Stomach Cancer

Anatomy and Physiology

 Anatomy and Physiology
• The stomach, stimulated by the vagus nerves is where protein
digestion begins. It is most dilated part of the alimentary tract,
situated between the oesphagus and duodenum and lying in the
epigastrium and left hypochondrium. It is roughly J-shaped, with
the upper opening at the level of the T9 vertebra and the lower
opening at the pylorus or gastroduodenal junction to the right of
the midline at the level of the L1 vertebra (transpyloric plane).
The stomach has three parts: the fundus (the part above the level
of entry of the oesophagus), the body (main part), and the
pyloric part (pyloric antrum, with the pyloric sphincter at the
junction with the duodenum)
 Pathophysiology
• Most gastric cancers are adenocarcinomas
and can occur in any portion of the stomach.
The tumor infiltrates the surrounding
mucosa. Penetrating the wall of the stomach
and adjacent organs and structures. The
liver, pancreas, esophagus, and duodenum
are often affected at the time of diagnosis.
Metastasis through lymph to the peritoneal
cavity occurs later in the disease.
 Assessment
• The nurse elicits a dietary history from the patient,
focusing on recent nutritional intake and status. Has
the patient lost weight? If so, how much and over what
period of time? Can the patient tolerate a full diet. If
not, what foods can he or she eat? What other changes
in eating habits have occurred. Is there a history of
infection with H. pylori bacteria? Other health
information to obtain includes the patient’s smoking
and alcohol history and the family history (any first or
second degree relatives with gastric or other cancer). A
psychosocial assessment, including questions about
social support, individual and family coping skills, and
financial resources, will help the nurse plan for care in
acute and community settings. After the interview, the
nurse performs a complete physical examination,
 Sign and Symptoms
 Anorexia
 Dyspepsia (Indigestion)
 Weight loss
 Abdominal Pain
 Constipation
 Anemia
 Nausea and Vomiting
 Nursing Diagnosis
 Anxiety related to the disease and anticipated
treatment
 Imbalanced nutrition, less than body
requirements, related to anorexia
 Pain related to tumor mass
 Anticipatory grieving related to the diagnosis of
cancer
 Deficient knowledge regarding self-care
activities
 Imaging Studies
 Endoscopy for biopsy and cystologic washings is
the usual diagnostic study
 Barium x-ray examination of the upper GI tract may
also be performed.
 CT Scan, Bone scan, and Liver scan are valuable in
determining the extent of metastasis.
 Complete X-Ray Examination
 Lab Test
 Fecal Occult Blood Test is used to detect microscopic blood in the
stool, which may indicate stomach or other gastrointestinal (GI)
cancers
 Complete Blood Count (CBC) is a simple blood test used to measure
the concentration of white blood cells, red blood cells, and platelets.
 In an upper GI series, or Barium Swallow, the patient drinks a thick,
chalky liquid that coats the esophagus and stomach and makes it
easier to detect abnormal areas on r-ray. In Double-Contrast Barium
Swallow, air is blown into the esophagus and stomach to help the
liquid coat the wall of the organs more thoroughly.
Pictures
 Planning
 Reduced anxiety
 Optimal nutrition
 Relief pain
 Anticipated lifestyles changes
 Nursing Intervention
 The nurse encourages the family in their efforts to support the patient, offering
reassurance and supporting positive coping measures.
 The nurse advises the patient about any procedures and treatment so that the
patient knows what to expect.
 The nurse encourages the patient to eat small, frequent portions of
nonirritating foods to decrease gastric irritation.
 The nurse monitors the IV therapy and nutritional status and records intake,
output, and daily weights to ensure that the patient is maintaining or gaining
weight.
 The nurse works with patient to manage pain by suggesting non
pharmacologic methods for pain relief, such as position changes, imagery,
distraction, relaxation exercises, backrubs, massage and periods of rest and
relaxation.
 The nurse explain manage pain, nausea, vomiting or other symptoms.
 Self care activities will depend on the mode of treatment used surgery,
chemotherapy, radiation, or palliative care.
 The nurse also teaches the patient or caregiver to recognize and report signs
and symptoms of complications that require medical attention, such as
bleeding, obstruction, perforation, or any symptoms that become progressively
 Evaluation
 Reports less anxiety
a. Expresses fears and concerns about surgery
b. Seeks emotional supports
 Attains optimal nutrition
a. Eats small, frequent meals high in calories, iron, and vitamins A
and C
b. Complies with enteral or parenteral nutrition as needed
 Has less pain
 Performs self-care activities and adjusts to lifestyle changes
a. Resumes normal activities within 3 months
b. Alternates periods of rest and activity
c. Manages tube feedings
Thank You!!!