Colorectal cancer nursing: assessment, staging, and care priorities

Colorectal cancer (CRC) is the third most common cancer in the United States and the second leading cause of cancer-related death. The American Cancer Society estimates approximately 150,000 new diagnoses each year and around 52,000 deaths. The five-year survival rate for localized disease exceeds 90%, but only about 40% of CRC is caught at that early stage — the majority of cases present after regional or distant spread, when outcomes are considerably worse.

The disease is preventable and detectable at a pre-cancerous stage in a way that most cancers are not. Colonoscopy with polypectomy interrupts the adenoma-to-carcinoma sequence that underlies 95% of cases. Screening uptake remains suboptimal, and nurses are frequently in the position of educating patients about screening eligibility, reinforcing follow-up after abnormal findings, and advocating for high-risk populations who need earlier and more frequent surveillance.

Nurses encounter CRC patients across the full disease trajectory: in procedural units during diagnostic colonoscopy, on surgical floors after hemicolectomy or abdominoperineal resection, in infusion centers administering FOLFOX or FOLFIRI, and in palliative and home health settings managing ostomy complications and treatment toxicities. This reference covers the clinical foundation needed to care confidently for these patients and to approach CRC questions on the NCLEX.

Pathophysiology and epidemiology

The adenoma-carcinoma sequence

Adenocarcinoma accounts for more than 95% of colorectal cancers. The majority arise from adenomatous polyps through a well-characterized sequence of genetic mutations: loss of the APC tumor suppressor gene is typically the initiating event, followed by activation of KRAS oncogene, loss of SMAD4, and finally inactivation of TP53. This progression from normal mucosa to adenoma to invasive carcinoma takes approximately 10–15 years, which is precisely why colonoscopy at recommended intervals is so effective — it removes polyps before the final transformation.

Serrated polyps (sessile serrated adenomas/polyps) represent a distinct pathway — accounting for 15–20% of CRC — often via BRAF mutation and CpG island methylation. These lesions are flat, pale, and harder to visualize on colonoscopy, which partly explains why some interval cancers (CRC diagnosed within 3–5 years after a “clean” colonoscopy) arise from the proximal colon.

Risk factors

Modifiable risk factors include obesity, physical inactivity, a diet high in red and processed meat, low dietary fiber intake, heavy alcohol use, and cigarette smoking. Non-modifiable risk factors include:

• Age: Risk rises sharply after age 50; however, CRC in adults under 50 is increasing — rates in this group have risen approximately 2% per year since the 1990s, driving the USPSTF to lower the recommended screening start age from 50 to 45.
• Personal history: Prior adenomatous polyps or prior CRC.
• Family history: First-degree relative with CRC increases risk 2–4-fold; the risk is higher with younger age of onset in the relative.
• Inflammatory bowel disease: Ulcerative colitis carries a higher CRC risk than Crohn’s disease, though both elevate risk — particularly with long disease duration, extensive colonic involvement, and primary sclerosing cholangitis. Patients with longstanding IBD require surveillance colonoscopy more frequently than average-risk individuals.
• Lynch syndrome (HNPCC): The most common hereditary CRC syndrome. Autosomal dominant; caused by germline mutations in mismatch repair (MMR) genes — most often MLH1 or MSH2, also MSH6 and PMS2. Lifetime CRC risk reaches 70–80%. Lynch syndrome also dramatically increases risk of endometrial cancer (up to 60% lifetime risk), ovarian, gastric, urinary tract, and small bowel cancers. The Amsterdam II criteria and Bethesda guidelines identify patients who should undergo genetic testing. Immunohistochemistry (IHC) for MMR proteins or PCR for microsatellite instability (MSI) on tumor tissue is now recommended for all newly diagnosed CRC patients.
• Familial adenomatous polyposis (FAP): Autosomal dominant APC mutation; hundreds to thousands of colorectal polyps develop in adolescence; without prophylactic colectomy, CRC is virtually inevitable by age 40.

Staging

AJCC TNM staging and Dukes correlation

The liver is the most common site of distant metastasis — approximately 50% of patients who die of CRC have hepatic involvement. Liver metastases from CRC are potentially resectable in select patients (approximately 20% of those with liver-only disease), and resection can be curative. The lung is the second most common metastatic site. Peritoneal carcinomatosis indicates widespread intra-abdominal dissemination and carries the poorest prognosis within Stage IV.

