GASTRIC CARCINOMA

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GASTRIC CARCINOMA
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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

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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

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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

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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

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Anatomy of the stomach
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location

• 37 in the proximal third of the stomach
• 30 in the distal stomach
• 20 in the midsection
• Remaining 13 in the entire stomach

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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

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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

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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

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Physical Assessment cont.

• Advanced stage
• Nausea/vomiting
• Obstructive symptoms
• Iron deficiency/anemia
• Palpable epigastric mass
• Enlarged lymph nodes
• Weakness/fatigue
• Progressive weight loss

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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

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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

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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

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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

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Surgical Interventions

• Surgery is the preferred method of treatment
• Curative
• Total gastrectomy
• Subtotal gastrectomy
• Palliative
• To relieve patients pain and ease their
  suffering

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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

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Gastric Carcinoma
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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.

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Grading Criteria

• Joint effort by Elaine M. Lund and Monique Kolin