Working with a Client with Colorectal Cancer

Colorectal cancer is the third most commonly occurring cancer in men and the second most commonly occurring cancer in women. There were over 1,096,601 million new cases and 551,269 deaths worldwide in 2018. Incidence rates have been decreasing for most of the past two decades due to colorectal screening tests that allow for early detection and removal of polyps before they turn into cancer. Incidence rates have, however, increased by nearly 2% in people younger than age 50. 

Colorectal cancer refers to cancer of the large intestine. The first five feet of the intestine is called the colon (bowel) and the last six to eight inches is called the rectum. It is sometimes difficult to pinpoint a tumor in the large bowel and, therefore, the colon and rectum are often grouped together as the colorectum. Colon cancer and rectal cancer have many features in common. 

Most colorectal cancers start as a growth on the inner lining of the colon or rectum. These growths are called polyps. Some types of polyps can change into cancer over the course of many years, but not all polyps will become cancerous. The chance of a polyp changing into cancer depends on the type of polyp it is. The 2 main types of polyps are:

  • Adenomatous polyps (adenomas) – these polyps have the propensity to change into cancer and are called a pre-cancerous condition.
  • Hyperplastic polyps and inflammatory polyps – these polyps occur more often but generally are not considered pre-cancerous.

Other factors that can increase someone’s risk of developing colorectal cancer include:

  • A polyp larger than 1 cm
  • Having more than 2 polyps

Studies indicate that certain lifestyle factors increase the risk of colorectal cancer:

  • A diet high in red, processed, or heavily cooked meats
  • Lack of exercise
  • Obesity, particularly having excess fat in the waist area, rather than the hips or thighs
  • Type II diabetes
  • Being black
  • Personal history of chronic inflammatory bowel disease (ulcerative colitis or Crohn disease), cancer of the colon, rectum, or ovaries
  • Having a personal history of high-risk colorectal polyps
  • Cigarette smoking – a 30-40% greater risk than nonsmokers to die of colorectal cancer
  • Heavy alcohol consumption
  • Inherited genetic conditions (lynch Syndrome & hereditary non-polyposis colorectal cancer or familial adenomatous polyposis (FAP)
  • Family history 

Consumption of milk and calcium (higher blood levels of vitamin D) seem to decrease the risk of colorectal cancer Regular use of NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin may also reduce the risk. Unfortunately, these drugs can have their own serious adverse health consequences, so they are not recommended for people at “average” risk. Starting at age 50, men and women with “average” risk should begin screening to detect and allow for the removal of colorectal polyps that could potentially become cancerous.

Following a total colectomy, patients will stay in the hospital until they regain bowel function which may take a couple of days to a week. It will take several weeks for full recovery. Walking is essential to a smooth recovery and should be a part of each day’s activities in the recovery period. Patients should avoid lifting anything over ten pounds for the first 1-2 months.

Following a proctectomy, patients will remain in the hospital for 4-7 days and full recovery may take up to three months. Patients should begin walking soon after surgery and incorporate it daily. No heavy lifting for six weeks.

Following a colostomy, patients will remain in the hospital for 3-10 days and full recovery may take up to six weeks. Patients should avoid contact or “rough” sports. The surgical incision should be completely healed before lifting weights and special attention should be paid if performing “crunch-type” exercises

Following a low anterior resection, most patients spend 4-6 days in the hospital after a low anterior resection, depending on how the surgery was done and their overall health. Full recovery may take 3-6 weeks. Patients should begin walking and performing Kegel exercises soon after surgery and incorporate both daily. Continuing to do Kegel exercises after the ileostomy is closed will keep anal sphincter muscles strong. Patients should not lift anything heavier than ten pounds, strain, or do strenuous exercise for at least 6 weeks after surgery.

Following an abdominal perineal resection, most patients spend several days in the hospital after an APR, depending on how the surgery is done and their overall health. Recovery time at home may be 3 to 6 weeks.

Following a total mesorectal excision, most patients spend several days in the hospital after surgery, depending on how it was done and their overall health. It could take 3 to 6 weeks to recover at home Patients can start doing pelvic floor muscle exercises 2-3 weeks after stoma closure.

Following pelvic exenteration, most patients will spend at least 7-10 days in the hospital with full recovery taking at least three months. Early walking and deep breathing should be encouraged to prevent blood clots and pneumonia. Care should be taken with lifting, bending or stretching, particularly in the first few weeks after surgery. If a vaginal reconstruction is done, patients will only be able to lie on their back, side, or stand; they will be unable to sit for 6-8 weeks.

Points to remember:

  1. If your client has diarrhea or vomiting, they should NOT exercise for 24-26 hours and they must re-hydrate and replenish electrolytes
  2. If they have chills, fever and abdominal pain, they must report this to their doctor immediately
  3. If lymph nodes are removed or irradiated. take initial lower body measurements, begin each exercise session with lower body lymph drainage exercises, and make sure client is wearing compression garments if they have been prescribed.

To learn more about colorectal cancer and 25 other cancers, consider becoming a Cancer Exercise Specialist