Clinical presentation

Presenting symptoms depend heavily on tumor location within the colon. The physiologic differences between the right and left colon explain the distinct clinical pictures.

Right-sided colon cancer (cecum, ascending colon, hepatic flexure)

The right colon has a wide lumen and liquid fecal content. Right-sided tumors grow to large sizes before causing obstructive symptoms and tend to bleed slowly — the blood mixes with stool and becomes oxidized, producing occult bleeding rather than visible red blood. The classic presentation is:

• Iron-deficiency anemia — fatigue, pallor, dyspnea on exertion, palpitations. Many right-sided CRC patients are diagnosed after workup for unexplained iron-deficiency anemia. Any adult with iron-deficiency anemia and no obvious source (heavy menstrual bleeding, dietary deficiency) requires lower GI evaluation. See the anemia nursing reference for the full diagnostic approach.
• Vague right lower or right upper quadrant discomfort — dull, crampy, intermittent.
• Palpable abdominal mass — in some patients, the tumor itself is palpable on examination.
• Weight loss and anorexia — constitutional symptoms are more prominent in right-sided disease.
• Change in stool caliber — less prominent than in left-sided disease; may present as alternating constipation and diarrhea.

Because right-sided CRC is often clinically silent until late, it tends to present at more advanced stages.

Left-sided colon cancer (splenic flexure, descending colon, sigmoid colon)

The left colon has a narrower lumen and formed, semi-solid stool. Tumors here cause obstructive symptoms earlier:

• Overt rectal bleeding — bright-red or dark red blood mixed with or coating the stool. Any rectal bleeding in adults over 40 warrants evaluation; it should not be attributed to hemorrhoids without ruling out CRC.
• Change in bowel habits — alternating constipation and diarrhea; narrowed or pencil-thin stools (stool passes around a partially obstructing lesion).
• Obstructive symptoms — colicky abdominal pain, abdominal distension, nausea and vomiting. Complete large bowel obstruction from CRC is a surgical emergency. See bowel obstruction nursing for the clinical management of large bowel obstruction.
• Tenesmus — feeling of incomplete evacuation; more prominent with sigmoid and rectal involvement.

Rectal cancer

Rectal cancer shares many features with left-sided colon cancer but has distinct presentation and management implications:

• Rectal bleeding — often bright red, associated with defecation.
• Tenesmus — persistent sensation of needing to defecate even after emptying.
• Pelvic pain — when the tumor involves the mesorectal fascia or adjacent pelvic structures.
• Incomplete emptying — fecal urgency with small-volume stools.

Rectal cancers within 12 cm of the anal verge are managed differently from colon cancer, particularly with respect to radiation therapy and surgical technique.

Diagnostic workup

• Colonoscopy with biopsy — the gold standard for diagnosis. Allows direct visualization of the tumor, biopsy for histologic confirmation, and evaluation of the entire colon for synchronous lesions (present in 3–5% of cases). All CRC patients require complete colonoscopic assessment of the colon before or soon after definitive surgery.

• CT of chest, abdomen, and pelvis with contrast — standard staging workup. Evaluates tumor size and local invasion, regional lymph nodes, liver metastases, pulmonary metastases, and peritoneal disease.

• MRI pelvis — essential for rectal cancer staging. Provides superior soft-tissue resolution for T-staging and assessment of the circumferential resection margin (CRM) and the mesorectal fascia. Involvement of the CRM predicts local recurrence and drives the decision to use preoperative chemoradiation.

• Carcinoembryonic antigen (CEA) — a serum tumor marker. CEA is NOT used to diagnose CRC — it is insensitive and non-specific, elevated in smokers, cirrhosis, inflammatory bowel disease, and other cancers. Its clinical role is: (1) establish a pretreatment baseline, (2) monitor response to therapy, and (3) surveillance for recurrence after curative resection. A rising CEA after resection requires workup. Normal CEA ≤2.5 ng/mL (non-smoker); elevated values >5 ng/mL post-resection suggest recurrence.

• CBC and metabolic panel — assess for iron-deficiency anemia, nutritional status, and hepatic or renal dysfunction that affects treatment planning.

• Molecular testing — all metastatic CRC patients require testing for KRAS and NRAS mutations, BRAF V600E mutation, MSI/MMR status, and HER2 amplification, because these results determine which targeted therapies and immunotherapies are appropriate. MSI-H/dMMR status (present in approximately 5% of metastatic CRC, more common in Lynch syndrome) predicts response to checkpoint inhibitor immunotherapy.

