Cancer stomach

RISK FACTORS
Stomach cancer has been associated with diets containing smoked foods, salted
fish and meat, and pickled vegetables.
• Whole grains and fresh fruits and vegetables are associated with reduced
rates of stomach cancer.
• Infection with H. pylori, especially at an early age, is a risk factor for
stomach cancer.
• It is possible that H. pylori and resulting cell changes can induce a
sequence of transitions from dysplasia to cancer.
• Individuals with lymphoma of the stomach (mucosa-associated lymphoid
tissue [MALT]) are at higher risk of stomach cancer.
• PREDISPOSING FACTORS
• Other predisposing factors include atrophic gastritis, pernicious anemia,
adenomatous polyps, hyperplastic polyps, and achlorhydria.
• Smoking and obesity both increase the risk of stomach cancer. Although
first-degree relatives of patients with stomach cancer are at increased risk,
only 8% to 10% of stomach cancers have an inherited familial component.
Early Manifestations
• Typically, patient presents with same symptoms as gastric ulcer; later, on
evaluation, the lesion is found to be malignant.
• 1. Progressive loss of appetite.
• 2. Noticeable change in or appearance of GI symptoms—gastric fullness
(early satiety), dyspepsia lasting longer than 4 weeks.
• 3. Blood (usually occult) in the stools.
• 4. Vomiting.
• a. May indicate pyloric obstruction or cardiac–orifice obstruction.
• b. Occasionally, vomiting has a coffee-ground appearance because of
slow leaks of blood from ulceration of the cancer.
Later Manifestations
• 1. Pain, usually induced by eating and relieved by vomiting.
• 2. Weight loss, loss of strength, anemia, metastasis (usually to liver),
hemorrhage, obstruction.
• 3. Abdominal or epigastric mass.
 Management

• 1. The only successful treatment of gastric cancer is surgical removal. Gastric resection is surgical removal of
part of the stomach.

• 2. If tumor has spread beyond the area that can be excised surgically, cure is not possible.

• a. Palliative surgery, such as subtotal gastrectomy with or without gastroenterostomy, may be performed to
maintain continuity of the GI tract.
• b. Surgery may be combined with chemotherapy to provide palliation and prolong life.
Complications
• 1. If surgery is performed, possible risk of hemorrhage or infection.
• 2. Dumping syndrome following gastrectomy.
• 3. Metastasis and death.
Nursing Assessment
• 1. Assess for anorexia, weight loss, GI symptoms (gastric fullness,
dyspepsia, vomiting).
• 2. Evaluate for pain, noting characteristics/location.
• 3. Check stool for occult blood.
• 4. Monitor CBC to assess for anemia.
• After total gastrectomy, the NG tube does not drain a large quantity of
secretions because removal of the stomach has eliminated the reservoir
capacity.
• The NG tube is removed when intestinal peristalsis has resumed.
• Small amounts of clear fluid may then be started. Closely observe the
patient for signs of leakage of the fluids at the anastomosis site as
evidenced by an elevation in the temperature and increasing dyspnea.
• When the patient tolerates fluids without distress, fluid intake is increased
along with the addition of some solid foods.
 • As a consequence of a total gastrectomy, a patient experiences the
symptoms of dumping syndrome.
• Weight loss often occurs.
• Postoperative wound healing may be impaired because of poor nutritional
intake. This necessitates IV or oral replacement of vitamins C, D, and K; the
B-complex vitamins; and cobalamin. Because these vitamins (with the
exception of cobalamin) are normally absorbed in the duodenum, they
need to be replaced.
• Nursing DiagnosesPain related to disease process or surgery.
• Risk for Injury, shock and other complications related to surgery and
impaired gastric tissue function.
• Imbalanced Nutrition: Less Than Body Requirements related to malignancy
and treatment.
Promoting Comfort and Wound Healing
• 1. Turning, coughing, deep-breathing every 2 hours to prevent vascular
and pulmonary complications and promote comfort.
• 2. Institute NG suction, if ordered, to remove fluids and gas in the stomach
and prevent painful distention.
• 3. Administer parenteral antibiotics, as ordered, to prevent infection.
• 4. Administer analgesics, as ordered.
Preventing Shock and Other Complications
• 1. Shock and hemorrhage.
• a. Monitor changes in BP, pulse, and respiration.
• b. Observe the patient for evidence of changes in mental status, pallor,
clammy skin, dizziness.
• c. Check the dressings and suction canister frequently for evidence of
bleeding.
• d. Administer IV infusions and blood replacement, as prescribed.
• 2. Cardiopulmonary complications.
 • a. Encourage the patient to cough and take deep breaths to promote
ventilatory exchange and enhance circulation.
• b. Assist the patient to turn and move, thereby mobilizing secretions.
• c. Promote ambulation, as prescribed, to increase respiratory exchange.
• 3. Thrombosis and embolism.
• a. Initiate a plan of self-care activities to promote circulation.
• b. Encourage early ambulation to stimulate circulation.
• c. Prevent venous stasis by use of elastic stockings, if indicated.
• d. Check for tight dressings or binder that might restrict circulation.
4. Dumping syndrome
• A complex reaction that may occur because of excessively rapid emptying
of gastric contents.
• Manifestations include nausea, weakness, perspiration, palpitation, some
syncope, and possibly diarrhea. Instruct the patient as follows:
• a. Eat small, frequent meals rather than three large meals.
• b. Suggest a diet high in protein and fat and low in carbohydrates, and
avoid meals high in sugars, milk, chocolate, salt.
• c. Reduce fluids with meals, but take them between meals.
• d. Take anticholinergic medication before meals (if prescribed) to lessen GI
activity.
• e. Relax when eating; eat slowly and regularly.
• f. Take a rest after meals.
• Attaining Adequate Nutritional Status1. Administer parenteral nutrition, if
ordered.
• 2. Follow prescribed diet progressions.
• a. Give fluids by mouth when audible bowel signs are present.
• b. Increase fluids according to the patient’s tolerance.
• c. Offer a diet with vitamin supplements when the patient’s condition
permits.
• d. Avoid high-carbohydrate foods, such as milk, which may trigger
dumping syndrome.
• e. Offer diet, as prescribed—usually high in protein and calories to
promote wound healing.