Stomach Cancer (Gastric Cancer)

INTRODUCTION

 GASTRIC CANCER refers to malignant lesions found in the stomach.

 Stomach cancer usually develops in the mucus forming cells that line the stomach or the;
 ADENOCARCINOMA and accounts for around 90 – 95 % of all stomach cancers
 It is difficult to diagnose because most people typically don’t show symptoms in earlier
stage

INCIDENCE

 The incidence of gastric or stomach cancer continues to decrease in the US, it still
accounts for more than 11,000 deaths annually.
 The typical patient with gastric cancer is between 60s – 80 years old, but it can also occur
in people younger than 40 yrs old.
 Stomach cancer is twice as common in men as in women
 The fifth leading causes of cancer and the third leading cause of cancer – related death
across the globe.

ANATOMY & PHYSIOLOGY

The stomach has 5 parts:

 CARDIA – the first portion (closest to the esophagus

 FUNDUS – the upper part of the stomach next to the cardia.
 BODY (CORPUS) – the main part of the stomach, between the upper and lower parts.
 ANTRUM – the lower portion (near the intestine), where the food is mixed with gastric
juice.
 PYLORUS – the last part of the stomach, which acts as a valve to control emptying of the
stomach contents into the small intestine.

Stomach has five layers:

 MUCOSA
 SUB MUCOSA
 SMOOTH MUSCLE LAYER
 SUB SEROSA
 SEROSA

STAGES OF STOMACH CANCER

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

Stage 1

 Tumor invaded only the submucosa – cancer cells may be found in up to 6 lymph nodes
 Tumor invaded the muscle layer or the sub serosa
 Cancer cells have not spread to lymph nodes or other organs

Stage II

 Tumor has invaded only the submucosa – cancer cells have spread to 7-15 lymph nodes
 Tumor has invaded the muscle layer or sub serosa – cancer cells have spread to 1-6
lymph nodes
 Tumor has penetrated outer layer of the stomach
 Cancer cells have not spread to lymph nodes or other organs

Stage III

 Tumor has invaded the muscle layer or subserosa – 7-15 lymph nodes or
 Tumor has penetrated the outer layer – 1-15 lymph nodes
 Tumor has invaded nearby organs, such as the liver or spleen
 Cancer cells have not spread to lymph nodes or distant organs

Stage IV

 Cancer cells have spread to more than 15 lymph nodes or

 Tumor has invaded nearby organs and at least 1 lymph node
 Cancer cells have spread to distant organs
 Recurrent cancer
 Has come back
 May recur in the stomach or in another part

RISK FACTORS

 Exact causes unknown

 AGE – most are 72 or older
 SEX – men are most likely than women
 RACE – more common in Asian, Pacific Islander, Hispanic and African
  DIET – diet high in foods that are smoked, salted or pickled
 Helicobacter pylori Infection – raises risk of stomach inflammation and stomach ulcers
 Smoking – people who smoke is more at risk
 Certain health problems: stomach surgery, chronic gastritis, pernicious anemia
 Family History – rare type of stomach cancer runs in some families

CLINICAL MANIFESTATION

EARLY MANIFESTATION

- loss of appetite

- Vomiting & Nausea

- Upper Abdominal pain

- Heartburn

LATE MANIFESTATION

- Weight loss

- Anemia

- Blood usually occult in the stool

- Hemorrhage

- Difficulty swallowing

- Loss of strength

DIAGNOSIS

 Personal and Family history

 Physical Exam – checks abdomen for fluid, swelling or other changes
 Upper GI series – xrays of esophagus and stomach
 Endoscopy – use 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
 Laparoscopy – small incisions in the abdomen. The surgeon may remove lymph nodes or
take tissue samples for biopsy.

TREATMENT

 Local therapy – removes or destroys cancer in or near the stomach

 Surgery – either partial or total gastrectomy
 Radiation – uses high energy rays to kill cancer cells

 Systemic therapy – the drug enters the bloodstream and destroys or controls cancer
throughout the body
 Chemotherapy – uses anticancer drugs

Complementary and alternative medicine

(CAM)

 Acupuncture
 Massage therapy
 Herbal products
 Vitamins or special diets
 Visualization
 Meditation
 Spiritual healing

NURSING MANAGEMENT

ASSESSMENT

NURSING DIAGNOSIS

 Acute pain related to damage of mucosa layer of stomach

 Fluid volume deficit related to vomiting
 Imbalanced nutrition less than body requirement related to disease process
 Sleeping pattern disturbance related to pain
 Anxiety related to hospitalization
INTERVENTION (PREVENTION )
 Take an occasional aspirin
 Avoid smoking
 Avoid red meat
 Get enough calcium and Vitamin D
 Exercise
 Genetic counseling