STOMACH CANCER P 998 1001 Definition Adrenocarcinoma of the stomach wall Asian Americans Pacific Islanders Hispanics and African Americans with higher rates of stomach cancer than whites More prevalent in lower socioeconomic class urban Incidence increases with age with majority over 65 STOMACH CANCER 1 P a g e Etiology and Pathophysiology No single causative agent identified Begins with infection h pylori repeated exposure to irritants such as o o o o o o Bile Inflammatory agents Tobacco use Smoked foods Salted fish and meat Pickled veggies Associated with diets containing Lower rates associated with diets containing o whole grain fresh fruits o Other predisposing factors Atrophic gastritis Pernicious anemia Adenomatous polyps o o o o Gastropathy o Gastrectomy for PUD Clinical Manifestations Lifestyle Factors o High alcohol intake o Coffee o o o Stress and depression Smoking Infection with herpes and CMV Gastric Ulcers Less common than duodenal ulcers o o Duodenal ulcers 80 of all peptic ulcers Back diffusion of HCl acid into gastric mucosa cellular destruction and inflammation H pylori o o Leads to intestinal metaplasia in stomach chronic gastritis tissue damage PUD Produces urease release of inflammatory cytokines Medication Induced Injury o Ulcerogenic drugs aspirin NSAID s inhibit prostaglandin synthesis and increases gastric secretion o Corticosteroids affect mucosal cell renewal and decreases protective effects o o SSRI s Anticoagulants STOMACH CANCER 2 P a g e o Incidence highest between 35 45 Clinical Manifestations Unexplained weight loss Lack of appetite Ingestion Abdominal discomfort or pain Anemia Pale and weak Fatigue o o o Weakness o Dizziness o Shortness of breath Stool positive for occult blood Mass felt on epigastrium Diagnostic Studies Upper endoscopic exam Biopsy Upper GI barium gastric emptying Endoscopic ultrasound CT and PET scanning Laparoscopy Blood chemistry studies to detect anemia o CBC o o Liver enzymes Serum amylase levels Stool exam Collaborative Care Surgical removal of tumor Correction of nutritional deficits and treatment of anemia Transfusions of packed RBC s Gastric decompression to resolve gastric outlet obstruction Surgical Therapy Same as PUD Remove much of stomach possible to remove tumor and a margin of normal tissue Adjuvant Therapy Surgical resection followed by fluorouracil Radiotherapy Combo chemotherapeutic agents Nursing Management Assessment Similar to PUD Nutritional assessment Appetite changes o o Changes in eating pattern over 6 months o Weight changes such as unexplained weight loss o Dyspepsia Psychosocial history Personal perception of health problem o o Method of coping o Support patient and family Patient perceptions of health problems Need for care STOMACH CANCER 3 P a g e Physical exam Subjective Data PMH chronic kidney disease pancreatic disease chronic obstructive pulmonary disease serious illness or trauma cirrhosis of liver Medications aspirin corticosteroids NSAID s Surgery or other treatments complicated or prolonged surgery Health perception chronic alcohol abuse smoking caffeine use family history of PUD Nutrition weight loss anorexia N V hematemesis dyspepsia heartburn belching Elimination black tarry stools Cognitive perceptual duodenal ulcers gastric ulcers Coping acute and chronic stress Objective Data General anxiety irritability GI epigastric tenderness Diagnostics guaiac positive stools positive blood urine breath or stool test h pylori abnormal GI endoscopic and barium studies Nursing Diagnosis Imbalanced nutrition less than body requirements Activity intolerance r t generalized weakness ab discomfort nutritional deficits Anxiety r t lack of knowledge of diagnostic tests unknown diagnostic outcome disease process therapeutic regimen Acute pain r t underlying disease process and SE of surgery chemotherapy or radiation therapy Grieving r t perceived unfavorable diagnosis and impending death Nursing Implementation Health Promotion Identify patient at risk due to o H pylori infection Pernicious anemia o Achlorhydria o Be aware of symptoms associated with stomach cancer Poor appetite o o Weight loss o o Fatigue Persistent stomach distress Encourage patients with family history Emotional and physical support Provide information Clarify test results Preoperative Care Maintain positive attitude with respect Make sure instructions are clear on what to expect after surgery including comfort measures pain relief coughing beathing use of Assist with meals and encourage intake Blood replacement and fluid volume restoration Clarify and interpret questions NG tube and IV administration Postoperative Care Insertion of chest tubes NG tube to decompress stomach and decrease pressure o Observe gastric aspirate for color amount and odor o 24 hours usually bright red at first gradual darkening STOMACH CANCER 4 P a g e 36 to 48 hours yellow green color o o Clogged gentle irrigations with normal saline o Ensure that NG suction is working and tube remains patent Clog can lead to anastomosis distention of remaining portion of stomach leading to rupture of sutures leakage of gastric contents into peritoneal cavity hemorrhage possible abscess formation Observe for signs of decreased peristalsis o o Abdominal distention Lower abdominal discomfort Monitor and record accurate I O every 4 hours Administer pain meds and frequent changes in position Splint incision area with pillow to prevent rupture and respiratory complications Observe dressing for drainage and odor for infection Encourage early ambulation IV therapy o Add potassium and vitamin supplements C D K and B complex vitamins cobolamin Aspirate stomach within 1 2 hours of feeds to assess amount remaining and color and consistency Adequate rest adequate nutrition adherence to prescribed therapy avoid irritants and stressors