Gastric cancer is the sixth most common cancer and third leading cause of cancer death worldwide. Risk factors include infection with H. pylori bacteria and low fruit/vegetable intake. Precancerous conditions include atrophic gastritis and intestinal metaplasia. Diagnosis involves endoscopy with biopsy. Treatment options include surgery to remove all or part of the stomach, chemotherapy, and radiation therapy. Post-operative care focuses on managing complications and preventing issues like dumping syndrome.

2. GASTRIC CANCER
• Gastric cancer is the sixth most common cancer and the third most
common cause of cancer-related death in the world.
• Generally, stomach cancer rates are about twice as high in males as
in females.
• The average age for developing gastric cancer is 70 years.

3. ETIOLOGY AND RISK FACTORS
• Infection with H. pylori is the largest risk factor for gastric cancer
because it carries the cytotoxin-associated gene A (CagA) gene.
• Patients with pernicious anemia, gastric polyps, chronic atrophic
gastritis, and achlorhydria (absence of secretion of hydrochloric acid)
are 2 to 3 times more likely to develop gastric cancer.

4. RISK FACTORS
• Eating pickled foods, nitrates from processed foods, and salt added to food.
• A low intake of fruits and vegetables.
• Gastric surgery
• Barret esophagus
• GERD
• Obesity

5. PATHOPHYSIOLOGY
• Gastric cancer usually begins in the glands of the stomach mucosa.
• Atrophic gastritis and intestinal metaplasia (abnormal tissue development)
are precancerous conditions.
• Inadequate acid secretion in patients with atrophic gastritis creates an
alkaline environment that allows bacteria (especially H. pylori) to multiply.
• This infection causes mucosa-associated lymphoid tissue (MALT)
lymphoma, which starts in the stomach

6. CLINICAL MANIFESTATIONS
Early Gastric Cancer
• Indigestion
• Abdominal discomfort initially relieved with antacids
• Feeling of fullness
• Epigastric, back, or retrosternal pain

7. CLINICAL MANIFESTATIONS
Advanced Gastric Cancer
• Nausea and vomiting
• Obstructive symptoms
• Iron deficiency anemia
• Palpable epigastric mass
• Enlarged lymph nodes
• Weakness and fatigue
• Progressive weight loss

8. COMPLICATIONS OF GASTRIC CANCER
• Pathologic peritoneal and pleural effusions
• Obstruction of the gastric outlet, gastroesophageal junction, or small bowel
• Bleeding in the stomach from esophageal varices or at the anastomosis
after surgery
• Intrahepatic jaundice caused by hepatomegaly
• Extrahepatic jaundice
• Inanition from starvation or cachexia of tumor origin

9. DIAGNOSIS
• The goal of obtaining laboratory studies is to assist in determining optimal
therapy. Potentially useful tests in patients with suspected gastric cancer
include the following:
• CBC: May be helpful to identify anemia, which may be caused by bleeding,
liver dysfunction, or poor nutrition; approximately 30% of patients have
anemia
• Electrolyte panels
• Liver function tests
• Tumor markers such as CEA and CA 19-9: Elevated CEA in 45-50% of
cases; elevated CA 19-9 in about 20% of cases

10. DIAGNOSIS
• Esophagogastroduodenoscopy (EGD): To evaluate gastric wall and lymph
node involvement
• Double-contrast upper GI series and barium swallows: May be helpful in
delineating the extent of disease when obstructive symptoms are present or
when bulky proximal tumors prevent passage of the endoscope to examine
the stomach distal to an obstruction
• Chest radiography: To evaluate for metastatic lesions
• CT scanning or MRI of the chest, abdomen, and pelvis: To assess the local
disease process and evaluate potential areas of spread
• Endoscopic ultrasonography (EUS): Staging tool for more precise
preoperative assessment of the tumor stage

11. DIAGNOSIS
• Biopsy
• Biopsy of any ulcerated lesion should include at least six specimens taken from
around the lesion because of variable malignant transformation..
• Histologically, the frequency of different gastric malignancies is as follows:
Adenocarcinoma - 90-95%
Lymphomas - 1-5%
Gastrointestinal stromal tumors (formerly classified as either leiomyomas
or leiomyosarcomas) - 2%
Carcinoids - 1%
Adenoacanthomas - 1%
Squamous cell carcinomas - 1%

12. SURGICAL MANAGEMENT
• The surgical approach in gastric cancer depends on the location, size, and
locally invasive characteristics of the tumor.
Types of surgical intervention in gastric cancer include the following:
• Total gastrectomy, if required for negative margins
• Esophagogastrectomy for tumors of the cardia and gastroesophageal
junction
• Subtotal gastrectomy for tumors of the distal stomach
• Lymph node dissection.

13. CHEMOTHERAPY
• Antineoplastic agents and combinations of agents used in managing gastric
cancer include the following:
• Platinum-based combination chemotherapy: First-line regimens include
epirubicin/cisplatin/5-FU or docetaxel/cisplatin/5-FU
• Trastuzumab in combination with cisplatin and capecitabine or 5-FU
• Ramucirumab

14. NEOADJUVANT, ADJUVANT, AND PALLIATIVE
THERAPIES
Potentially useful therapies in gastric cancer include the following:
• Neoadjuvant chemotherapy
• Intraoperative radiotherapy (IORT)
• Adjuvant chemotherapy (eg, 5-FU)
• Adjuvant radiotherapy
• Adjuvant chemoradiotherapy
• Palliative radiotherapy
• Palliative-intent procedures (eg, wide local excision, partial gastrectomy, total
gastrectomy, simple laparotomy, gastrointestinal anastomosis, bypass)

15. PRE OPERATIVE NURSING MANAGEMENT
• NG tube aspirations
• To correct malnutrition before surgery, the health care provider may
prescribe enteral supplements to the diet and/or total parenteral
nutrition (TPN).
• Vitamin, mineral, iron, and protein supplements are essential to
correct nutritional deficits.

16. POST OPERATIVE NURSING MANAGEMENT
• Monitor for the complications of surgery (bleeding, infection, paralytic ileus).
• Auscultate the lungs for adventitious sounds (crackles or reduced breath
sounds), and monitor for the return of bowel sounds.
• Auscultate the lungs for adventitious sounds (crackles or reduced breath
sounds).
• Monitor for the return of bowel sounds.
• Provide pulmonary exercises and early ambulation to prevent respiratory
complications and deep vein thrombosis.

17. POST OPERATIVE NURSING MANAGEMENT
• Monitor for the complications of surgery (bleeding, infection, paralytic ileus).
• Auscultate the lungs for adventitious sounds (crackles or reduced breath
sounds), and monitor for the return of bowel sounds.
• Auscultate the lungs for adventitious sounds (crackles or reduced breath
sounds).
• Monitor for the return of bowel sounds.
• Provide pulmonary exercises and early ambulation to prevent respiratory
complications and deep vein thrombosis.

18. DUMPING SYNDROME MANAGEMENT
• Eat small, frequent meals
• Avoid drinking liquids with meals
• Avoid foods that cause discomfort
• Eliminate caffeine and alcohol consumption
• Begin a smoking-cessation program, if needed
• Administer B12 injections, as prescribed
• Lie flat after eating for a short time