ASKEP KANKER KOLOREKTAL

MARIDI M. DIRDJO
Latar Belakang
Tipe kanker tersering ketiga dan penyebab kedua
kematian akibat kanker
Pseseorang dengnriwayat keluarga kanker kolon
atau ulcerative colitis beriko tinggi mengalami ini.
The American Cancer Society memerkirakan 135,400
kasus baru tiap tahun dan 56,700 meningga akibat
colorectal cancer pd tahun 2001

Suatu penyakit dimana lapisan sel normal di kolon
atau rektum yang mulai berubah dan berkembang tak
terkontrol dan tidak lama kemudian meninggal

Biasanya dimulai sebagai polip nonkanker dan dengan
berjalannya waktu menjadi kanker

Pengertian
Fungsi Kolon dan Rektum

Kolon dan rektum
merupakan bagian dari
usus besar (large intestine)

Fungsi utamanya usus
besar adalah merubah isi
perut cair menjadi feses
yang padat

Faktor Risiko Kanker Kolorektal
Polip (suatu kelainan nonkanker atau pertumbuhan
prakanker terkait dengan menua)
Umur
Inflammatory bowel disease (IBD)
Diet tinggi lemak jenus, seperti daging merah
Riwayat diri atau keluarga menderita kanker
Obesitas
Merokok
Lain-lain
Penyebab dari pada kanker Colon tidak diketahui. Diet yang dimakan
dicurigai berperan.
Makanan-makanan yang pasti di curigai mengandung zat-zat kimia yang
menyebabkan kanker pada usus besar.
Makanan tersebut juga mengurangi waktu peredaran pada perut,yang
mempercepat usus besar menyebabkan terjadinya kanker.
Makanan yang tinggi lemak terutama lemak hewan dari daging
merah,menyebabkan sekresi asam dan bakteri anaerob, menyebabkan
timbulnya kanker didalam usus besar.
Daging yang di goreng dan di panggang juga dapat berisi zat-zat kimia yang
menyebabkan kanker.
Diet dengan karbohidrat murni yang mengandung serat dalam jumlah yang
banyak dapat mengurangi waktu peredaran dalam usus besar.
Beberapa kelompok menyarankan diet yang mengadung sedikit lemak
hewan dan tinggi sayuran dan buah-buahan.
Makanan yang harus dihindari : Daging merah, Lemak hewan, Makanan
berlemak, Daging dan ikan goreng atau panggang dan Karbohidrat yang
disaring (example:sari yang disaring)

Etiologi
Hereditary Colorectal Cancer
Syndromes: HNPCC
Hereditary non-polyposis colorectal cancer (HNPCC),
sometimes called Lynch syndrome, accounts for
approximately 5% to 10% of all colorectal cancer cases
The risk of colorectal cancer in families with HNPCC is 70%
to 90%, which is several times the risk of the general
population
People with HNPCC are diagnosed with colorectal cancer
at an average age of 45
Genetic testing for the most common HNPCC genes is
available; measures can be taken to prevent development
of colorectal cancer
Hereditary Colorectal Cancer
Syndromes: FAP
Familial adenomatous polyposis (FAP) accounts for 1% of
colorectal cancer cases
People with FAP typically develop hundreds to thousands of colon
polyps (small growths); the polyps are initially benign
(noncancerous), but there is nearly a 100% chance that the polyps
will develop into cancer if left untreated
Colorectal cancer usually occurs by age 40 in people with FAP
Mutations (changes) in the APC gene cause FAP; genetic testing is
available
Yearly screening for polyps is recommended
Attenuated familial adenomatous polyposis (AFAP) is related to
FAP; people have fewer polyps

Hereditary Colorectal Cancer
Syndromes
Several other less common syndromes can increase a
persons risk of colorectal cancer

Talk with your doctor about finding a genetic
counselor if you have a history of colorectal cancer in
your family and family members developed cancer
before age 50

For more information, visit www.plwc.org/genetics
Tumor terjadi ditempat yang berada dalam colon
mengikuti kira-kira pada bagian ( Sthrock 1991 a ) :
26 % pada caecum dan ascending colon
10 % pada transfersum colon
15 % pada desending colon
20 % pada sigmoid colon
30 % pada rectum

Patofisiologi
Typical sites of incidence and sympoms of colon cancer
Karsinoma Colon sebagian besar menghasilkan adenomatus polip.
Biasanya tumor ini tumbuh tidak terditeksi sampai gejala-gejala
muncul secara berlahan dan tampak membahayakan.
Penyakit ini menyebar dalam beberapa metode.Tumor mungkin
menyebar dalam tempat tertentu pada lapisan dalam di
perut,mencapai serosa dan mesenterik fat.
Kemudian tumor mulai melekat pada organ yang ada
disekitarnya,kemudian meluas kedalam lumen pada usus besar
atau menyebar ke limpa atau pada sistem sirkulasi.
Sistem sirkulasi ini langsung masuk dari tumor utama melewati
pembuluh darah pada usus besar melalui limpa, setelah sel tumor
masuk pada sistem sirkulasi,biasanya sel bergerak menuju liver.
Tempat yang kedua adalah tempat yang jauh kemudian metastase
ke paru-paru. Tempat metastase yang lain termasuk : Kelenjar
Adrenal, Ginjal, Kulit, Tulang dan Otak

