Gastric Cancer Elicia Jackson, Hana Johnson, Jordyn Neal Adult Health Theory ｜ Dr. Lakeshur Green Chapter 41 What is Gastric Cancer? Ethnicity Demographics Asian Americans, Pacific Islander, Hispanics, and blacks have a higher rate of incidence than non-hispanic whites Gender Men are twice as likely to develop stomach cancer than women Age Older people are the most common age group with diagnostic average age being 68. Pathophysiology & Etiology Risk Factors & Causes H. Pylori, repeated exposure to irritants, tobacco use Stomach cancer can be caused by nonspecific mucosal injury as a result of infection at an early age, irritation of bile, or irritation caused by NSAIDs. Predisposing Factors: Atrophic gastritis, pernicious anemia, adenomatous polyps, hyperplastic polyps, and achlorhydria Smoking and obesity increase risk Diets high in smoked foods, salted fish and meat, and pickled vegetables. Clinical Manifestations Progression of the disease is insidious. Cancer spreads to adjacent organs before the manifestations are present. These include: ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ Weight loss Abdominal pain and discomfort Signs and symptoms of anemia ➢ Chronic Blood Loss ➢ Pernicious Anemia Early satiety Pale and weakness Fatigue, weakness, and dizziness Positive occult blood in the stool Supraclavicular lymph nodes that are hard and enlarged Shortness of breath in severe cases Poor Prognosis Sign: ascites Diagnostic Assessment Best Diagnostic Tool: Upper GI Endoscopy History & physical exam Stool examination to determine presence of occult blood Diagnostic Studies Stage the disease with: Endoscopic ultrasound, CT, MRI, and PET Histologic and tissue biopsy are important in diagnosis Laparoscopy is done to determine the peritoneal spread CBC is used to: determine the severity of anemia Increased liver enzymes and serum amylase levels indicate liver and pancreatic involvement Tumor Markers can help diagnose cancer alpha-Fetoprotein carbohydrate antigen carcinoembryonic antigens Interprofessional Care ❏ 01 02 Focus on correcting nutritional deficits and treatment of anemia. Nutritional Deficits Anemia Preoperative Goals ❏ Gastric decompression may be needed for surgery. (Gastric Outlet Obstruction) ❏ Transfusion of packed RBCs needs to be implemented to correct the anemia. Surgical Therapy ❏ Aim to remove majority of the stomach of the tumor and a margin of normal tissue. ❏ ❏ Specific surgery sites: 1. Location and extent of the lesion 2. Patient’s physical condition 3. HCP preference Types of procedures ➢ Billroth I or II: Lesions in the antrum or pyloric region ➢ Total gastrectomy with esophagojejunostomy: Lesion in the fundus ➢ Extended surgeries: metastasis to organs (spleen, ovaries, or bowel) ➢ Partial colon resection: tumor extends into the transverse colon. Chemotherapy & Radiation Therapy ❏ List of Chemotherapy drugs for stomach cancer ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ Fluorouracil Capecitabine (Xeloda) Carboplatin Cisplatin Docetaxel (Taxotere) Epirubicin (Ellence) Irinotecan (Camptosar) Oxaliplatin (Eloxatin) Pacilataxel ❏ Combination therapies (Different phases of the cell cycle) ➢ ➢ ECF (epirubicin, cisplatin, fluorouracil) and docetaxel, irinotecan, oxaliplatin Cisplatin with fluorouracil or capecitabine ❏ ➢ Radiation Therapy Used together with chemotherapy to reduce the recurrence or as palliative measure to decrease tumor mass and provide temporary relief of obstruction. Targeted Therapy ❏ Stomach cancer treatment: Trastuzumab (Herceptin) & Ramucirumab (Cyramza) ❏ Patient with stomach cancer have too much HER-2 (surface of the cancer cells) ➢ Trastuzumab: targets the HER-2 protein and kills the cancer kills ➢ Ramucirumab: bind to receptor VEGF and prevent VEGF from binding to the receptor preventing the growth and spread of cancer. (Used to treat esophageal cancer). Nursing Management Assessment Obtain Data on: ● ● ● ● Nutritional assessment Psychosocial history Patients perception of health problems and need for care Physical examination Goals of Care (Planning) 3 Goals: 1) Minimal discomfort 2) Achieve optimal nutritional status 3) Maintain degree of psychological well-being appropriate to the disease stage Acute Care ● ● ● ● ● Retest, provide support, provide information and maintain a positive attitude. Provide several smaller meals rather than 3 frequent meals Provide preoperative and postoperative information as needed Packed RBCs and fluid volume may be given preoperative Provide detailed instructions of radiation and chemo therapies Ambulatory ● ● ● After radiation and chemo therapy referral to a home health care may be beneficial Provide a list of community agencies Encourage patient to adhere prescribed therapies, keep appointment, and inform healthcare providers of changes in physical conditions Evaluation Same as the goals: ● Have no minimal discomfort, pain, or nausea ● Achieve optimal nutritional status ● Maintain a degree of psychological well-being appropriate to the disease stage Health Promotion Encourage Detection Identify the patients at risk of specific disorders such as H. pylori infection, pernicious anemia, and achlorhydria Be aware of symptoms Symptoms often occur late and mimic conditions such as PUD which include poor appetite, weight loss, fatigue and persistent stomach distress Patient with positive family history of stomach cancer to be evaluated for anemia, PUD, or vague epigastric distress. Recognize The possibility of stomach cancer in patient who is treated for PUD and does not get relief with therapy Discussion Question An optimal teaching plan for an outpatient with stomach cancer receiving radiation therapy should include information about a. cancer support groups, alopecia, and stomatitis. b. nutrition supplements, ostomy care, and support groups. c. prosthetic devices, wound and skin care, and grief counseling. d. wound and skin care, nutrition, drugs, and community resources. Correct answer: d Rationale: Radiation therapy is an adjuvant to surgery or for palliation in treatment of stomach cancer. The nurse’s role is to provide detailed instructions, to reassure the patient, and to ensure completion of the designated number of treatments. The nurse should start by assessing the patient’s knowledge of radiation therapy. The nurse should teach the patient about skin care, the need for nutrition and fluid intake during therapy, and the appropriate use of antiemetic drugs. Discussion Question A patient who has been diagnosed with stomach cancer a year ago comes to the hospital complaining of abdominal discomfort, loss of appetite, and shortness of breath. Which diagnostic or surgical procedure can best determine the spread of stomach cancer to the peritoneum? a. Biopsy b. Ultrasound c. Laparoscopy d. CT Correct answer: c A laparoscopy can determine the spread of cancer to the peritoneum. A biopsy of the tissue and subsequent histologic examination are important for the diagnosis of stomach cancer. Ultrasound and CT studies are used to stage the disease. References Elsevier. (n.d.). Lewis's medical-surgical nursing. Lewis's Medical-Surgical Nursing - 11th Edition. Retrieved March 20, 2022, from https://www.elsevier.com/books/lewiss-medical-surgical-nursing/harding/978-0-323-55149-6 Thank You !
