Stomach Cancer

Anatomy and Physiology

Anatomy and Physiology

• The stomach, stimulated by the vagus nerves is where protein digestion begins. It is most dilated part of the alimentary tract, situated between the oesphagus and duodenum and lying in the epigastrium and left hypochondrium. It is roughly J-shaped, with the upper opening at the level of the T9 vertebra and the lower opening at the pylorus or gastroduodenal junction to the right of the midline at the level of the L1 vertebra (transpyloric plane). The stomach has three parts: the fundus (the part above the level of entry of the oesophagus), the body (main part), and the pyloric part (pyloric antrum, with the pyloric sphincter at the junction with the duodenum)

Pathophysiology

• Most gastric cancers are adenocarcinomas and can occur in any portion of the stomach. The tumor infiltrates the surrounding mucosa. Penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus, and duodenum are often affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease.

Assessment

• The nurse elicits a dietary history from the patient, focusing on recent nutritional intake and status. Has the patient lost weight? If so, how much and over what period of time? Can the patient tolerate a full diet. If not, what foods can he or she eat? What other changes in eating habits have occurred. Is there a history of infection with H. pylori bacteria? Other health information to obtain includes the patient’s smoking and alcohol history and the family history (any first or second degree relatives with gastric or other cancer). A psychosocial assessment, including questions about social support, individual and family coping skills, and financial resources, will help the nurse plan for care in acute and community settings. After the interview, the nurse performs a complete physical examination, carefully assesses the patient’s abdomen for tenderness or masses, and also palpates and percusses to detect ascites.

Sign and Symptoms

AnorexiaDyspepsia (Indigestion)Weight lossAbdominal PainConstipationAnemiaNausea and Vomiting

Nursing Diagnosis

Anxiety related to the disease and anticipated treatment

Imbalanced nutrition, less than body requirements, related to anorexia

Pain related to tumor massAnticipatory grieving related to the diagnosis of

cancerDeficient knowledge regarding self-care

activities

Imaging Studies

Endoscopy for biopsy and cystologic washings is the usual diagnostic study

Barium x-ray examination of the upper GI tract may also be performed.

CT Scan, Bone scan, and Liver scan are valuable in determining the extent of metastasis.

Complete X-Ray Examination

Lab Test

Fecal Occult Blood Test is used to detect microscopic blood in the stool, which may indicate stomach or other gastrointestinal (GI) cancers

Complete Blood Count (CBC) is a simple blood test used to measure the concentration of white blood cells, red blood cells, and platelets.

In an upper GI series, or Barium Swallow, the patient drinks a thick, chalky liquid that coats the esophagus and stomach and makes it easier to detect abnormal areas on r-ray. In Double-Contrast Barium Swallow, air is blown into the esophagus and stomach to help the liquid coat the wall of the organs more thoroughly.

Pictures

Planning

Reduced anxiety Optimal nutrition Relief pain Anticipated lifestyles changes

Nursing Intervention

The nurse encourages the family in their efforts to support the patient, offering reassurance and supporting positive coping measures.

The nurse advises the patient about any procedures and treatment so that the patient knows what to expect.

The nurse encourages the patient to eat small, frequent portions of nonirritating foods to decrease gastric irritation.

The nurse monitors the IV therapy and nutritional status and records intake, output, and daily weights to ensure that the patient is maintaining or gaining weight.

The nurse works with patient to manage pain by suggesting non pharmacologic methods for pain relief, such as position changes, imagery, distraction, relaxation exercises, backrubs, massage and periods of rest and relaxation.

The nurse explain manage pain, nausea, vomiting or other symptoms. Self care activities will depend on the mode of treatment used surgery,

chemotherapy, radiation, or palliative care. The nurse also teaches the patient or caregiver to recognize and report signs

and symptoms of complications that require medical attention, such as bleeding, obstruction, perforation, or any symptoms that become progressively worse.

Evaluation

Reports less anxiety a. Expresses fears and concerns about surgery b. Seeks emotional supports Attains optimal nutrition a. Eats small, frequent meals high in calories, iron, and vitamins A

and C b. Complies with enteral or parenteral nutrition as needed Has less pain Performs self-care activities and adjusts to lifestyle changes a. Resumes normal activities within 3 months b. Alternates periods of rest and activity c. Manages tube feedings

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