Patofisiologi
Colorectal Cancer and Early
Detection
Colorectal cancer can be prevented through regular
screening and the removal of polyps

Early diagnosis means a better chance of successful
treatment

Screening should begin at age 50 for all average risk
individuals or sooner if you have a family history of
colorectal cancer, symptoms, or a personal history of
inflammatory bowel disease

Screening Methods for Colorectal
Cancer
Colonoscopy (currently the best way to prevent and detect
colorectal cancer)

Virtual colonography

Sigmoidoscopy

Fecal occult blood test

Double contrast barium enema

Digital rectal examination
result of interplay between environmental and
genetic factors

Central environmental factors:

diet and lifestyle

35% of all cancers are attributable to diet

50%-75% of CRC in the US may be preventable
through dietary modifications
Development of CRC
consumption of red meat

animal and saturated fat

refined carbohydrates

alcohol
increased risk
Dietary factors implicated in
colorectal carcinogenesis
dietary fiber

vegetables

fruits

antioxidant vitamins

calcium

folate (B Vitamin)
decreased risk
Dietary factors implicated in
colorectal carcinogenesis
Tanda dan Gejala Kanker Kolorektal
weight loss

loss of appetite

night sweats

fever
rectal bleeding

change in bowel habits

obstruction

abdominal pain & mass

iron-deficiency anemia
Symptom lainya dari Kanker Kolorektal
A change in bowel habits: diarrhea, constipation, or a feeling that
the bowel does not empty completely

Bright red or dark blood in the stool

Stools that appear narrower or thinner than usual

Discomfort in the abdomen, including frequent gas pains,
bloating, fullness, and cramps

Unexplained weight loss, constant tiredness, or unexplained
anemia (iron deficiency)

Menegakkan Diagnosis Kanker
Diagnosis is confirmed with a biopsy

Stage of disease is confirmed by pathologists and
imaging tests, such as computerized tomography (CT
scan)

Endoscopic ultrasound and magnetic resonance
imaging (MRI) may also be used to stage rectal cancer

Colorectal Cancer Staging
Staging is a way of describing a cancer, such as the
depth of the tumor and where it has spread
Staging is the most important tool doctors have to
determine a patients prognosis
Staging is described by the TNM system: the size (the
depth of penetration of the Tumor into the wall of
the bowel), whether cancer has spread to nearby
lymph Nodes, and whether the cancer has
Metastasized (spread to organs such as the liver or
lung)
The type of treatment a person receives depends on
the stage of the cancer
TNM system

Primary tumor (T)

Regional lymph nodes (N)

Distant metastasis (M)

Staging of CRC
Stage 0 Colorectal Cancer
Known as cancer in situ,
meaning the cancer is
located in the mucosa
(moist tissue lining the
colon or rectum)

Removal of the polyp
(polypectomy) is the usual
treatment

Stage I Colorectal Cancer
The cancer has grown
through the mucosa and
invaded the muscularis
(muscular coat)

Treatment is surgery to
remove the tumor and
some surrounding lymph
nodes

Stage II Colorectal Cancer
The cancer has grown beyond
the muscularis of the colon or
rectum but has not spread to
the lymph nodes

Stage II colon cancer is
treated with surgery and, in
some cases, chemotherapy
after surgery

Stage II rectal cancer is
treated with surgery,
radiation therapy, and
chemotherapy
Stage III Colorectal Cancer
The cancer has spread to the
regional lymph nodes (lymph
nodes near the colon and
rectum)

Stage III colon cancer is
treated with surgery and
chemotherapy

Stage III rectal cancer is
treated with surgery,
radiation therapy, and
chemotherapy

Stage IV Colorectal Cancer
The cancer has spread
outside of the colon or
rectum to other areas of
the body
Stage IV cancer is treated
with chemotherapy.
Surgery to remove the
colon or rectal tumor may
or may not be done
Additional surgery to
remove metastases may
also be done in carefully
selected patients

Coping With the Side Effects of
Cancer and its Treatment
Side effects are treatable; talk with the doctor or nurse
Fatigue is a common, treatable side effect
Pain is treatable; non-narcotic pain relievers are available
Antiemetic drugs can reduce or prevent nausea and
vomiting
Cancer Treatment: Surgery
Foundation of curative therapy

The tumor, along with the adjacent healthy colon or
rectum and lymph nodes, is typically removed to offer
the best chance for cure

May require temporary or (rarely) permanent
colostomy (surgical opening in abdomen that
provides a place for waste to exit the body)



