Gastric cancer

gastric cancer, risk factors, staging, TNM classification, pathophysiology, signs, symptoms, diagnosis, treatment, nursing interventions.

1. Prepared by Mehwish Jamil Gastric cancer

2. incidence of gastric or stomach cancer continues to decrease in the United States, it still accounts for more than 11,000 deaths annually (American Cancer Society, 2009 ). Prognosis : prognosis is generally poor; the diagnosis is usually made late because most patients are asymptomatic during the early stages of the disease.

3. Risk factor/ causes Age ( between 40 and 70 years of age ) Gender Diet appears to be a significant factor: A diet high in smoked, salted, or pickled foods and low in fruits and vegetables may increase the risk of gastric cancer Chronic gastritis H.pylori infection pernicious anemia, smoking, achlorhydria , gastric ulcers, previous subtotal gastrectomy (more than 20 years ago ), Genetics(blood group A)

4. Pathophysiology

5. staging Stage1 cancer has just begun to affect the inner stomach. Stage2 cancer has begun to penetrate toward the outer layer of stomach . Nearby lymph nodes may be involved. Stage3 cancer has progressed farther through tissue layers of stomach or more distant lymph nodes may be involved. Stage4 cancer has penetrated all tissue layers of stomach or distant lymph nodes may be involved. Stage5 cancer has affected all nearby tissues and organs. Cancer have been carried through lymph system to other distant body parts. This is known as metastasis. Mainly to liver, lungs, bones.

6. symptoms Symptoms of progressive disease include: dyspepsia (indigestion), early satiety, weight loss(62%), abdominal pain just above the umbilicus(52%), loss or decrease in appetite, bloating after meals nausea and vomiting(34%) Symptoms are similar to those of peptic ulcer disease.

7. signs Sister Mary Joseph’s nodules( periumbilical node) Left Supraclavicular node( virchows ) Left axillary node(Irish) Enlarged ovary( krukenburg’s ) ascites

8. Diagnosis Tests and procedures used to diagnose stomach cancer include: upper endoscopy Biopsy Imaging tests . Imaging tests used to look for stomach cancer include CT scans and a special type of X-ray exam called a barium swallow .

9. Conti… Determining the extent (stage) of stomach cancer: Blood tests Endoscopic ultrasound Exploratory surgery Imaging tests. Tests may include CT and positron emission tomography (PET ).

10. treatment Treatment options for stomach cancer depend on the cancer's location, stage and aggressiveness . Surgery: The goal of surgery is to remove all of the cancer and some of the healthy tissue around it . Operations used for stomach cancer include :

11. Removing early-stage tumors from the stomach lining: Procedures to cut away cancer from the inside lining of the stomach include endoscopic mucosal resection and endoscopic sub mucosal resection . b . Removing part of the stomach (subtotal gastrectomy). During subtotal gastrectomy, the surgeon removes the part of the stomach affected by cancer and some of the healthy tissue around it. This operation may be an option if your stomach cancer is located in the part of the stomach nearest the small intestine.

12. c. Removing the entire stomach (total gastrectomy). Total gastrectomy involves removing the entire stomach and some surrounding tissue. The esophagus is then connected directly to the small intestine to allow food to move through your digestive system. Total gastrectomy is used most often for stomach cancers that affect the body of the stomach and those that are located in the gastro esophageal junction . d . Removing lymph nodes to look for cancer e. Surgery to relieve signs and symptoms

13. Chemotherapy Chemotherapy can be given before surgery to help shrink the cancer so that it can be more easily removed. Chemotherapy is also used after surgery to kill any cancer cells that might remain in the body. Chemotherapy is often combined with radiation therapy. Chemotherapy may be used alone or with targeted drug therapy in people with advanced stomach cancer.

14. Radiation therapy Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. The energy beams come from a machine that moves around you as you lie on a table . For advanced stomach cancer that can't be removed with surgery, radiation therapy may be used to relieve side effects, such as pain or bleeding, caused by a growing cancer.

15. Targeted drug therapy Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. For stomach cancer, targeted drugs are usually combined with chemotherapy for advanced cancers or cancer that comes back after treatment.

16. Immunotherapy Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body's disease-fighting immune system might not attack cancer because the cancer cells produce proteins that make it hard for the immune system cells to recognize the cancer cells as dangerous. Immunotherapy works by interfering with that process .

17. Supportive (palliative) care Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing aggressive treatments, such as surgery, chemotherapy or radiation therapy . When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer . Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

18. Nursing interventions

19. Nursing intervention Monitor nutritional intake and weigh patient regularly. Monitor CBC and serum vitamin B12 levels to detect anemia, and monitor albumin and prealbumin levels to determine if protein supplementation is needed. Provide comfort measures and administer analgesics as ordered. Frequently turn the patient and encourage deep breathing to prevent pulmonary complications, to protect skin, and to promote comfort. Maintain nasogastric suction to remove fluids and gas in the stomach and prevent painful distention.

20. Conti… Provide oral care to prevent dryness and ulceration. Keep the patient nothing by mouth as directed to promote gastric wound healing. Administer parenteral nutrition, if ordered. When nasogastric drainage has decreased and bowel sounds have returned, begin oral fluids and progress slowly. Avoid giving the patient high-carbohydrate foods and fluids with meals, which may trigger dumping syndrome because of excessively rapid emptying of gastric contents. Administer protein and vitamin supplements to foster wound repair and tissue building

21. Eat small, frequent meals rather than three large meals. Reduce fluids with meals, but take them between meals. Stress the importance of long term vitamin B12 injections after gastrectomy to prevent surgically induced pernicious anemia. Encourage follow-up visits with the health care provider and routine blood studies and other testing to detect complications or recurrence.