Esophageal Cancer 1 P a g e ESOPHAGEAL CANCER P 977 979 Etiology and Pathophysiology Cause is unknown Important risk factors Barrett s metaplasia Smoking Excess alcohol intake o o o o Central obesity o Diet intake low in fruits and veggies o Exposure to asbestos and cement dust Most located in middle and lower proportions of the esophagus Malignant tumor appears as an ulcerated lesion Obstruction occurs in later stages Clinical Manifestations Onset of symptoms late Progressive dysphagia Dysphagia occurs only with meat soft foods and eventually liquids Hemorrhage if cancer erodes through the esophagus and into the aorta Esophageal perforation with fistula formation into the lung or trachea Complications Diagnostic Studies Endoscopy biopsy Barium swallow Capsule endoscopy CT and MRI Collaborative Care Depends on location of tumor Poor prognosis Surgical Therapy Endoscopic Procedures Photodynamic or laser therapy Radiation and Chemotherapy Administered for palliation of symptoms especially dysphagia Started before surgery is performed Restoration of swallowing function Maintenance of nutrition and hydration Nutritional Therapy Dilation or stent placement to relieve obstruction Parenteral fluids after surgery Jejunostomy feeding tube Swallowing study prior to fluids Water given hourly to small frequent bland meals Upright position Removal of part or all of the esophagus esophagectomy Resection of a portion of the esophagus and anastomosis of the remaining portion of the stomach esophahohastrostomy Resection of a portion of the esophagus and anastomosis of a segment of colon to the remaining portion esophagoenterostomy Esophageal Cancer 2 P a g e Observe for signs of intolerance Observe for leakage pain increased temperature dyspnea Gastronomy tube placed to feed patient Nursing Assessment Ask patient about history of GERD hiatal hernia achalasia or Barrett s esophagus Ask about tobacco and alcohol use Assess patient for progressive dysphagia Odynophagia burning squeezing pain while swallowing Ask patient types of substances that cause dysphagia meats foods liquids Assess for pain choking heartburn cough anorexia weight loss regurgitation Nursing Diagnoses Risk for aspiration r t impaired esophageal function Deficient fluid volume r t inadequate intake Chronic pain r t compression of tumor on surrounding tissues and stenosis Imbalanced nutrition less than body requirements r t dysphagia odynophagia weakness chemotherapy radiation therapy Ineffective health maintenance r t lack of knowledge of disease process and therapeutic regimen Anxiety r y diagnosis of cancer Grieving r t diagnosis of life threatening malignancies Nursing Implementation Health Promotion Maintain good oral hygiene Acute Intervention Preoperative Care IV lines Pain management o Chest tubes o o NG tubes o o Gastrostomy o o o Coughing o Deep breathing Jejunostomy feeds Turning Counsel patient with GERL Barrett s hiatal hernia regarding regular follow up evaluation General preoperative teaching and prep High calorie high protein diet IV fluid replacement I O to assess fluid and electrolyte balances Meticulous oral care cleanse mouth thoroughly including tongue gingivae and teeth Remove crust formation using milk of magnesia with mineral oil Education on Postoperative care NG tube bloody drainage 8 12 hours greenish yellow Assess drainage o o Maintain tube do not reposition the NG tube or reinsert it without surgeon consult o Oral and nasal care Turning and repositioning q2 hours Coughing and deep breathing q2 hours Incentive spirometry Patient in semi Fowler s to prevent reflux and aspiration of gastric secretions Esophageal Cancer 3 P a g e Ambulatory Home Care Long term follow up care after surgery Chemotherapy and radiation Maintain adequate nutrition Permanent feeding gastronomy
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