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

 Early stages: symptoms may be absent or may resemble those of the patient
with benign ulcers (eg, pain relieved with antacids)
 Progressive disease: symptoms include:
• Indigestion
• Anorexia
• Dyspepsia
• Weight loss
• Abdominal pain
• Constipation
• Anemia
• Nausea and vomiting
• Ascites

Diagnostic Methods

 Radiography of the upper gastrointestinal system with barium.

 Endoscopy for biopsy and cytologic washings.
  CT scan, bone scan and liver scan to determine extent of metastasis.
 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

 Removal of gastric carcinoma; curative if tumor can be removed while still

localized to the stomach.
 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
 Chemotherapy
 Radiation therapy

Nursing Interventions

Reducing anxiety
 Provide relaxed, nonthreatening atmosphere
 Advise about any procedure and treatment
 Suggest patient to discuss feelings

Promoting optimal nutrition

 Encourage small, frequent feedings of non irritating foods to decrease gastric
irritation
 Ensure that food supplements are high in calories and vitamins A and C and iron.
 Administer parenteral vitamin B12 indefinitely if total gastrectomy is performed
 Monitor rate and frequency of IV
 Record intake and output, amd daily weights
 Administer antiemetics as prescribed

Relieving pain
 Administer analgesics as prescribed
 Assess frequency, intensity and duration of pain to determine effectiveness of
analgesic agent
 Suggest non pharmacologic methods for pain relief (eg imagery, distraction,
relaxation tapes, back rubs and massage)
 Encourage periods of rest and relaxation.

 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:
 Hepatocellular carcinoma (HCC) is by far the most common type of
primary liver cancer.
 Cholangiocellular carcinoma
 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
 Intravenous injection of antibodies that specifically attack tumor-associated
antigens
 Percutaneous placement of high-intensity source for interstitial radiation therapy

Chemotherapy
 Systemic chemotherapy and regional infusion are used to administer
antineoplastic agents
 An implantable pump is used to deliver high-concentration chemotherapy to the
liver through hepatic artery

Percutaneous Biliary Drainage

 Use to bypass biliary ducts obstructed by the liver, pancreatic or bile ducts in
patients with inoperable tumors
 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
 Removal of the lobe of the liver
 Thoracoabdominal incision is used

Liver Transplantation
 Removal of the liver and replacement with healthy donor
 Patient with small tumor have good prognosis

Nursing Management
 Assess problems related to cardiopulmonary involvement, vascular complications
and respiratory and liver dysfunction
 Give careful attention to metabolic abnormalities
 Encourage early ambulation
 Teach patients about signs of complications
 Teach irrigation technique to avoid introducing bacteria
Selected Cancers

leukemia

breast

oropharyngeal/ laryngeal

bronchi/ lungs

stomach

liver

prostate

colorectal

kidneys/ urinary bladder