Treatment overview

Surgery

Surgery is the primary treatment for non-metastatic CRC. The extent of resection depends on tumor location and the vascular supply of the affected colon segment.

• Right hemicolectomy: For cecal, ascending colon, and hepatic flexure tumors. Resects the right colon from the ileocecal valve to the mid-transverse colon with an end-to-end or side-to-side ileocolic anastomosis. Typically does not require a stoma in elective cases.

• Left hemicolectomy: For descending colon and splenic flexure tumors. Resects the left colon and splenic flexure with a primary anastomosis in most elective cases.

• Sigmoid colectomy / anterior resection: For sigmoid colon tumors. A primary anastomosis is usually feasible.

• Low anterior resection (LAR): For rectal cancers in the mid and upper rectum. Preserves the anal sphincter and allows a colo-anal or colorectal anastomosis. A temporary diverting loop ileostomy is often created to protect the anastomosis during healing and is typically reversed after 2–3 months once the anastomosis heals. LAR is associated with anterior resection syndrome — urgency, frequency, incomplete evacuation, and fecal incontinence that persists in some patients after ileostomy reversal.

• Abdominoperineal resection (APR): For low rectal and anal canal tumors too close to the anal sphincter for sphincter-preserving surgery. Removes the rectum and the entire anal sphincter complex through both an abdominal and a perineal incision. Results in a permanent end colostomy. The perineal wound is often packed and requires specific wound care, particularly in patients who received preoperative radiation (delayed healing).

• Emergency colectomy with Hartmann’s procedure: When a left-sided CRC causes complete obstruction or perforation, a primary anastomosis may be unsafe. Hartmann’s procedure resects the affected segment, creates a temporary end colostomy, and closes the rectal stump. A second surgery to restore bowel continuity may be performed later.

Radiation therapy

Radiation is used primarily for rectal cancer (not colon cancer). The mesorectal lymph nodes are enclosed within the pelvis and accessible to radiation fields; the colon is mobile and bowel in the radiation field changes with position, making colon radiation less practical.

• Preoperative (neoadjuvant) chemoradiation: Standard for locally advanced rectal cancer (T3–T4 or node-positive disease on MRI). 5-fluorouracil-based concurrent chemoradiation over 5–6 weeks is given before surgery. Goals: downstage the tumor to facilitate sphincter preservation, increase rates of complete resection, and reduce local recurrence. Restaging MRI and CT are performed 6–8 weeks after completion.

• Short-course preoperative radiation (5 × 5 Gy): A shorter regimen used in some centers for intermediate-risk rectal cancer, followed by delayed surgery after interval tumor response.

Chemotherapy

Nursing priorities

Post-operative care after colorectal surgery

Colorectal surgery carries specific post-operative nursing priorities beyond routine surgical care.

Return of bowel function: Paralytic ileus is expected after abdominal surgery. Monitor for return of bowel sounds, passage of flatus (first sign of return of motility), and eventually stool. Patients are typically kept NPO or on clear liquids until bowel sounds return and flatus is passed. Enhanced recovery after surgery (ERAS) protocols now encourage early oral intake (clear liquids within hours of surgery) and early ambulation, both of which reduce ileus duration.

NG tube management: When an NG tube is in place, maintain patency by irrigating with 30 mL NS as ordered. Monitor output character — bilious green output is normal; brown feculent output may indicate prolonged ileus or obstruction. Document output volume accurately (it is replaced in IV fluid calculations).

Anastomotic leak: Anastomotic leak is one of the most feared post-operative complications after colorectal surgery. It occurs when the surgical join (anastomosis) breaks down, allowing intestinal contents to leak into the peritoneal cavity. Risk is highest on days 4–7 post-operatively.

Clinical signs:

• Fever (often the first sign)
• Abdominal pain – worsening or new-onset after initial improvement
• Tachycardia
• Elevated WBC (leukocytosis)
• Peritoneal signs on examination — guarding, rigidity, rebound tenderness
• In patients with a drain: persistent cloudy, feculent, or bile-stained drain output

Anastomotic leak is a surgical emergency. Nursing priority: notify the surgeon immediately. Do not administer oral intake. Prepare the patient for urgent CT scan and likely return to the operating room. See also the related GI bleed nursing reference for management of GI hemorrhage, which can also complicate anastomoses.

Wound care: Monitor surgical incision for erythema, warmth, swelling, or purulent drainage at each assessment. Perineal wounds after APR are particularly prone to delayed healing, especially in patients who received preoperative pelvic radiation. These wounds may be left open or loosely approximated and require regular dressing changes.

