STOMACH

CANCER

MS. SAYALI S. SHETE

CLINICAL INSTRUCTOR
BVCON
 THE STOMACH
Hollow organ in the upper abdomen, under
the ribs
5 layers:
◦ Inner layer – where most stomach cancer begins
◦ Submucosa – support tissue for the inner layer
◦ Muscle layer – create a rippling motion that
mixes and mashes food
◦ Subserosa – support tissue for the outer layer
◦ Outer layer (serosa) – covers the stomach and
hold it in place
 STOMACH CANCER
• Gastric cancer was once the second most common cancer in
the world.
• In most developed countries, however, rates of stomach
cancer have declined dramatically over the past half
century.
• Men have a higher incidence of gastric cancer than women.
• Most of these deaths Tumors in the stomach can be benign
or malignant.
• Gastric cancer is a disease in which tumors are found in the
stomach.
• Stomach cancer is common throughout the world and affect
occur in people older than 40 years of age.
If it is not diagnosed it may spread to other parts of your
stomach as well to other organs.
There are twice as many males with this disease than
females. Stomach cancer usually begins in cells in the inner
layer of the stomach.
 Over time, the cancer may invade more deeply into the
stomach wall.
A stomach tumor can grow through the stomach's outer
layer into nearby organs, such as the liver, pancreas,
esophagus, or intestine.
 Risk Factors
Exact causes unknown
Diet – diet high in foods that are smoked, salted or pickled
Helicobacter pylori infection – raises risk of stomach
inflammation and stomach ulcers
Long term inflammation of stomach
Smoking- heavy smokers are at more risk
Certain health problems: stomach surgery, chronic gastritis,
pernicious anemia.
Family history – rare type of stomach cancer runs in some
families
Lack of physical activity
 Stages of Stomach Cancer

• Stage 0 – cancer found only in the inner layer of

the stomach
• Stage 1
• Tumor invaded the muscle layer or the sub-serosa
• Cancer cells have not spread to lymph nodes or other
organs
Stages of Stomach Cancer

• Stage II
• Tumor has invaded the muscle layer or
subserosa
• Tumor has penetrated outer layer of the
stomach
• Cancer cells have not spread to lymph nodes
or other organs
Stages of Stomach Cancer

• Stage III
• Tumor has penetrated the outer layer
• Tumor has invaded nearby organs, such as the
liver or spleen
• Cancer cells have not spread to lymph nodes or
distant organs
Stages of Stomach Cancer

• Stage IV
• Tumor has invaded nearby organs and at least
1 lymph node
• Cancer cells have spread to distant organs
 PATHOPHYSIOLOGY
Most gastric cancer is adenocarcinomas and
occur in a portion of stomach

The tumor infiltrate the surrounding mucosa

Penetrating the wall of the stomach and

adjacent organs and structures

Liver, pancrease, esophagus and duodenum are

often affected
 SYMPTOMS
Stage I ( EARLY)
•INDIGESTION OR BURNING SENSATION
•LOSS OF APPETITE
•ABDOMINAL DISCOMFORT OR IRRITATION

STAGE II( MODERATE)

•WEAKNESS AND FATIGUE
•BLOATING OF THE STOMACH, USUALLY AFTER MEAL
STAGE III(LATE)
•ABDOMINAL PAIN IN UPPER ABDOMEN
•DIARRHEA OR CONSTIPATION
•WEIGHT LOSS
•BLEEDING( VOMITING BLOOD)
•DYSPHAGIA
 Diagnosis
• Personal and family health history
• Physical exam – checks abdomen for fluid, swelling
or other changes
• Upper GI series – x-rays of esophagus and stomach
• Endoscopy – use of a thin, lighted tube
(endoscope) to look into the stomach
• Biopsy – checks tissue sample under a microscope
for cancer cells
 Other Tests

Blood tests – CBC to check for anemia and how the liver
is working
Chest x-ray – checks for tumors in the lungs
CT scan – detailed pictures of the organs
Endoscopic ultrasound
Laparoscopy – small incisions in the abdomen. The
surgeon may remove lymph nodes or take tissue samples
for biopsy.
 MANAGEMENT OF STOMACH
CANCER
• CHEMOTHERAPY
• RADIATION THERAPY
 SURGICAL MANAGEMENT

• Surgery is the most common treatment.

