GASTRIC CARCINOMA Pathophysiology Adenocarcinoma characterized as intestinal or

Pathophysiology • Adenocarcinoma characterized as intestinal or diffuse • Spreads through stomach into the

Etiology • H. pylori: 80 percent of gastric carcinomas result from H. pylori due

Etiology cont. • • Epstein-Barr virus is now implicated as a cause Pernicious anemia

Incidence/Prevalence • 3 rd most common GI malignancy (after colorectal and pancreatic) • 14

location • • 37% in the proximal third of the stomach 30% in the

Onset • • • Insidious (slowly developing) Usually discovered in advanced stages Men>Women Occurs

Assessment • History: – High risk foods – Alcohol/tobacco use – Treated for H.

Physical Assessment • Early gastric cancer – Indigestion – Abdominal discomfort initially relieved with

Physical Assessment cont. • Advanced stage: – Nausea/vomiting – Obstructive symptoms – Iron deficiency/anemia

Labs • Decreased hematocrit and hemoglobin • Macrocytic or microcytic anemia (decreased vit. B

Radiographic assessment • • • Double contrast upper GI series C. T. Esophagogastroduodenoscopy (EGD)

Interventions • Meds: chemotherapy – Fluruorouracil (5 -FU) – Doxorubicin – Mitomycin-C – Cisplatin

Interventions cont. • Radiation – Used most commonly for pre-op – Used in specific

Surgical Interventions • Surgery is the preferred method of treatment – Curative: Total gastrectomy

Nursing Interventions • Teach: – – – – – s/s of dumping syndrome Eat

Questions? • True or False: Lab findings have shown stool positive for occult blood,

Grading Criteria • Joint effort by Elaine M. Lund and Monique Kolin

Slides: 20

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GASTRIC CARCINOMA

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

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

Etiology cont. • • Epstein-Barr virus is now implicated as a cause Pernicious anemia Chronic atrophic gastritis Gastric polyp Achlorhydria Barrett’s esophagus Having had a Billroth 2 procedure Genetic factors include: – First degree relatives – Type A blood

Incidence/Prevalence • 3 rd most common GI malignancy (after colorectal and pancreatic) • 14 th cause of cancer related death in U. S. • 85 -95% are caused by adenocarcinoma • 15% are caused by Non-Hodgkin’s lymphoma & leiomysosarcomas

Anatomy of the stomach

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

Onset • • • Insidious (slowly developing) Usually discovered in advanced stages Men>Women Occurs between the ages of 50 -70 Increased mortality in – – – Japanese Costa Ricans Chileans Native Americans African Americans Scandinavians

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

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

Physical Assessment cont. • Advanced stage: – Nausea/vomiting – Obstructive symptoms – Iron deficiency/anemia – Palpable epigastric mass – Enlarged lymph nodes – Weakness/fatigue – Progressive weight loss

Labs • Decreased hematocrit and hemoglobin • Macrocytic or microcytic anemia (decreased vit. B 12 and iron absorption) • Stool positive for occult blood In Advanced stages: • Hypoalbuminemia • Bilirubin and alkaline phosphate will be abnormal • Increased level of carcinoembryonic antigen

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

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

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

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

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 B 12, and folate Dressing changes Side effects of chemo/radiation Always provide emotional support

Gastric Carcinoma

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.

Grading Criteria • Joint effort by Elaine M. Lund and Monique Kolin