DVT prophylaxis: CRC patients are at high VTE risk — both from the cancer itself and the surgery. Ensure pharmacologic prophylaxis (low-molecular-weight heparin or unfractionated heparin) and mechanical prophylaxis (sequential compression devices) are in place unless contraindicated. Early ambulation is the most important modifiable factor.

Ostomy care

Patients undergoing APR receive a permanent end colostomy. Patients undergoing LAR frequently receive a temporary loop ileostomy during anastomotic healing. Ostomy care is a critical nursing skill.

Stoma assessment: A healthy stoma should be:

• Brick red or beefy red — indicating good blood supply
• Moist and glistening — like the inside of the mouth
• Slightly raised above the skin surface (especially for ileostomies, which have a protruding spout to direct output away from the skin)

Ischemic stoma: A purple, dusky, or black stoma indicates compromised vascular supply — a surgical emergency. Call the surgeon immediately. Do not apply the pouching system; the stoma needs urgent assessment and possible surgical intervention. Do not delay notification to wait for confirmatory signs.

Stoma output types comparison:

High-output ileostomy: An ileostomy producing more than 1,200 mL per day is high-output and significantly increases the risk of dehydration, hyponatremia, hypokalemia, hypomagnesemia, and metabolic acidosis (bicarbonate loss). Nursing priorities: strict intake and output, daily weights, electrolyte monitoring, and dietary counseling (restrict hypotonic fluids, encourage oral rehydration solutions, reduce fiber and high-output foods). Loperamide and other motility-slowing agents can reduce output. Parenteral nutrition or IV fluid replacement may be required in severe cases.

Pouching system and skin care:

• Change the system every 3–5 days or when leakage begins (not on a set schedule regardless of leakage).
• Measure stoma diameter at each pouch change for the first 6–8 weeks (stomas shrink as edema resolves post-operatively; an ill-fitting flange causes peristomal skin exposure to output).
• Use skin barrier powder on denuded or weeping peristomal skin before applying the flange.
• Apply a thin ring of stoma paste around the stoma opening on the flange to fill any contours or uneven skin surfaces.
• Empty the pouch when it is one-third to one-half full to prevent weight from breaking the seal.
• Teach the patient to check the stoma color at each pouch change.

Patient education: Patients often experience grief, altered body image, and anxiety about ostomy management. Allow adequate time for teaching and demonstration. The patient should return-demonstrate full pouch change before discharge. Certified Wound, Ostomy, and Continence (CWOC) nurse consultation is the standard of care for ostomy education and follow-up.

Chemotherapy toxicity management

Oxaliplatin — cold-induced peripheral neuropathy: Oxaliplatin causes two distinct neurotoxic syndromes. The acute syndrome appears within hours to days of infusion and is triggered by cold: patients experience dysesthesias (tingling, burning, abnormal sensations) in the hands, feet, and perioral area when touching cold objects or drinking cold liquids. This is not permanent but can be disabling. The chronic syndrome is cumulative sensory peripheral neuropathy — numbness and tingling in hands and feet that worsens with successive cycles and may persist long-term or permanently after treatment ends.

Nursing education priorities for oxaliplatin:

• No cold drinks during and for several days after infusion; room-temperature or warm beverages only
• Wear gloves when reaching into the freezer or refrigerator
• Cover hands and face before going outside in cold weather
• No ice chips for nausea (standard anti-nausea strategy that is contraindicated here)
• Report worsening numbness or tingling at each visit — cumulative neuropathy may require dose reduction or discontinuation

5-fluorouracil and capecitabine — mucositis and diarrhea: 5-FU and its oral prodrug capecitabine damage rapidly dividing mucosal cells throughout the GI tract. Mucositis (painful mouth sores) and diarrhea are common. Nursing interventions: assess oral mucosa daily; teach regular saline rinses and avoidance of irritants; aggressive anti-diarrheal therapy per protocol; maintain hydration. Patients with dihydropyrimidine dehydrogenase (DPD) enzyme deficiency are at risk for severe, life-threatening 5-FU toxicity — a rare pharmacogenomic consideration.

