Professional Documents
Culture Documents
Gastric cancer
No one knows why some people develop stomach cancer and others don’t. The number of people
affected varies widely between different countries. For example, stomach cancer is far more common
in Japan than in the UK. There is also evidence that people from poorer backgrounds are at increased
risk.
There are a many other factors that increase the risk of developing stomach cancer.
Age. Stomach cancer is most common around the age of 60. It’s rare under the age of 40.
Gender. Men are around twice as likely to develop stomach cancer as women.
Helicobacter pylori infection. These bacteria live in the stomach lining of many people, and
don’t usually cause any symptoms. However, the infection sometimes causes inflammation
of the stomach lining (gastritis), indigestion and stomach ulcers. It is known to increase the
risk of stomach cancer.
Diet. A diet high in salt and foods that are smoked or cured may increase the risk of stomach
cancer. In particular, certain food preservative chemicals known as nitrosamines, which are
found cured meats such as bacon and ham, may increase your chance of developing stomach
cancer.
Family history. Some people inherit an increased risk of developing stomach cancer.
Type A blood group. Some research indicates that people who have type A blood are at
higher risk of developing stomach cancer.
Smoking. When you smoke, you swallow small amounts of tobacco smoke, which increases
your risk of getting stomach cancer.
Atrophic gastritis. This condition causes the lining of the stomach to waste away. It has also
been linked with an increased risk of stomach cancer.
Pernicious anaemia. This is type of anaemia raises your risk of stomach cancer.
Assessment
1. Most often, the patient presents with the same symptoms as gastric ulcer. Later, evaluation
shows the lesion to be malignant.
2. Gastric fullness (early satiety), dyspepsia lasting more than 4 weeks, progressive loss of
appetite are initial symptoms.
3. Stool samples are positive for occult blood.
4. Vomiting may occur and may have coffee-ground appearance.
5. Later manifestations include pain in black or epigastric area (often induced by eating,
relieved by antacids or vomiting); weight loss; hemorrhage; gastric obstruction.
Diagnostic Evaluation
1. Upper GI X-ray with contrast media may initially show suspicious ulceration that requires
further evaluation.
2. Endoscopy with biopsy and cytology confirms malignant disease.
3. Imaging studies (bone scan, liver scan, CT scan) helps determining metastasis.
4. Complete blood count (CBC) may indicate anemia from blood loss.
The only successful treatment of gastric cancer is gastric resection, surgical removal of part
of the stomach with involved lymph nodes; postoperative staging is done and further
treatment may be necessary.
Surgical options include proximal or distal subtotal gastric resection; total gastrectomy
(includes adjacent organs such as tail of pancreas, portion of liver, duodenum); or palliative
surgery such as subtotal gastrectomy with gastroenterostomy to maintain continuity of the
GI tract.
Surgery may be combined with chemotherapy to provide palliation and prolong life.
Pharmacologic Intervention
Chemotherapeutic agents used as adjuvant (in addition to) or neoadjuvant (before surgery)
often in combination: fluorouracil, doxorubicin, methyl-CCNU, cisplatin, methotrexate,
etoposide to treat cancer that has metastasized to organs beyond stomach; shrink tumors
before surgery.
B vitamin complex tablet Combat vitamin B12deficiency and megaloblastic anemia from lack
of intrinsic factor
Narcotic analgesics manage pain, side effects of treatment drugs such as morphine,
meperidine which increase patient comfort during end-stage disease
Other Medications: Antiemetics may be used to control nausea, which increases as the
tumor enlarges. In the advanced stages, the physician may prescribe sedatives, narcotics,
and tranquilizers to increase the patient’s comfort. Antispasmodics and antacids may also
help relieve GI discomfort.
Nursing Intervention
Documentation Guidelines
Teach the patient the importance of compliance with palliative and follow-up care. Be sure
the patient understands all medications, including the dosage, route, action, and adverse
effects.
Teach the patient the signs and symptoms of infection and how to care for the incision.
Instruct the patient to notify the physician if signs of infection occur.
Encourage the patient to seek psychosocial support through local support groups (e.g.,I Can
Cope),clergy,or counseling services. If appropriate,suggest hospice services.
Teach the patient methods to enhance nutritional intake to maintain ideal body weight.
Several small meals a day may be tolerated better than three meals a day. Take liquid
supplements and vitamins as prescribed. Refer the patient to the dietitian for a consultation.
Teach family members and friends prevention strategies. Strategies include increasing the
intake of fresh fruits and vegetables that are high in vitamin C; maintaining adequate protein
intake; and decreasing intake of salty, starchy, smoked, and nitrite- preserved foods.