GASTRIC CANCER

GASTRIC CANCER

• is cancer that starts when cancerous cells

form in the inner lining of the stomach.
• It is also known as stomach cancer.
• Most of these deaths occur in people older
than 40 years of age, but they occasionally
occur in younger people.
• Men have a higher incidence of gastric
cancers than women do.
 CLASSIFICATION OF STOMACH
CANCER

• According to the location of stomach cancer:

 gastric cardia cancer
 gastric cancer
 gastric antrum cancer
 ACCORDING TO PATHOLOGICAL
CLASSIFICATION

• early gastric cancer

• advanced gastric cancer
 STAGES OF STOMACH
CANCER

• Stage I
• Stage II
• Stage III
• Stage IIII
• Stage I
 At this stage, the tumor is limited to the top layer of tissue that
lines the inside of the esophagus or stomach. Cancer cells also
may have spread to a limited number of nearby lymph nodes.
• Stage II
 The cancer at this stage has spread deeper, growing into a
deeper muscle layer of the esophagus or stomach wall. Cancer
may also have spread to more of the lymph nodes.
• Stage III
 At this stage, the cancer may have grown through all
the layers of the esophagus or stomach and spread to
nearby structures. Or it may be a smaller cancer that
has spread more extensively to the lymph nodes.
• Stage IV
 This stage indicates that the cancer has spread to
distant areas of the body.
 PATHOPHYSIOLOGY

GASTRIC MUCOSA

Superficial gastritis

Chronic inflamation

Atropic gastritis
Intestinal metaplasia

Dysplasia

Gastric cancer
 SIGNS AND SYMPTOMS OF GASTRIC
CANCER

• Feeling bloated after a meal

• Indigestion that is unrelenting
• severeSlight nausea
• Loss of appetite
• Persistent vomiting
• Heartburn
 DIAGNOSTIC EXAM
• Biopsy: This involves cutting a small piece of
tissue from the stomach for inspection to detect any
cancer cells.
• CT scan: This is a powerful X-ray that outlines the
inside body parts in a picture format.
• Blood tests: It is performed to establish any signs
of cancer in the body.
• Upper GI series test: This is a chalky liquid with
barium and taken before the X-ray scan to help to
optimize the results of the picture.
• Upper endoscopy: In this process, the doctor inserts a
thin flexible tube fitted with a small camera down your
throat for scanning.
 TREATMENT FOR STOMACH
CANCER
• Surgical resection:
 It is only suggested for early stage stomach cancer
patients.
 vagotomy and pyloroplasty (disconnecting nerves that
stimulate acid secretion and opening the pylorus).
 a partial gastrectomy, and a total gastrectomy (removal
of the stomach).
• Radiation and Chemotherapy:
 Chemotherapy kills normal cells while killing cancer
cells, resulting in damage to the immune system, and
has toxic side effects such as: hair loss, vomiting, etc.
 It is not suitable for advanced stomach cancer patients.
 NEW TREATMENT OPTIONS FOR
STOMACH CANCER PATIENTS

• Minimally Invasive Technology

 interventional therapy
 photodynamic therapy
 natural therapy
 gene-targeted therapy
• Interventional Therapy:
 With a 1-2 millimeter incision, anti-cancer
drugs are directly given to the tumor, causing
fewer side effects and drug concentration is 2-
8 times higher than systemic chemotherapy,
killing cancer cells more accurately.
• Photodynamic therapy:
 When photosensitizer is exposed to a specific
wavelength of light, they produce a form of
oxygen that kills nearby cells.
 It functions quickly (in 48 to 72 hours) with less
pain, lower recurrence rate, and is suitable for
weak or advanced patients.
• Gene Targeted Therapy:
 Killing cancer cells from their roots, gene-
targeted therapy is the most radical anticancer
treatment. Compared with traditional
therapies, gene-targeted therapy is more
accurate, more effective and safer.
• Green Chemotherapy:
 Improved from traditional chemotherapy,
green chemotherapy, avoiding the
disadvantage of systematic chemotherapy,
greatly improving curative effect and reducing
toxic side effects, is a new generation of
chemical weapons that kills tumors.
 NURSING DIAGNOSIS
• Based on the assessment data:
 Anxiety related to the disease and anticipated
treatment
 Imbalanced nutrition, less than body requirements,
related to anorexia
 Pain related to tumor mass
 Anticipatory grieving related to the diagnosis of cancer
 Deficient knowledge regarding self-care activities
 NURSING INTERVENTIONS
 