Irinotecan — dual diarrhea mechanism: Irinotecan causes diarrhea through two completely different mechanisms requiring different treatments:

1. Early-onset cholinergic diarrhea (during infusion or within 24 hours): caused by irinotecan’s inhibition of acetylcholinesterase → excess acetylcholine → bowel hypermotility, diaphoresis, lacrimation, salivation, rhinorrhea, cramping, bradycardia. Treatment: atropine 0.25–1 mg IV or subcutaneously. Prophylactic atropine may be given before infusion in patients who have experienced previous early-onset reactions.

2. Late-onset secretory diarrhea (more than 24 hours after infusion): caused by active metabolite (SN-38) directly damaging intestinal epithelium. Can be severe (Grade 3–4), causing rapid dehydration and electrolyte imbalances. Treatment: high-dose loperamide protocol — loperamide 4 mg at first loose stool, then 2 mg every 2 hours (or 4 mg every 4 hours at night) until diarrhea-free for 12 hours. Maximum 16 mg per day. Maintain aggressive oral hydration. Hospitalize for IV fluids if patient cannot maintain hydration or has Grade 3–4 diarrhea.

Bevacizumab — hypertension and wound healing: Bevacizumab inhibits VEGF-driven angiogenesis. Because VEGF also maintains endothelial function in vessels, bevacizumab causes systemic hypertension in up to 35% of patients. Blood pressure must be measured before every infusion — elevated BP that is uncontrolled warrants holding the drug. Wound healing requires angiogenesis; bevacizumab should be held for 4–6 weeks before and after any major surgical procedure to prevent dehiscence, fistula, and GI perforation. GI perforation is rare but potentially fatal.

Nutrition

CRC treatment significantly affects nutritional status through multiple mechanisms: surgery alters GI anatomy and absorptive capacity; chemotherapy causes mucositis, nausea, and diarrhea; radiation to the pelvis causes radiation enteritis and proctitis. Nursing priorities:

• Low-residue diet during active treatment and in the immediate post-operative period reduces stool volume and GI irritation.
• High-protein, high-calorie diet (1.2–1.5 g protein/kg/day) supports wound healing and prevents treatment-related weight loss.
• Patients with colostomies can gradually advance to a normal diet, avoiding foods that cause excessive gas, odor, or unpredictable output initially (cabbage, beans, onions, carbonated beverages).
• Ileostomy patients require increased fluid and electrolyte intake throughout the life of the stoma.
• Referral to a registered dietitian is indicated for significant weight loss (>5%), malnutrition screening positivity, or ongoing treatment-related GI symptoms.

NCLEX tips

• CEA is not a diagnostic test. CEA is NOT used to screen for or diagnose CRC — it is a baseline marker and post-treatment surveillance tool. Exam question stem: “CEA level is elevated in a patient being evaluated for abdominal pain. Which diagnostic test should the nurse anticipate?” Answer: colonoscopy, not more CEA testing. CEA >5 ng/mL post-resection = possible recurrence → workup needed.

• Stoma color is a safety-critical assessment. Brick-red or beefy red = normal, well-perfused stoma. Purple, dusky, or black = ischemia → call the surgeon immediately. The exam will ask what to do — always: notify surgeon immediately. Do not apply the pouch system and continue monitoring. This is a surgical emergency.

• Oxaliplatin neuropathy = cold sensitivity. The classic NCLEX trigger: patient on FOLFOX reaches into the freezer and experiences severe hand pain. Correct action: patient education — avoid cold contact, wear gloves, drink warm beverages. This is expected toxicity, not an emergency. Do not confuse with the chronic cumulative neuropathy (numbness/tingling that persists), which does require dose-reduction evaluation.

• Anastomotic leak peaks day 4–7. Fever + abdominal pain + tachycardia + elevated WBC on post-operative day 5 after colorectal surgery = anastomotic leak until proven otherwise. Priority nursing action: notify the surgeon immediately; keep NPO; prepare for CT abdomen/pelvis. This is a surgical emergency.

• APR = permanent colostomy; LAR = potentially reversible. APR (abdominoperineal resection) removes the entire rectum and anus — the patient will always have a colostomy. LAR (low anterior resection) preserves the sphincter — a temporary diverting ileostomy may be created but is usually reversed later. Exam distinguisher: the word “permanent” only applies to APR.

• MSI-H/dMMR = checkpoint inhibitor eligible. MSI-H (microsatellite instability-high) or dMMR (deficient mismatch repair) tumors respond to pembrolizumab and nivolumab. Lynch syndrome tumors are frequently MSI-H. For other metastatic CRC, immunotherapy does not work (proficient MMR/MSS tumors are not immunotherapy-responsive). The NCLEX may test: “which patient is eligible for pembrolizumab?” → the one with MSI-H or Lynch syndrome.

