Transcript Gastric Cancer

Gastric Cancer
Dr. Belal Hijji, RN, PhD
February 1, 2012
Learning Outcomes
At the end of this lecture, students will be able to:
• Explain the pathophysiology of gastric cancer and its
clinical picture.
• Describe assessment and diagnostic evaluation of
gastric cancer.
• Discuss the medical management of gastric cancer.
• Discuss the nursing process for the care of a patient with
gastric cancer.
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Pathophysiology
• Gastric cancers can occur anywhere in the stomach.
However, most frequently, they occur on the lesser
curvature (next slide).
• The tumor infiltrates the surrounding mucosa,
penetrating the wall of the stomach and adjacent organs
and structures.
• At the time of diagnosis, the liver, pancreas, esophagus,
and duodenum are often affected.
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Clinical manifestations
• Pain relieved by antacids.
• Dyspepsia (indigestion), early satiety
(‫)تخمة‬, weight loss, abdominal pain
above the umbilicus.
• Loss of appetite and nausea and
vomiting.
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Assessment and diagnostic findings
• The physical examination may not be helpful in detecting
the cancer because most early gastric tumors are not
palpable. In advanced cases, a gastric mass may be
palpable.
• Ascites and hepatomegaly may be apparent if
metastasis occurs.
• Palpable nodules around the umbilicus (slide 6).
• Esophagogastroduodenoscopy for biposy and cytologic
washings is the diagnostic study of choice.
• CT completes the diagnostic studies to assess for
surgical resectability of the tumor before surgery is
scheduled.
• CT of the chest, abdomen, and pelvis is important in
staging of gastric cancer.
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Sister Mary Joseph's nodule of the umbilicus
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Medical management
• Successful treatment of gastric cancer is through tumor
removal.
• Cure could be achieved if the tumor has been removed
while it is still localised to the stomach. Otherwise, cure
is less likely.
• Unresectable tumor in a patient with advanced disease,
chemotherapy using single agent chemotherapeutic
medications including 5-fluorouracil (5-FU), cisplatin,
doxorubicin, and mitomycin.
• It is now more common to administer combination
therapy, primarily 5-FU-based therapy with other agents.
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• Total gastrectomy may be performed for a resectable
cancer. The entire stomach, the duodenum, the lower
portion of the esophagus, supporting mesentry, and
lymph nodes are removed. Esophagojejunostomy is
performed to reconstruct the GI tract.
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Nursing process
For a patient with gastric cancer
Assessment
• Ask patient about loss of weight, how much and over
what period of time. Ask about tolerating full diet. If not,
what foods s(h)e eats. Does the patient feel full after
eating small amount? Is there any pain? Do foods,
antacids, or medications relieve pain? The nurse should
then perform the physical examination to assess the
abdomen for tenderness or masses, palpates the
abdomen to detect ascites.
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Nursing diagnoses, planning and goals
• Based on assessment data, nursing diagnoses may
include:
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Anxiety related to the disease and anticipated treatment.
Imbalanced nutrition related to early satiety or anorexia.
Pain related to tumor mass.
Anticipatory grieving related to diagnosis of cancer.
Deficient knowledge regarding self-care activities.
• The major goals for the patient may include:
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reduced anxiety
optimal nutrition
pain relief
adjustment to diagnosis and anticipated life style changes
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Nursing interventions
• Reducing anxiety:
– Provide a relaxed, nonthreatening atmosphere so that the
patient freely expresses his fears, concerns, and possibly
anger about diagnosis.
– Encourage significant others to support the patient.
– Advise the patient about any procedures and treatments so
that he knows what to expect.
• Promoting optimal nutrition:
– Encourage the patient to eat small frequent portions of
nonirritating foods that are high in calories and vitamins (A, C)
and iron to enhance tissue repair.
– Provide parenteral nutrition if prescribed before surgery.
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– Explain ways to prevent and manage dumping syndrome
(rapid emptying of the stomach contents into the small
intestine; characterized by sweating and weakness) after
surgery. In this condition, the patient has a feeling of fullness,
nausea, and diarrhea; this causes dehydration, hypotension,
and tachycardia. Therefore:
• Encourage the patient to have six small meals daily that are low
in carbohydrate and sugar with fluids between, rather than with,
meals. Inform the patient that symptoms will often resolve after
several months.
– Monitor the IV therapy and nutritional status.
– Record intake and output and daily weight.
– Assess for signs and symptoms of dehydration.
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• Relieving pain:
– Administer analgesics as prescribed
– Assess the level of pain
– Encourage nonpharmacologic methods for pain relief.
• Providing psychosocial support:
– Help the patient express fear, concern, and grief about
diagnosis.
– Answer the patient’s questions honestly, and encourage him
to participate in the treatment decisions.
– Offer emotional support and involve significant others.
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Evaluation
Expected outcomes may include the following:
• Reports less anxiety
• Attains optimal nutrition
• Has less pain
• Performs self care activities and adjust to lifestyle
changes
• Prepares for the dying process
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