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Colorectal cancer/ Kanker Kolorektal
- 1. COLORECTAL CANCER Dwi Kartika Rukmi
- 4. COLORECTAL CANCER Colorectal cancer (CRC) is a major cause of morbidity and mortality throughout the world. It accounts for over 9% of all cancer incidence. CRC is the third most common cancer worldwide and the fourth most common cause of death In 2012, highest CRC incidence in both female and male are in Japan (Miyagi Prefecture: ♀ 37,2/100.000 and ♂ 62,4/100.000) Arnold M, Sierra MS, Laversanne M, et al. Gut 2017;66:683–691
- 5. COLORECTAL CANCER RISK FACTOR NON MODIFIABLE (20%) Age Personal History of Adenomatous Polyps Personal History of Inflammatory Bowel Disease Family History of Colorectal Cancer or Adenomatous Polyps Inherited Genetic Risk MODIFIABLE (80%) A diet low in fibre, vegetables, and folate and high in fat, red meat Heavy alcohol consumption A sedentary occupation Cigarette smoking Hamza, Aglan, Ahmed,2017; Granados Romero JJ et al. 2017
- 6. Cont Age: increases progressively from age 40, rising sharply after 50. Personal History of Adenomatous Polyps : tubular or villous adenomas (life time risk for adenomas is 19% and 95% CRC develops from these adenomas) Villous Adenoma Tubular AdenomaHamza, Aglan, Ahmed,2017; Granados Romero JJ et al. 2017
- 7. Cont Personal History of Inflammatory Bowel Disease :Ulcerative colitis and Crohn disease usually described as inflammatory bowel disease (IBD) . The relative risk of CRC in patients with inflammatory bowel disease has been estimated between 4- to 20-fold Family History of Colorectal Cancer or Adenomatous Polyps :People with a history of CRC or adenomatous polyps in one or more first-degree relatives are at increased risk. CRC develop 100% in FAP untreated by age 45 Ulcerative colitis Familial Adenomatous Polyps (FAP) Hamza, Aglan, Ahmed,2017
- 8. Cont Inherited Genetic Risk Approximately 5 to 10% of colorectal cancers are a consequence of recognized hereditary conditions. The most common inherited conditions are FAP and HNPCC, also called Lynch syndrome HNPCC is associated with mutations in genes involved in the DNA repair pathway FAP is caused by mutations in the tumor suppressor gene APC The lifetime risk of CRC in people with the recognized HNPCC-related mutations may be as high as 70 to 80%, and the average age at diagnosis in their mid-40s Hamza, Aglan, Ahmed,2017
- 9. A diet low in fibre, vegetables, and folate and high in fat, red meat Hamza, Aglan, Ahmed,2017
- 10. Cont Alcohol comsumption Rossi, M.,Anwar MJ.,Usman A.,et al. 2017
- 11. Cont A sedentary occupation Hamza, Aglan, Ahmed,2017
- 12. Cont Cigarette Smoking Liang, 2009
- 13. Pathophysiology of CRC (Nguyen, Duong, 2018)
- 14. LOCATION OF CRC Rectum (37%) Sigmoid (31%) Ascending colon (9%) Cecum (8%) Descending colon (5%) Transverse colon (4%) Hepatic angle (4%) Splenic Angle (2%) Granados Romero JJ et al. 2017
- 15. SYMPTOM OF CRC Bleeding from the rectum Blood in the stool or in the toilet after having a bowel movement Dark or black stools A change in the shape of the stool (e.g., more narrow than usual) Cramping or discomfort in the lower abdomen An urge to have a bowel movement when the bowel is empty Constipation or diarrhea that lasts for few days Decreased appetite Unintentional weight loss Anemia from blood loss causes weakness and fatique Hamza, Aglan, Ahmed,2017
- 16. DIAGNOSIS OF CRC (Granados Romero JJ et al. 2017)
- 17. Cont
- 18. Cont
- 19. STAGING OF CRC (Venook,2019; Hamza,Aglan ,Ahmed,2017)
