Colorectal Cancer _ ___________________________________________________________________________
testing is usually limited to patients who may benefit from further intervention, including [339]: • Patients with stage II or III colorectal cancer • Patients who would be candidates for resection of liver metastases Patient Support after Apparently Curative Resection The NICE recommends offering follow-up for the first three years to all patients with primary colorectal cancer undergoing treatment with curative intent [238]. Follow-up should begin at an outpatient clinic visit four to six weeks after potentially curative treatment. Regular surveillance with colonoscopy, CEA testing, and CT of the chest, abdomen, and pelvis, should be provided as indicated by the treating oncology team. Any clinical, radiologic, or biochemical finding suspicious of recurrent disease should initiate further testing [238]. Regular follow-up may be halted when the patient and healthcare professional have discussed and agreed that likely benefits no longer outweigh risks of further tests or when the patient can no longer tolerate further treatments. Information about Bowel Function After any treatment, patients should receive specific information on managing the effects of treatment on their bowel function. This could include information on incontinence, diarrhea, difficulty emptying bowels, bloating, excess flatus, diet, and where to go for help in the event of symptoms. Verbal and written information should be clearly understood by the patient and free from jargon. Information about support organizations or Internet resources may be included [238].
CONCLUSION Several critical needs regarding the care of patients with colorectal cancer have been identified. The high volume of new emerging information on colorectal cancer therapies can overwhelm clinicians who lack the time to adequately review the new information in this rapidly expanding field. However, improved clinician knowledge of the most recent research on new diagnostic and therapy modalities is required in order to improve patient outcomes and reduce side effects.
GLOSSARY
Colostomy : Surgery in which the end of the colon is passed through the abdominal wall to make the stoma [341]. Ileostomy : Surgery whereby the end of the ileum is passed through the abdominal wall to make the stoma [341]. Metachronous colorectal tumors : Primary tumors diagnosed more than six months apart [267]. Oncogene : Mutated form of a gene involved in normal cell growth, which can facilitate cancer cell growth. Gene mutations that become oncogenes arise through an inherited trait or environmental exposure to carcinogens [267]. Ostomy pouch : A removable external collection pouch attached to the stoma and worn outside the body for collection of intestinal contents or stool [341]. Ostomy surgery : Surgery of the bowel (also termed bowel diversion) involving removal of a bowel segment with the need to reroute passage of stool from the anus to and through the abdominal wall [341]. The ostomy brings the end of the intestines through an abdominal incision and attaches it to the skin, creating an opening outside the body. Stoma : Refers to the end of the intestines that exits through the abdominal incision. Stomas range in width from 0.75–2 inches [341]. Synchronous colorectal tumors : Primary tumors diagnosed within six months of each other [267]. Tumor suppressor gene : Gene that produces a tumor suppressor protein that helps control cell growth. Mutations (changes in DNA) in tumor suppressor genes may promote cancer [267].
Culturally and Linguistically Competent Patient Education
As a result of the evolving demographics in the United States, interaction with patients for whom English is not a native language is inevitable. It is each practitioner’s responsibility to ensure that information and instructions are explained in such a way that allows for patient understanding. In this multicultural landscape, interpreters are a valuable resource to help bridge the communication and cultural gap between clients/patients and practitioners. Interpreters are more than passive agents who translate and transmit information back and forth from party to party. When they are enlisted and treated as part of the interdisciplinary clinical team, they serve as cultural brokers, who ultimately enhance the clinical encounter. In any case in which information regarding diagnostic procedures, treatment options, and medication/treatment measures is being provided, the use of an interpreter should be considered.
WORKS CITED https://qr2.mobi/colorectal-cancer
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