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GASTRIC CARCINOMA (PowerPoint)

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					GASTRIC CARCINOMA
                  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
                   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
                  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
       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
Anatomy of the stomach
                  location

•   37% in the proximal third of the stomach
•   30% in the distal stomach
•   20% in the midsection
•   Remaining 13% in the entire stomach
                            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
               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
        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
   Physical Assessment cont.
• Advanced stage:
  – Nausea/vomiting
  – Obstructive symptoms
  – Iron deficiency/anemia
  – Palpable epigastric mass
  – Enlarged lymph nodes
  – Weakness/fatigue
  – Progressive weight loss
                     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
      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
                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
          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
       Surgical Interventions
• Surgery is the preferred method of
  treatment
  – Curative:
            Total gastrectomy
            Subtotal gastrectomy
  – Palliative:
            To relieve patients pain and ease their
            suffering
          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
Gastric Carcinoma
                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.
           Grading Criteria
• Joint effort by Elaine M. Lund and
  Monique Kolin

				
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