• reducing anxiety
• promoting optimal nutrition
• relieving pain
• providing psychosocial support
• promoting home and community-based care
 REDUCING ANXIETY
• A relaxed, nonthreatening atmosphere is
provided so that patient can express fears,
concerns, and possibly anger about the
diagnosis and prognosis.
• The nurse advises the patient about any
procedures and treatments so that the patient
knows what to expect
 PROMOTING OPTIMAL
NUTRITION
• The nurse encourages the patient to eat small,
frequent portions of nonirritating foods to
decrease gastric irritation.
• Food supplements should be high in calories,
as well as vitamins A and C and iron, to
enhance tissue repair.
 RELIEVING PAIN
• The nurse administers analgesics as prescribed. A
continuous in-fusion of an opioid may be necessary for
severe pain.
• The nurse assesses the frequency, intensity, and
duration of the pain to de-termine the effectiveness of
the analgesic being administered.
• The nurse works with the patient to manage pain by
suggesting non-pharmacologic methods for pain relief,
such as position changes, imagery, distraction,
relaxation exercises (using relaxation audio tapes),
backrubs, massage, and periods of rest and relaxation.
 PROVIDING PSYCHOSOCIAL
SUPPORT
• The nurse helps the patient express fears,
concerns, and grief about the diagnosis. It is
important to answer the patient’s questions
honestly and to encourage the patient to
participate in treatment decisions.
• The nurse offers emotional support and
involves family members and significant others
whenever possible.
 PROMOTING HOME AND
COMMUNITY-BASED CARE 

• Teaching Patients Self-Care

 Self-care activities will depend on the mode of
treatment used surgery, chemotherapy, radiation, or
palliative care.
 Patient and family teaching will include information
about diet and nutrition, treatment regimens, activity
and lifestyle changes, pain management, and
possible complications
• Continuing Care
 The need for ongoing care in the home will depend
on the patient’s condition and treatment.
 The home care nurse reinforces nutritional
counseling and supervises the administration of any
enteralor parenteral feedings; the patient or family
member must become skillful in administering the
feedings and in detecting and pre-venting untoward
effects or complications related to the feedings
PANCREATIC CANCER
 PANCREATIC CANCER
• This is a type of cancer that occurs in the pancreas.
The pancreas is a glandular organ in the digestive
system that is located behind the stomach. The
pancreas produces hormones and digestive
enzymes.
• In the Philippines, however, it does not even figure
among the Top 10, and merely occupies the 14th
spot.
• The probable annual death rate of pancreatic cancer
for Filipinos is about 1,400, according to Dr Philip S.
Chua.
 TYPES OF PANCREATIC
CANCER

• Exocrine
• Endocrine
• Exocrine - occurs in the part of the pancreas that
produces digestive enzymes. Digestive enzymes help to
break down food so that it can be absorbed into the
body.
• Endocrine - occurs in the part of the pancreas that
produces hormones. Hormones such as insulin help
keep your blood sugar levels stable.
 SIGNS AND SYMPTOMS
• Pancreatic cancer is not easy to notice in the early
stages because it is mostly asymptomatic.
• Pain in the stomach area and back Jaundice
• Fever and chills
• Blood clots that form in a vein
• Unexplainable loss of weight.
 
