GASTRIC CANCER

Calag, Prescilla
Tavas, Charme Faye
 Definition

 A malignant tumor of the stomach

it occurs when cancerous cells form in the stomach
lining.
also called gastric cancer
 Types
Adenocarcinomas develop within the cells of the
innermost lining of the stomach.
Lymphoma is a cancer of the immune system tissue that
may start anywhere there are lymph tissues, including the
stomach.
Gastrointestinal stromal tumors, or GISTs, are a rare type of
stomach cancer that starts in a special cell found in the
lining of the stomach called interstitial cells of Cajal
(ICCs).
Carcinoid tumors typically start in the hormone producing
cells of the stomach.
 Causes
Age and gender are risk factors and the disease is more
common in men over the age of 55.
A diet in high salt and nitrates and low in vitamins A and C
increases the risk for stomach cancer.
Medical conditions that increase risk for the disease
include pernicious anemia (vitamin B-12 deficiency),
chronic inflammation of the stomach (atrophic gastritis),
and intestinal polyps (noncancerous growths)
Genetic risk factors include heredity nonpolyposis colon
cancer (HNPCC) syndrome and Li-Fraumeni syndrome
(conditions that result in a predisposition to cancer) and a
family history of gastrointestinal cancer.
Pathophysiology
 Signs and Symptoms
• Poor appetite
• Weight loss (without trying)
• Abdominal (belly) pain
• Vague discomfort in the abdomen, usually above
the navel
• A sense of fullness in the upper abdomen after
eating a small meal
• Heartburn or indigestion
• Nausea
• Vomiting, with or without blood
• Swelling or fluid build-up in the abdomen
• Low red blood cell count (anemia)
 Diagnosis

• the main test used to find

stomach cancer. It may be
used when someone has
certain risk factors or when
signs and symptoms suggest
this disease may be present.
• Endoscopic
ultrasound - a wand-
shaped probe called
a transducer is placed
on the skin. It gives off
sound waves and
detects the echoes as
they bounce off
internal organs. The
pattern of echoes is
processed by a
computer to produce
a black and white
image on a screen.
• Barium Swallow - a
person swallows a
liquid containing
barium, and a series of
x-rays are taken.
Barium coats the lining
of the esophagus,
stomach, and
intestines, so tumors or
other abnormalities
are easier to see on
the x-ray.
• A CT scan can be
used to measure the
tumor’s size.
Sometimes, a special
dye called a contrast
medium is given
before the scan to
provide better detail
on the image. This dye
is usually given both as
a solution to swallow
and into a vein.
• Positron emission
tomography (PET) or PET-CT
scan. A PET scan is a way to
create pictures of organs and
tissues inside the body. A
small amount of a
radioactive sugar substance
is injected into the patient’s
body. This sugar substance is
taken up by cells that use the
most energy. Because
cancer tends to use energy
actively, it absorbs more of
the radioactive substance. A
scanner then detects this
substance to produce
images of the inside of the
body.
• A laparoscopy is a minor
surgery in which the
surgeon inserts a thin,
lighted, flexible tube
called a laparoscope
into the abdominal
cavity. It is used to find
out if the cancer has
spread to the lining of
the abdominal cavity or
liver. A CT or PET scan
cannot often find
cancer that has spread
to these areas.
• A biopsy is the removal
of a small amount of
tissue for examination
under a microscope.
Other tests can suggest
that cancer is present,
but only a biopsy can
make a definite
diagnosis.
 Treatment
• Removing early-stage tumors from the stomach lining. Very small
cancers limited to the inside lining of the stomach may be removed
using endoscopy in a procedure called endoscopic mucosal
resection.
• Removing a portion of the stomach (subtotal gastrectomy). During
subtotal gastrectomy, the surgeon removes only the portion of the
stomach affected by cancer.
• 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.
• Removing lymph nodes to look for cancer. The surgeon examines and
removes lymph nodes in your abdomen to look for cancer cells.
• Surgery to relieve signs and symptoms. Removing part of the stomach
may relieve signs and symptoms of a growing tumor in people with
advanced stomach cancer. In this case, surgery can't cure advanced
stomach cancer, but it can make you more comfortable.
• Radiation therapy
In gastroesophageal junction cancer, as well as in cancer of the
stomach body, radiation therapy can be used before surgery
(neoadjuvant radiation) to shrink a tumor so that it's more easily
removed. Radiation therapy can also be used after surgery (adjuvant
radiation) to kill any cancer cells that might remain in the area around
your esophagus or stomach.
• Chemotherapy
Chemotherapy can be given before surgery (neoadjuvant
chemotherapy) to help shrink a tumor so that it can be more easily
removed. Chemotherapy is also used after surgery (adjuvant
chemotherapy) to kill any cancer cells that might remain in the body.
Chemotherapy is often combined with radiation therapy.
Chemotherapy may be used alone in people with advanced stomach
cancer to help relieve signs and symptoms.
• Drugs
• Trastuzumab (Herceptin) for stomach cancer cells that produce too
much HER2
• Ramucirumab (Cyramza) for advanced stomach cancer that hasn't
responded to other treatments
• Imatinib (Gleevec) for a rare form of stomach cancer called
gastrointestinal stromal tumor
• Sunitinib (Sutent) for gastrointestinal stromal tumors
• Regorafenib (Stivarga) for gastrointestinal stromal tumors
• Lab tests
a complete blood count (CBC) to look for anemia (which could
be caused by the cancer bleeding into the stomach). A fecal occult
blood test may be done to look for blood in stool (feces) that isn’t visible
to the naked eye.
 Nursing Management
 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.
 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.
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.