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Gastro intestinal cancer by Azu and Dere (1) (4).pptx
1. SALALE UNIVERSITY COLLEGE OF HEALTH SCIENCE
DEPARTMENT OF ADULT HEALTH NURSE MASTERS
PROGRAM
Presented by: 1. Azazhu Abate, ID NO: 177/2015
2. Dereje Ayele , ID NO: 179/2015
Submitted to: Mr Tadele K. (BSC, MSc, Ass/t Prof)
SEP, 2023
Fitche, Ethiopia
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2. Presentation outline
• Introduction to gastrointestinal cancer
• Epidemiology of gastrointestinal cancer
• Causes and Risk factors of gastrointestinal cancer
• Clinical manifestation of gastrointestinal cancer
• Pathophysiology of gastrointestinal cancer
• Types of GI cancers
• Diagnosis of gastrointestinal cancer
• Treatment of gastrointestinal cancer
• Complication of gastrointestinal cancer
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3. Introduction
• Gastrointestinal cancer is cancer that develops along
the GI tract (also called the digestive tract).
• Refers to malignant conditions of the gastrointestinal
tract and accessory organs of digestion, including the
esophagus, stomach, biliary system, pancreas, small
intestine, large intestine, rectum and anus.
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5. Epidemiology
• Globally, gastrointestinal cancers represent more
than one-fourth of all cancer incidence and one-
third of cancer-related mortality.
• There were an estimated 4.8 million new cases of
gastrointestinal (GI) cancers and 3.4 million related
deaths, worldwide, in 2018.
• GI cancers account for 26% of the global cancer
incidence and 35% of all cancer-related deaths
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6. Risk factors
• H. pylori infection
• Other medical conditions, gastritis
• Genetics and family history
• Aging, obesity , alcohol use, tobacco use
• Diet low in fruits and vegetables such as fat
• Environmental and occupational exposures to
toxins, radiations
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7. causes
• The cause of Gastrointestinal Cancer do not yet fully
understandable. Still, cell damage increases the
chance that abnormalities will appear, and that can
come from infections, obesity, smoking, and other
factors.
• GI tract cancers begin when the cells lining one or
more of the organs in the digestive tract mutate and
begin to grow, producing tumors and sometimes
spreading to the lymph nodes and other organs.
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8. Con…
• For example: Bile acids are synthesized in the liver
to facilitate digestion of dietary fats. Exposure of
the gastrointestinal tract to bile acids can occur in
several different settings, but most significantly is
prevalent among individuals who have a high
dietary fat intake.
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11. Clinical manifestations of GI cancers
• Pain or discomfort in the abdomen.
• Nausea and vomiting.
• Loss of appetite.
• Fatigue or weakness.
• Bleeding (vomiting blood or passing blood in stools)
• Weight loss, abdominal swelling
• Early satiety (cannot eat a complete meal because of
a “full feeling”)
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12. Diagnosis
Its recommend that a combination of tests, based on
the symptoms and health history is useful:
• Imaging tests: Advanced imaging tests, such as CT,
MRI, capture fine details of internal organs. These
pictures show a tumor’s exact location and help
doctors confirm or rule out cancer. These are also
helpful if the cancer cells are metastatic or not.
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13. Con…
• Blood tests: Cancer cells make substances called
tumor markers. Blood tests that measure tumor
markers can help diagnose GI cancer.
• Endoscopy: is a thin, bendable tube with a camera
at its tip down your throat. These evaluate the
upper digestive tract, including the esophagus and
stomach.
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14. Con…
• Barium swallow: For this radiology test, the patient
drink a special liquid which makes image more
clearly seen and then have X-rays.
• Endoscopic ultrasound: is a minimally invasive
procedure that uses sound waves to take pictures
of internal organs, such as the digestive tract and
pancreas.
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15. Con…
• Colonoscopy: is a flexible instrument attached to a
camera inside the rectum. This procedure is to
evaluate the lower digestive organs, such as the colon
and rectum.
• Biopsy: During this procedure, a gastroenterologist or
surgeon uses an instrument called an endoscope to
remove a small sample of tissue from the affected
area for further diagnosis.