- 21. TREATMENT OF CRC (Granados Romero JJ et al. 2017) Stage 0 cancer can be treated by removing cancer cells by colonoscopy. Stage I, II and III Cancer, it is necessary to perform surgery using radical colectomy of the segment involved with margins > 5 cm, lymphadenectomy to the root of the nutrient vessel (minimum 12N), suspicious ganglion biopsy outside the resection field It has been demonstrated that the laparoscopic approach is as safe as the traditional open approach for colorectal cancer. Stage III: also treatment with radiotherapy combination with chemotherapy Chemotherapy (Fluorouracil and Leucovorin) complementary chemotherapy for Stage III after surgery for 6-8 months for improving symptom and prolong survival The 5 - Fluoracil continues to be the cytostatic mostly used in the treatment of colon cancer, those who make use of it or at least approach the fulfilment of the therapeutic standard, achieve better percentages of survival. Anti angiogenesis therapy: Bevacizumab (lowering vascular endothelial growth factor (VEGF). Anti angiogenesis + chemotherapy is better than chemotherapy only improve global survival Stage IV with metastatic : various therapy approaches (ablation, chemotherapy, radiotherapy, cryotherapy or surgery)
- 22. Colonoscopy
- 23. SURGERY OF CRC
- 24. TOP TEN REPORT OF CRC PATIENTS Worry, anxiety or fear Information needs Fatigue Constipation or diarrhea Making plans Pain Sleep problems Tingling in hands and feet Work or education Other medical condition NHS,2015
- 25. NURSING DIAGNOSIS Anxiety Deficient knowledge Fatigue Constipation Diarrhea Pain Disturbed Sleep Pattern Fear
- 26. NOC Diagnosis NOC Anxiety • Anxiety control • Coping Deficient knowledge • Diseases Process • Health behavior Fatigue • Energy conservation • Nutritional status: energy Constipation Bowel elimination Diarrhea Bowel elimination Pain • Pain Level • Pain Control Disturbed Sleep Pattern • Sleep • Rest Fear Fear control
- 27. NIC Diagnosis NIC Anxiety • Anxiety reduction Deficient knowledge • Teaching: diseases process • Teaching: individual Fatigue • Energy management Constipation Constipation/Impaction Management Diarrhea Diarrhea management Pain • Pain management • Analgesic administration Disturbed Sleep Pattern • Sleep enhancement Fear Coping enhancement
- 28. Arnold M, Sierra MS, Laversanne M, et al. Gut 2017;66:683–691 dalam https://gut.bmj.com/content/gutjnl/66/4/683.full.pdf Hamza AH,Aglan AH,Ahmed HH.2017. dalam http://www.avidscience.com/wp-content/uploads/2017/04/RAC0C-15-06.pdf Granados Romero JJ et al. 2017. Int J Res Med Sci. Nov 5(11):4667-4676 dalam https://www.researchgate.net/publication/320676335_Colorectal_cancer_a_review Rossi, M.,Anwar MJ.,Usman A.,et al. 2017 dalam https://pdfs.semanticscholar.org/a1ae/a03533995169bf2dc3ac66db6ffb6108bcdf.pdf Liang,P. 2009. Int. J. Cancer: 124, 2406–2415 dalam https://www.researchgate.net/publication/23786425_Cigarette_smoking_and_colorectal_cancer_incidence_and_mortality_Systematic_review_and_meta-analysis Dulai,PS.,Sunborn,WJ.,Gupta,S.2016 dalam http://cancerpreventionresearch.aacrjournals.org/content/9/12/887 Venook,AP.2019 dalam https://www.medscape.org/viewarticle/501381 Nguyen,HT.,Duong,HQ.2018 dalam https://www.spandidos-publications.com/ol/16/1/9 NHS.2015 dalam https://www.england.nhs.uk/wp-content/uploads/2015/03/colorectal-cancer-proms-report-140314.pdf
Editor's Notes
- #14: Figure 1. - Colorectal adenoma-carcinoma sequence. The APC mutation is the first step transforming normal colorectal epithelium to adenoma. The adenoma-carcinoma sequence is caused by three major pathways: CIN, MSI and CIMP. CIN, Chromosomal instability; MSI, microsatellite instability; CIMP, CpG island methylator phenotype; APC, adenomatous polyposis; KRAS, KRAS proto-oncogene GTPase; BRAF, B-Raf proto-oncogene serine/threonine kinase; TP53, tumor protein 53; LOH, loss of heterozygosity; HNPPC, hereditary non-polyposis colorectal cancer; MLH1, mutL homolog 1; MSH2, mutS homolog 2; DCC, DCC netrin 1 receptor; TGFBR, transforming growth factor-β receptor; BAX, BCL2 associated X apoptosis regulator; IGF2R, insulin like growth factor 2 receptor; CDC4, cell division control protein 4