• Irinotecan diarrhea: two syndromes, two treatments. Early (<24 hours) = cholinergic reaction → atropine. Late (>24 hours) = secretory diarrhea → high-dose loperamide protocol. Getting them reversed on an exam is a classic distractor.

• Bevacizumab: hold before/after surgery and monitor blood pressure. The two most tested bevacizumab priorities: (1) hold 4–6 weeks before and after major surgery — impairs wound healing and increases GI perforation risk; (2) measure BP before every infusion — holds if uncontrolled hypertension. On the NCLEX, if a patient on bevacizumab is scheduled for elective surgery, the correct action is to notify the oncologist before proceeding.

• Cetuximab/panitumumab: check RAS mutation first. Anti-EGFR therapy is only effective in RAS wild-type CRC. If KRAS or NRAS is mutated, the drug will not work and may cause harm. Exam question: “Before initiating cetuximab, what information is most important to verify?” → RAS mutation status (or KRAS/NRAS test result). This is a “assessment before administration” safety question.

• Capecitabine = oral 5-FU prodrug; hand-foot syndrome is dose-limiting. Capecitabine is taken orally twice daily. The dose-limiting toxicity is palmar-plantar erythrodysesthesia (hand-foot syndrome): redness, swelling, pain, blistering, peeling of the palms and soles. Nursing: inspect palms and soles at each visit; teach patients to report early signs; avoid hot water, tight shoes, and friction. Grade 2–3 hand-foot syndrome requires dose reduction.

• High-output ileostomy: electrolyte and dehydration risk. Output >1,200 mL/day from an ileostomy → hyponatremia, hypokalemia, hypomagnesemia, dehydration, and potential AKI. Exam priority: strict intake and output, daily weights, electrolyte monitoring. Teaching: increase oral fluid and electrolyte intake; restrict hypotonic fluids (plain water in large amounts can worsen hyponatremia). See electrolyte imbalances nursing for full electrolyte management reference.

• CEA >5 ng/mL post-resection = possible recurrence. After curative resection, serial CEA monitoring is used for surveillance. A rising or persistently elevated CEA (>5 ng/mL) requires imaging workup for recurrence — this is not a normal finding and should trigger physician notification and restaging CT.

• Lynch syndrome essentials. Lynch syndrome (HNPCC) is autosomal dominant, caused by mutations in MLH1, MSH2, MSH6, or PMS2. Lifetime CRC risk is 70–80%. It also dramatically elevates risk of endometrial cancer (up to 60%), ovarian, gastric, and urinary tract cancers. All newly diagnosed CRC patients should have tumor MMR testing (IHC or MSI testing) — Lynch syndrome tumors show loss of MMR protein expression.

• Left-sided vs right-sided CRC presentation. Left-sided: overt rectal bleeding, pencil-thin stools, obstructive symptoms, change in bowel habits — diagnosed earlier due to symptoms. Right-sided: occult bleeding, iron-deficiency anemia, often silent until late stage — diagnosed later. Any adult with unexplained iron-deficiency anemia requires lower GI evaluation.

• Right-sided CRC and iron-deficiency anemia. The NCLEX pattern: postmenopausal woman or older man with fatigue, pallor, and iron-deficiency anemia, no obvious bleeding source → colonoscopy. Do not assume anemia is dietary in adults without investigating a lower GI source. See the anemia nursing reference for the full iron-deficiency anemia workup algorithm.

Right-sided vs left-sided CRC: quick reference

Related nursing resources

For related clinical content, see the following references on this site:

• Oncology nursing reference — comprehensive oncology nursing overview including myelosuppression management, neutropenic precautions, chemotherapy administration safety, and tumor lysis syndrome
• IBD nursing — inflammatory bowel disease including Crohn’s disease and ulcerative colitis; IBD as a major modifiable risk factor for CRC
• Bowel obstruction nursing — large bowel obstruction including management of CRC-related obstruction and Hartmann’s procedure
• GI bleed nursing reference — lower GI bleeding presentation, assessment, and management
• Anemia nursing reference — iron-deficiency anemia workup and nursing care; key presentation of right-sided CRC
• Lung cancer nursing — chemotherapy toxicity cross-reference; lung is the second most common site of CRC metastasis; immunotherapy irAE management
• Leukemia nursing — chemotherapy nursing care principles shared across oncology settings