Colorectal Cancer & Ostomy Care

Colorectal cancer risk rises sharply after age 45, with screening recommended starting at that age (colonoscopy is one of several accepted modalities). Key risk factors include familial adenomatous polyposis (FAP), Lynch syndrome, a history of ulcerative colitis longer than 8–10 years, high-fat/low-fiber diets, and smoking. The hallmark warning sign is a change in bowel habits — alternating constipation and diarrhea — plus rectal bleeding and ribbon-shaped stools suggesting a left-sided lesion. Right-sided tumors are more insidious, presenting with iron-deficiency anemia and vague abdominal pain rather than obvious stool changes. CEA (carcinoembryonic antigen) is used to monitor treatment response and recurrence, not as a screening tool. Surgical resection often results in a colostomy or ileostomy. A colostomy produces formed to semi-formed stool; an ileostomy produces liquid, enzyme-rich effluent that is highly corrosive to peristomal skin. Stoma assessment follows the rule: it should be beefy red and moist — a dusky, pale, or cyanotic stoma signals compromised circulation and requires immediate provider notification. Pouch the stoma within 24–48 hours postop. The appliance opening should be cut to 1/8 inch larger than the stoma to protect surrounding skin without constricting tissue.