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16. Types of GIT cancers
The most common
• Esophageal cancer
• Gastric cancer
• Colorectal cancer
• Pancreatic cancer
• Liver cancer
Other less common
• Gallbladder cancer
• Small intestine cancer
• Anal cancer
NB: classification is
based on area affected
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17. Most Common Types of GI Cancer and their burden
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19. Types of Esophageal Cancer
1. Squamous Cell Carcinoma: is most common type
formed in upper and middle esophagus. It occurs at
thin cells that lining the esophagus.
2. Adenocarcinoma: is carcinoma in distal oesophagus.
Begins with columnar cells with in the cells of
mucus producing glands in the lower eusophagus.
3. Other rare types: sarcoma, lymphoma, melanoma
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20. Causes and Risk Factors
Although we don't know exactly what causes esophageal
cancer
Risk factors include:
• Smoking and Obesity
• Being Male and Age over 70
• Achalasia, varices, Barrett's esophagus
• gastroesophageal reflux disease
• alcohol consumption
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21. Symptoms of Esophageal Cancer
• Painful or difficult of swallowing: Patients often report
feeling like food is stuck in the throat or chest
• Loss of appetite and Weight loss
• Pain in the middle of the chest behind the breastbone
• Pressure or a feeling of burning in the throat
• Hoarseness and cough
• Persistent indigestion and heartburn
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22. Diagnosis
• Endoscopic imaging
• Biopsy and brushings
• CT of the chest and
• Positron emission tomography (PET)
• Endoscopic ultrasound
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24. Stomach cancer
• Stomach cancer, also called gastric cancer, begins
when cells in the stomach start to grow out of
control.
• It is the fourth-most-common type of cancer and
the second-highest cause of cancer death globally.
and remains the second cause of death of all
malignancies worldwide.
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25. Risk factors of gastric cancer
• Previous or family history
• Male
• Smoking cigarettes
• Helicobacter pylori infection
• Chronic gastritis, Old age
• A diet high in salted, smoked, or poorly preserved foods
• A diet low in fruits and vegetables
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26. Clinical manifestation
• Indigestion and stomach discomfort
• Trouble swallowing
• A bloated feeling after eating, Vomiting
• Blood in the stool
• Loss of appetite and Weight loss
• Heartburn, Stomach pain
• Jaundice and Ascites
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27. WHO classification of gastric cancer
1. Adenocarcinomas: Most cancers of the stomach
(about 90% to 95%) are adenocarcinomas. These
cancers develop from the gland cells in the innermost
lining of the stomach (the mucosa)
2. Adenosquamous carcinoma
3. Squamous cell carcinoma
4. Small cell CA
5. others
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28. Laurens Gastric cancer classification
a. The intestinal type (53%): tends to have a slightly
better prognosis (outlook). The cancer cells are more
likely to have certain gene changes that might allow
for treatment with targeted drug therapy
b. The diffuse type (33%): tends to grow spread
more quickly and it tends to be harder to treat
c. Unclassified (14%): not classified under either of
the above two.
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29. Diagnosis
• Advanced stage may be palpable as a mass, Ascites
and hepatomegaly
• CT of the chest abdomen and Pelvis
• Endoscopic ultrasound
• barium x-ray
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30. Treatment
• When the tumor is easy to reach, surgery might be
all that’s necessary.
• When it’s harder to reach or its removal would
significantly affect gastric function: chemotherapy,
radiation therapy, or targeted therapy may be tried
first.
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31. Prevention
• Prevention of Gastric cancer should remain a
priority.
• The primary prevention includes healthy diet, anti-
H. pylori therapies, chemoprevention, and
screening for early detection.
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32. Liver cancer
• Liver cancer, also known as hepatic cancer and
primary hepatic cancer, is cancer that starts in the
liver.
• Cancer which has spread from elsewhere to the
liver, known as liver metastasis, is more common
than that which starts in the liver
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33. Risk factors
• Anabolic steroids - used by athletes and weight
lifters. These male hormones, if used regularly and
for long enough, can raise the risk of developing liver
cancer, as well as some other cancers
• Aflatoxins - a substance made by a fungus and may
be found in moldy wheat, groundnuts, corn, nuts,
soybeans and peanuts.
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35. Clinical manifestations
• General weakness and fatigue
• Upper abdominal pain
• Vomiting, appetite loss, weight loss
• Abdominal swelling
• Yellow discoloration of your skin and the whites of
your eyes (jaundice)
• White, chalky stools
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36. Diagnosis
• HCC screening - high risk individuals for HCC should have
regular screenings for liver cancer. Early screening is
important
• Blood test - AFP (alpha fetoprotein), a type of protein, is
produced by liver tumors and detected in a blood test
• Imaging scans - either an MRI or CT scan
• Biopsy - a small sample of tumor tissue is removed and
analyzed.
