Colorectal Cancer for the NP Exam
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Colorectal Cancer for the Nurse Practitioner Licensing Exam
- Epidemiology:
- Colorectal cancer (CRC) is the third most common cancer in the U.S. and the second leading cause of cancer deaths.
- Most cases are diagnosed in individuals over age 50, but incidence in younger adults is rising.
- Risk Factors:
- Age: Risk increases significantly after age 50.
- Diet: High intake of red and processed meats and low fiber consumption.
- Family history: A first-degree relative with CRC increases risk, especially if diagnosed before age 60.
- Hereditary syndromes:
- Familial adenomatous polyposis (FAP): Caused by mutations in the APC gene.
- Lynch syndrome (HNPCC): Due to defective mismatch repair genes.
- Inflammatory bowel disease (ulcerative colitis or Crohn’s disease) also increases risk.
- Lifestyle factors: Smoking, obesity, and sedentary behavior contribute to risk.
- Clinical Presentation:
- Right-sided CRC: Presents with vague symptoms like iron deficiency anemia and fatigue due to occult bleeding.
- Left-sided CRC: More likely to cause hematochezia, changes in bowel habits, and obstruction.
- Rectal cancer: May present with rectal bleeding, tenesmus, and a feeling of incomplete defecation.
- Systemic symptoms such as weight loss and fatigue may indicate advanced disease.
- Screening:
- Colonoscopy is the preferred screening method, recommended starting at age 45 for average-risk individuals.
- Other options include:
- Fecal immunochemical test (FIT): Annual testing for occult blood.
- Flexible sigmoidoscopy: Performed every 5 years for distal colon examination.
- Diagnosis:
- Colonoscopy with biopsy is the gold standard for diagnosis.
- CT scans are used for staging and detecting metastases.
- Carcinoembryonic antigen (CEA) is a tumor marker used for monitoring treatment response.
- Treatment:
- Surgical resection is the treatment of choice for localized CRC.
- Adjuvant chemotherapy is used in stage III and high-risk stage II disease.
- Palliative chemotherapy is used in metastatic CRC to prolong survival.
Key Points
- Colorectal cancer risk increases with age, diet, family history, and certain hereditary syndromes like Lynch syndrome.
- Right-sided CRC presents with anemia, while left-sided CRC causes changes in bowel habits and bleeding.
- Colonoscopy is the gold standard for screening, with regular screening starting at age 45.
- Surgery is the primary treatment for localized disease, and chemotherapy is used in advanced stages.