cancer include a diet lacking fruit and vegetables, older age, obesity, and having a family member diagnosed with the disease. The treatment options include pharmacotherapy, chemotherapy, and surgery, depending on the cancer stage. Moreover, healthcare providers need to focus on prevention to reduce the number of positive diagnoses.
References
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