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37. Treatment
• Surgery: In the early stages, when the tumor is small and
occupies just a small part of the liver, it can be surgically
removed.
• Liver transplant
• Ablative therapy - substances are injected directly into
the tumor, such as alcohol. Lasers and radio waves can
also be used
• Radiation therapy (radiotherapy)
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38. Colorectal Cancer
Malignant growth of tumor that begins from the
inner wall of the colon or rectum. Can also involve
the anal canal.
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39. Burden of colorectal cancer
• The 3rd most common malignancy worldwide ( ≥
1.2 million new cases annually).
• Highest incidence rates in economically developed
countries. E.g. In Europe the five-year survival rate
for colorectal cancer is less than 60%.
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40. Pathophysiology
• The formation of colorectal CA is a multistep
process. Begins with an abnormal growth of tissue
known as a polyp (precursors to the disease)
originating from the innermost wall of the colon.
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42. Risk Factors
• History of Polyps, inflammatory bowel disease
• Diet high intake of fat, alcohol or red meat and low-
fiber diet
• Smoking cigarettes, male, old age
• Genital cancer or breast cancer
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43. Signs and symptoms
• worsening constipation.
• blood in the stool, decrease in stool thickness,
• loss of appetite, loss of weight.
• Nausea or vomiting .
• rectal bleeding, Anemia
• weight loss.
• change in bowel habit
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46. Cancer of the Pancreas
• Pancreatic cancer is a type of cancer that affects the
pancreas, an organ that lies behind the stomach and
in front of the spine.
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47. Causes and Risk Factors
we cannot pinpoint what the causes but the Risk
factors are:
• Smoking
• Age > 50 years old
• Having Diabetes.
• Chronic Pancreatitis.
• Family History.
• Obesity
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48. Signs and symptoms
• Jaundice (yellowing of the skin and whites of the eyes)
• Light-colored stools
• Dark urine
• Pain in the upper or middle abdomen and back
• Weight loss for no known reason
• Loss of appetite
• Feeling very tired
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49. Type of Pancreatic Cancer
Exocrine Cancer
• Ampullary cancer
• Adenosquamous carcinoma
• Squamous cell carcinoma
Endocrine Cancer/neuroendocrine tumors
• Gastrinoma
• Insulinoma
• Glucagonoma
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52. Complication of GI cancers
• Metastasis to other organs
• Esophageal obstruction
• Bowl obstruction
• Bleeding
• Anemia
• Death
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53. Nursing Care Plan
The major nursing diagnoses are include the following:
• Imbalanced nutrition, less than body requirements,
related to nausea and anorexia
• Risk for deficient fluid volume related to vomiting
• Anxiety related to impending surgery and the diagnosis
of cancer
• Pain related to tumor mass
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54. Nursing Management of GI cancers
• Maintaining Optimal Nutrition
• Providing Emotional Support
• Relieving Pain with analgesics
• Preparing the Patient for Surgery
• Postoperative Care
• Providing Wound Care
• Monitoring and Managing Complications
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55. Nursing management con…
• Advice the patients to eat small, frequent meals rather
than three large meals.
• Monitor CBC and serum vitamin B12 levels to detect
anemia.
• Manage treatment side effects
• Administer palliative therapy to non-surgical patients.
• Encourage the patient to avoid alcohol, smocking and
fried foods.
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56. Nursing management con…
• Acknowledge the patient’s feelings and concerns
about their health condition.
• Administer antiemetic before meals for those who
have discomfort, nausea, vomiting.
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57. Summery
• Gastro intestinal cancers are a group of malignant
conditions of the gastrointestinal tract and accessory
organs of digestion, including the esophagus, stomach,
biliary system, pancreas, small intestine, large
intestine, rectum and anus.
• The most common are esophageal, gastric, colorectal,
pancreatic, and liver cancers.
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58. Reference
1. Suzanne C, Brenda G, Janice L, Kerry H. Brunner and
Suddarth Medical and Surgical Nursing, Twelfth Edition,
Lippincot William & Wilkins, 2010.
2. Linda S, Paula D. Understanding Medical and Surgical
Nursing, Third Edition, page: 1138, FA Davis 2007.
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