Cancer of the Stomach
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KOMUNITAS BLOGGER UNIVERSITAS SRIWIJAYA
Cancer of the Stomach · Cancer of the stomach is usually adenocarcinoma.
· It typically occurs in males and people older than age 40. · Mostly occur in
lesser curvature or antrum of the stomach and infiltrate surrounding mucosa, stomach wall,
adjacent organs and structures. · Prognosis is poor because most patients have
metastases at the time of diagnosis. Etiology § Diet – high in smoked food and
lacking in fruits and vegetables § Chronic inflammation of the stomach §
Pernicious anemia § Achlorydria § Gastric ulcers § Helicobacter pylori
bacteria ] § Heredity Clinical Manifestations ü Early stages: symptoms may be
absent or may resemble those of the patient with benign ulcers (eg, pain relieved with
antacids) ü Progressive disease: symptoms include: · Indigestion ·
Anorexia · Dyspepsia · Weight loss · Abdominal pain ·
Constipation · Anemia · Nausea and vomiting · Ascites Diagnostic
Methods ü Radiography of the upper gastrointestinal system with barium. ü
Endoscopy for biopsy and cytologic washings. ü CT scan, bone scan and liver scan to
determine extent of metastasis. ü Complete radiographic examination of the
gastrointestinal tract if dyspepsia of more than 4 weeks’ duration in any person older
than 40 years of age. Medical Management Ø Removal of gastric carcinoma; curative
if tumor can be removed while still localized to the stomach. Ø Effective palliation (to
prevent symptoms such as obstruction) by resection of the tumor; radical subtotal
gastrectomy; total gastrectomy with anastomosis of the esophagus and jejunum Ø
Chemotherapy Ø Radiation therapy Nursing Interventions Reducing anxiety Ø
Provide relaxed, nonthreatening atmosphere Ø Advise about any procedure and
treatment Ø Suggest patient to discuss feelings Promoting optimal nutrition Ø
Encourage small, frequent feedings of non irritating foods to decrease gastric irritation
Ø Ensure that food supplements are high in calories and vitamins A and C and iron.
Ø Administer parenteral vitamin B12 indefinitely if total gastrectomy is performed
Ø Monitor rate and frequency of IV Ø Record intake and output, amd daily
weights Ø Administer antiemetics as prescribed Relieving pain Ø Administer
analgesics as prescribed Ø Assess frequency, intensity and duration of pain to
determine effectiveness of analgesic agent Ø Suggest non pharmacologic methods
for pain relief (eg imagery, distraction, relaxation tapes, back rubs and massage) Ø
Encourage periods of rest and relaxation. Ø Cancer of the Liver · Few
cancers originate in the liver · Primary Liver Tumors - usually are associated with
chronic liver disease, Hepatitis B and C infections and cirrhosis - Types: Ø
Hepatocellular carcinoma (HCC) is by far the most common type of primary liver cancer.
Ø Cholangiocellular carcinoma Ø Combined hepatocellular and
cholangiocellular carcinoma. Etiology · Primary liver cancer (hepatocellular
carcinoma)- alcohol abuse · chronic infection with diseases such as hepatitis B and
C · hemochromatosis (too much iron in the liver) · Cirrhosis (a scarring
condition of the liver. · SEX ( Men are more likely to get hepatocellular cancer than
women) · Anabolic steroids ( Male hormones used by athletes to increase muscle
can slightly increase liver cancer risk with long-term use) · Birth control pills Clinical
Manifestations · Early manifestations include pain (dull ache in the upper right
quadrant, epigastrium or back), recent weight loss, loss of strength, anorexia and anemia
· Liver enlargement and irregular surface may be noted on palpation ·
Jaundice is present only if larger bile ducts are occluded · Ascites occurs if portal
veins are obstructed or tumor tissue is seeded in the peritoneal cavity Assessment and
Diagnostic Methods · Clinical signs and symptoms, history and physical examination
· PET scan · CT scan · MRI · Arteriography ·
Laparoscopy · Biopsy · Laboratory assessment § Luekocytosis
(increased WBC) § Erythrocytosis (increased RBC) § Hypercalcemia §
Hypoglycemia § Hypocholesteronemia § Elevated levels of alpha-fetoprotein (AFP)
Medical Management Radiation therapy Ø Intravenous injection of antibodies that
specifically attack tumor-associated antigens Ø Percutaneous placement of highintensity source for interstitial radiation therapy Chemotherapy Ø Systemic
chemotherapy and regional infusion are used to administer antineoplastic agents Ø
An implantable pump is used to deliver high-concentration chemotherapy to the liver through
hepatic artery Percutaneous Biliary Drainage Ø Use to bypass biliary ducts
obstructed by the liver, pancreatic or bile ducts in patients with inoperable tumors Ø
Complications include sepsis, leakage of bile, hemorrhage and reobstruction of the biliary
system Other nonsurgical treatments · Hyperthermia: heat is directed to tumors to
cause necrosis of the tumors while sparing normal tissue · Cryosurgery: tumors are
destroyed by liquid nitrogen at 196?C · Embolization of arterial blood flow to the
tumor; effective in small tumors; alcohol injection may be used to cause tumor necrosis
· Immunotherapy; lymphocytes with antitumor reactivity are administered Lobectomy
Ø Removal of the lobe of the liver Ø Thoracoabdominal incision is used Liver
Transplantation Ø Removal of the liver and replacement with healthy donor Ø
Patient with small tumor have good prognosis Nursing Management Ø Assess
problems related to cardiopulmonary involvement, vascular complications and respiratory
and liver dysfunction Ø Give careful attention to metabolic abnormalities Ø
Encourage early ambulation Ø Teach patients about signs of complications Ø
Teach irrigation technique to avoid introducing bacteria DOWNLOAD