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GASTRIC CARCINOMA

Explore the pathophysiology, etiology, anatomy, assessment, labs, interventions, and nursing care for gastric carcinoma. Learn about its onset, radiographic assessment, side effects of treatments, and surgical interventions.

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GASTRIC CARCINOMA

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  1. GASTRIC CARCINOMA

  2. Pathophysiology • Adenocarcinoma characterized as intestinal or diffuse • Spreads through stomach into the gastric wall to the • Lymph nodes • Liver • Pancreas • Transverse colon • Omentum • Peritoneum • Ovaries • Pelvic cul-de-sac • Through portal vein into lungs, liver, and bone • Advanced stage: stomach muscle

  3. Etiology • H. pylori: 80 percent of gastric carcinomas result from H. pylori due to the result of free radicals • Dietary nitrates (bacteria in stomach breaks down nitrites to compounds that are carcinogenic in animals) • Hypochlorhydria: occurs in gastric atrophy and promotes bacterial growth in stomach • Foods such as starch, pickled vegetables, salted fish and meat, smoked foods and salt • People who smoke cigarettes or use alcohol are 3-5 times more likely

  4. Etiology cont. • Epstein-Barr virus is now implicated as a cause • Pernicious anemia • Chronic atrophic gastritis • Gastric polyp • Achlorhydria • Barrett’s esophagus • Having had a Billroth 2 procedure • Genetic factors include: • First degree relatives • Type A blood

  5. Incidence/Prevalence • 3rd most common GI malignancy (after colorectal and pancreatic) • 14th cause of cancer related death in U.S. • 85-95% are caused by adenocarcinoma • 15% are caused by Non-Hodgkin’s lymphoma & leiomysosarcomas

  6. Anatomy of the stomach

  7. location • 37% in the proximal third of the stomach • 30% in the distal stomach • 20% in the midsection • Remaining 13% in the entire stomach

  8. Onset • Insidious (slowly developing) • Usually discovered in advanced stages • Men>Women • Occurs between the ages of 50-70 • Increased mortality in • Japanese • Costa Ricans • Chileans • Native Americans • African Americans • Scandinavians

  9. Assessment • History: • High risk foods • Alcohol/tobacco use • Treated for H. Pylori infection • Gastritis, pernicious anemia, gastric surgery, polyps • Immediate family dx gastric cancer • Blood type

  10. Physical Assessment • Early gastric cancer • Indigestion • Abdominal discomfort initially relieved with antacids • Feeling of fullness • Epigastric, back, or retrosternal pain • NOTE: most people will show no clinical manifestations

  11. Physical Assessment cont. • Advanced stage: • Nausea/vomiting • Obstructive symptoms • Iron deficiency/anemia • Palpable epigastric mass • Enlarged lymph nodes • Weakness/fatigue • Progressive weight loss

  12. Labs • Decreased hematocrit and hemoglobin • Macrocytic or microcytic anemia (decreased vit.B12 and iron absorption) • Stool positive for occult blood In Advanced stages: • Hypoalbuminemia • Bilirubin and alkaline phosphate will be abnormal • Increased level of carcinoembryonic antigen

  13. Radiographic assessment • Double contrast upper GI series • C.T. • Esophagogastroduodenoscopy (EGD) • Endoscopic ultrasound (EUS) • Other findings include • Polypoid mass • Ulcer crater • Thickened fibrotic gastric wall

  14. Interventions • Meds: chemotherapy • Fluruorouracil (5-FU) • Doxorubicin • Mitomycin-C • Cisplatin • Etopide (best results when used in combination with each other) Side Effects include nausea/vomiting and bone marrow suppression

  15. Interventions cont. • Radiation • Used most commonly for pre-op • Used in specific hospitals for intra-op • Does not increase survival after operations Side Effects include skin integrity, fatigue, anorexia, and diarrhea

  16. Surgical Interventions • Surgery is the preferred method of treatment • Curative: Total gastrectomy Subtotal gastrectomy • Palliative: To relieve patients pain and ease their suffering

  17. Nursing Interventions • Teach: • s/s of dumping syndrome • Eat small, frequent meals • No liquids with meals (one hour before or after) • Increase protein, fat, and caloric intake • Decrease carbohydrates • Increase Iron, Vit B12, and folate • Dressing changes • Side effects of chemo/radiation • Always provide emotional support

  18. Gastric Carcinoma

  19. Questions? • True or False: Lab findings have shown stool positive for occult blood, decreased hematocrit and hemoglobin, and hypoalbuminemia in patients with gastric carcinoma • True or False: Most people will show many signs and symptoms indicating gastric cancer • True or False: People who have had gastritis are at a higher risk of developing gastric ca.

  20. Grading Criteria • Joint effort by Elaine M. Lund and Monique Kolin

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