 PATHOPHYSIOLOGY OF
PANCREATIC CANCER
• Typically, pancreatic cancer first metastasizes to regional lymph
nodes, then to the liver and, less commonly, to the lungs.
• It can also directly invade surrounding visceral organs such as
the duodenum, stomach, and colon, or it can metastasize to any
surface in the abdominal cavity via peritoneal spread. Ascites
may result, and this has an ominous prognosis.
• Pancreatic cancer may spread to the skin as painful nodular
metastases. Metastasis to bone is uncommon.
 DIAGNOSTIC EXAM
• Pancreatic ultrasound
• Imaging tests
• Endoscopic ultrasound (EUS)
• Removing a tissue sample for testing (biopsy)
• Blood test
 IMAGING TESTS

• Imaging tests that create pictures of your internal

organs. These tests help your doctors visualize your
internal organs, including the pancreas.
• Techniques used to diagnose pancreatic cancer
include ultrasound, computerized tomography (CT)
scans, magnetic resonance imaging (MRI) and,
sometimes, positron emission tomography (PET)
scans.
 ENDOSCOPIC ULTRASOUND
(EUS)
• An endoscopic ultrasound (EUS) uses an ultrasound
device to make images of your pancreas from inside
your abdomen.
• The device is passed through a thin, flexible tube
(endoscope) down your esophagus and into your
stomach in order to obtain the images.
 REMOVING A TISSUE SAMPLE
FOR TESTING (BIOPSY)
• A biopsy is a procedure to remove a small
sample of tissue for examination under a
microscope.
• Your doctor may obtain a sample of tissue
from the pancreas by inserting a needle
through your skin and into your pancreas (fine-
needle aspiration).
 BLOOD TEST
• Your doctor may test your blood for specific
proteins (tumor markers) shed by pancreatic
cancer cells.
• One tumor marker test used in pancreatic
cancer is called CA19-9.
 TREATMENT
• Surgery
• Radiation
• Chemotherapy
• Chemoradiation
 SURGERY
• Surgery for tumors in the pancreatic head. If your
cancer is located in the head of the pancreas, you
may consider an operation called a Whipple
procedure (pancreaticoduodenectomy).
• The Whipple procedure is technically difficult
operation to remove the head of the pancreas
• In such cases, a partial pancreatectomy (removal of
the tail and part of the body of the pancreas) is
performed.
 RADIATION THERAPY

• Radiation therapy
 uses high-energy beams, such as those made from X-
rays and protons, to destroy cancer cells.
 CHEMOTHERAPY

• Chemotherapy uses drugs to help kill cancer cells.

These drugs can be injected into a vein or taken orally.
You may receive one chemotherapy drug or a
combination of them.
• In people with advanced pancreatic cancer,
chemotherapy is often used to control cancer growth
and prolong survival.
 CHEMORADIATION
• typically used to treat cancer that has spread beyond the
pancreas, but only to nearby organs and not to distant
regions of the body.
• At specialized medical centers, this combination may be
used before surgery to help shrink the tumor. Sometimes
it is used after surgery to reduce the risk that pancreatic
cancer may recur.
 NURSING MANAGEMENT
• Pain management and attention to nutritional
requirements are important nursing measures to
improve the level of comfort.
• Skin care and nursing measures are directed toward
relief of pain and discomfort associated with jaundice,
anorexia, and profound weight loss.
 PROMOTING HOME AND
COMMUNITY-BASED CARE
 

• Teaching Patients Self-Care

 The specific patient and family teaching indicated varies
with the stage of disease and the treatment choices
made by the patient.
 The nurse instructs the family about changes in the
patient’s status that should be reported to the physician .
• Continuing Care
 A referral for home care is indicated to help the patient and
family deal with the physical problems and discomforts
associated with pancreatic cancer and the psychological impact
of the disease.
 The home care nurse assesses the patient’s physical status,
fluid and nutritional status, and skin integrity and the adequacy
of pain management.
 The nurse teaches the patient and family strategies to prevent
skin breakdown and relieve pain, pruritus, and anorexia.
Comparing yourself of what you have done, not
comparing it with others failure!...
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