Cancer Treatment: Chemotherapy
Drugs used to kill cancer cells

Typical medications include fluorouracil (5-FU), oxaliplatin
(Eloxatin), irinotecan (Camptosar), and capecitabine
(Xeloda)

A combination of medications is often used




Types of Chemotherapy
Adjuvant chemotherapy is given after surgery to
maximize a patients chance for cure

Neoadjuvant chemotherapy is given before surgery

Palliative chemotherapy is given to patients whose
cancer cannot be removed to delay or reverse cancer-
related symptoms and substantially improve quality
and length of life

Cancer Treatment: Radiation Therapy
The use of high-energy x-rays or other particles to destroy
cancer cell

Used to treat rectal cancer, either before or after surgery

Different methods of delivery

External-beam: outside the body

Intraoperative: one dose during surgery
New Therapies: Antiangiogenesis
Therapy
Starves the tumor by disrupting its blood supply

This therapy is given along with chemotherapy

Bevacizumab (Avastin) was approved by the U.S.
Food and Drug Administration (FDA) in 2004 for the
treatment of stage IV colorectal cancer

New Therapies: Targeted Therapy
Treatment designed to target cancer cells while
minimizing damage to healthy cells

Cetuximab (Erbitux) was approved by the FDA in
2004 for the treatment of advanced colorectal cancer

Riwayat: Sejarah dari keluarga terhadap Ca Colon, Radang usus
besar, Penyakit Crohns, Familial poliposis dan Adenoma
perubahan kebiasaan pada usus besar seperti diare dengan atau
tanpa darah pada feces klien mungkin merasa perutnya terasa
penuh, nyeri atau berat badan turun
Tanda-tanda Ca Colon tergantung pada letak tumor.Tanda-tanda
yang biasanya terjadi adalah :Perdarahan pada rektal, Anemia dan
Perubahan feces
Hal pertama yang ditunjukkan oleh Ca Colon adalah :
- teraba massa
- pembuntuan kolon sebagian atau seluruhnya
- perforasi pada karakteristik kolon dengan distensi abdominal
dan nyeri



Pengkajian
Ketidakseimbangan nutrisi : Kurang dari kebutuhan tubuh s/d
perkembangan sel kanker yang cepat, mual dan mutah.
Nyeri b/d obstruksi tumor pada usus besar skunder terhadap
penekanan organ yang lainnya.
Kecemasan b/d penyakit yang mengancam kehidupan dan
pengobatannya.
Ketidakefektifan pemeliharaan kesehatan b/d kurangnya
pengetahuan tentang proses penyakit, program diagnosa dan
rencana pengobatan.
Ketidakefektifan koping keluarga : Kompromi b/d gangguan pada
peran, perubahan gaya hidup dan ketakutan pasien terhadap
kematian.
Gangguan konsep diri: body image b/d perubahan penampilan

Diagnosis Keperawatan
Ketidakseimbangan nutrisi : Kurang dari kebutuhan tubuh s/d
perkembangan sel kanker yang cepat, mual dan mutah.
NOC
Pemulihan selera makan





Status nutrisi
NIC
Terapi nutrisi
Pentahapan diet
Manajemen nutrisi
Menejemen kelainan makan
Menejemen cairan
Monitoring nutrisi
Bantuan peningkatan BB
Konseling nutrisi
Pembelajaran: diet yang
diajurkan/ diperbolehkan


Nyeri kronik b/d obstruksi tumor pada usus besar
skunder terhadap penekanan organ yang lainnya
NOC
Tingkat kenyamanan


Kontrol nyeri


Nyeri: efek disruptif
NIC
Manajemen nyeri
Manajemen obat

Terapi relaksasi sederhana
Manajemen obat

Modifikasi perilaku
Peningkatan kemampuan
koping
Kecemasan b/d penyakit yang mengancam
kehidupan dan pengobatannya.
NOC
Tingkat kecemasan



Kontrol diri kecemasan
NIC
Penurunan kecemasan
Teknik menenangkan diri
Peningkatan kemampuan
koping
Penurunan kecemasan
Mendengarkan aktif
Petunjuk antisipasi
Humor
Ketidakefektifan pemeliharaan kesehatan b/d kurangnya
pengetahuan tentang proses penyakit, program diagnosa dan
rencana pengobatan
NOC
Perilaku peningkatan
kesehatan



Perilaku mencari kesehatan
NIC
Pendidikan kesehatan
Bantuan modifikasi diri
Peningkatan kemampuan
koping
Konseling
Dukungan pengambilan
keputusan
Penfasilitasan tanggungjawab
diri
Penfasilitas belajar
Follow-Up Care
Doctors and nurses visits
Serial carcinoembryonic antigen (SEA) measurements
are recommended
Colonoscopy one year after removal of colorectal
cancer
Surveillance colonoscopy every three to five years to
identify new polyps and/or cancers