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GASTRIC CARCINOMA

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Usually discovered in advanced stages. Men Women. Occurs between the ages of 50-70 ... Macrocytic or microcytic anemia (decreased vit.B12 and iron absorption) ... – PowerPoint PPT presentation

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Title: GASTRIC CARCINOMA


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
  • Barretts 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-Hodgkins 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
  • MengtWomen
  • 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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