• The surgeon removes part as well as the
surrounding lymph nodes, with the basic
goal of removing all cancer and a margin of
normal tissue.
Endoscopic mucosal resection

• Endoscopic mucosal resection is a treatment for early

gastric cancer (tumor only involves (mucosa), is removed
from the wall of the stomach using an electrical wire loop
through the e mucosa.
• In this procedure, the tumor, together with the inner
lining of stomach the endoscope.
• The advantage is that it is a much smaller operation than
removing the stomach.
 Endoscopic Submucosal
Dissection
• Endoscopic submucosal dissection is a similar
technique used to resect a large area of mucosa in
one piece.
• If the pathologic examination of the resected
specimen shows Incomplete resection
Gastric Bypass Procedures

• In this, the stomach is divided into a small

upper pouch and a much larger lower
"remnant" pouch and then rearranges the
small intestine to connect stomach joins
food pipe (esophagus) may need part of
food pipe removed as well.
Complications of Abdominal
Surgery

• Infection: Infection of the incisions or of

the inside of the abdomen (peritonitis,
abscess) may occur due to release of
bacteria from the bowel during the
operation.
• Venous thromboembolism: Any injury,
such as a surgical operation, causes the
body to increase the coagulation of the
blood.
• Hemorrhage: Many blood vessels must be cut in order to
divide the stomach and to move the bowel.
• Any of these may later begin bleeding, either into the
abdomen (intra-abdominal hemorrhage), or into the
bowel itself (gastrointestinal hemorrhage).
• Hernia: A hernia is an abnormal opening, either within
the abdomen or through the abdominal wall muscles.
• An internal hernia may result from surgery and
rearrangement of the bowel, and is a cause of bowel
obstruction.
• Bowel obstruction: Abdominal surgery always results in
some scarring of the bowel, called adhesions.
Stomach Cancer Prevention

• Gastric cancer can sometimes be associated with

known risk factors for the disease. Many risk factors
are modifiable though not all can be avoided.
Diet and lifestyle

• Excessive salt intake has been identified as a

possible risk factor for gastric cancer.
• Having a high intake of fresh fruits and
vegetables may be associated with a decreased
risk of gastric cancer.
• Studies have suggested that eating foods that
contain beta- carotene and vitamin C may
decrease the risk of gastric cancer, especially if
the intake of micronutrients is inadequate.
 Pre-existing conditions

• Infection with a certain bacteria, H. pylori,

is associated with development of an
abnormal cellular lining are also associated
with an increased risk of an increased risk of
gastric cancer.
 NURSING MANAGEMENT
Discuss situation and provide information about all
procedures and treatment.
Help client talk about feelings or concerns about
illness.
Discuss current and planned treatment measures.
Stress the importance of completing the prescribed
treatments.
Discuss stress reduction techniques and refer for stress
reduction counseling or workshops as indicated.
Help arrange meeting with social worker, counselor or
member of the clergy if needed.
 NURSING ASSESSMENT
• Careful selection of the varying therapeutic
modalities is essential.
• Such selection should consider not only the nature
of the symptoms to be relieved but also the general
medical and psychological status of the patient.
• Decisions should be taken in the context of the
predicted prognosis and the effect of any treatment
intervention on quality of life.
 NURSING DIAGNOSIS

Preoperative
•Acute pain related to the growth of cancer cells
•Anxiety related to plan surgery
•Imbalanced nutrition less than body
requirements related to nausea, vomiting, and no
appetite
•Activity intolerance related to physical
weakness.
Postoperative
• Ineffective breathing pattern related to the influence of
anesthesia
•Acute pains related to interruption of the body secondary to
invasive procedures or surgical intervention.
• Imbalanced nutrition less than body requirements related to
fasting status
•Risk for infection related to an increased susceptibility
secondary to the procedure.
 INTERVENTION
• Encouraging the patient to eat small and frequent portions
of nonirritating foods to decrease gastric irritation.
• Food supplements should be high in calories as well as
vitamin A and C and iron to enhance tissue repair.
• The nurse administers analgesic as prescribed.
• A continuous infusion of an opioid may be necessary for
severe pain.
• The nurse helps the patient express fears, concern grief and
diagnosis.
• Encouraging the patient to participate in treatment
decisions.