Malignancy of the GI tract

1. Arpana Bhusal
BNS
Malignancy of the GI tract

2.  Cancer of esophagus: malignant tumor of the
esophagus usually appear as ulcerated lesions,
most often in middle and lower portion of the
esophagus.
Incidence:
 More common in men than in women
 Usually between ages 50 to 70 years

3. Causes:
 Unknown
 Contributing factors:
 Cigarette smoking
 Excessive alcohol intake
 Trauma
 Poor oral hygiene
 Achalasia
 Diverticula

4. Clinical findings
 Dysphagia
 A sensation of mass in throat
 Substernal pain or fullness
 Regurgitation of undigested food with foul breath
and hiccups
 Weight loss
 Substernal burning after drinking hot fluids
 Narrowing of the esophagus the area of the tumor
seen in barium meal report

5. Diagnosis
 Esophagoscopy with biopsy
 Endoscopic ultrasound

6. Management
 Radiation therapy- inoperable tumor only for
symptom alleviation
 Chemotherapy:- not found effective
 Surgery:
 Esophagectomy
 Esophagogastrostomy
 Esophagoenterostomy
 Palliative gastrectomy

7. Nursing interventions
 Provide nursing care for the client receiving radiation
therapy
 Prepare client for surgery, in addition to routine pri-
operative care:
 Provide meticulous oral hygiene
 Explain that client may have a chest tube if thoracic approach is
used
 Prepare client for feeding through gastrostomy
 In addition to routine post-operative care:
 Monitor NG tube-expect bloody drainage for approximately 12
hrs with gradual changes to greenish to yellow
 Prevent gastric reflux
 Provide emotional support to client/significant others

8.  Provide client teaching:
 Gastrectomy and proper dietary measures
 Importance of cessation of smoking and elimination of
alcohol consumption
 Maintain good oral hygiene
 Maintain a high calorie, high protein diet

9. Cancer of the stomach
 50% of gastric cancer occurs in the pyloric region or
adjacent to antrum
 Most of adenocarcinoma
 Often not diagnosed until metastasis occurs, because the
stomach is able to accommodate to the growth of a tumor
and pain occurs late in disease.
 May metastasize by direct extension, lymphatic or blood to
the esophagus, spleen, pancreas, liver or bone
 Incidence high in men more than 40 years
 More frequent; African American, Japanese
 Age 50 to 70 yrs

10. Assessment findings of cancer of stomach
 Fatigue, weakness, lethargy
 Nausea and vomiting
 weight loss
 indigestion
 Epigastric fullness, epigastric pain
 Pallor, poor skin turgor
 mobile, palpable epigastric mass
 Shortness of breath

11. Diagnosis
 Stool test
 CEA +ve (carcino embriogenic antigen)
 Hb and HCT decreased
 Endoscopy with biopsy
 Barium x-ray
 CT and USG

12. Management
 Chemotherapy
 Radiotherapy
 Surgery: type depends on location and extension of
tumor
 Treatment for anemia, gastric decompression,
nutritional support, fluid and electrolyte
maintenance

13. Cancer of the pancreas
 Most pancreatic tumors are adenocarcinomas and
half occurs in the head of the pancreas
 Malignant growth from the epithelium of the
ductal system, producing cells that block the ducts
of the pancreas.
 Fibrosis pancreatitis and obstruction of the
pancreas
 Lesion tends to metastasize by direct extension to
the duodenal wall, spleenic flexure of the colon,
posterior stomach wall and common bile duct

14. Causes
 Heredity, DM, High fat diet
 Chemical carcinogens, cigarette smoking

15. Signs and symptoms
 Anorexia, rapid progressive weight loss
 Dull abdominal pain, located in the upper abdomen
or left hypochondrial region with radiating to back
related to eating
 Jaundice

16. Management
 Radiation therapy
 Chemotherapy
 Wipple's operation; resection of the proximal pancreas,
adjoining duodenum, distal portion of the stomach and
distal segment of the common bile duct
 Drug therapy: Oral hypoglycemic or insulin pancreatic
enzymes, bile salts (after surgery)

17. Nursing interventions
 Nursing management same as pancreatitis
 Provide care for client receiving chemotherapy,
radiation therapy
 Routine pre and post-op care
 Provide emotional support
 Provide client teaching:
 Need to eat small frequent meals of a low fat, high
carbohydrate diet with vitamin supplements
 Importance of adhering to medication regimen after
surgery

18. Cancer of the liver
 Primary cancer of the liver is extremely rare but it is a
common site for metastasis because of liver's large
blood supply and portal drainage from primary cancer
of the colon, rectum, stomach, pancreas, esophagus,
breast, lungs and melanomas frequently metastasizes to
the liver
 Enlargement, hemorrhage, necrosis are common
occurrences
 Primary liver tumor often metastasize to the lung
 Incidence high in men
 Prognosis poor; disease well advanced before clinical
signs evident

19. Signs and symptoms
 Weakness, anorexia, nausea and vomiting
 Weight loss
 Temperature slightly high
 Right upper quadrant discomfort, tenderness,
hepatomegaly, ascites, jaundice, increased liver
enzyme, increased bleeding tendency
 Peripheral edema

20. Diagnosis
 LFT, Alphafetoprotein
 CT, MRI, Abdominal X-ray< USG,
 Liver biopsy
Management:
 Palliative- Chemotherapy and radiation therapy
 Resection of liver segment or lobe if tumor is
localized

21. Nursing interventions
Same as cirrhosis of liver plus
1. Provide emotional support for client and significant others
regarding poor prognosis
2. Provide care of the patient receiving chemotherapy and
radiotherapy
3. Provide care if client with abdominal surgery plus:
 Preoperative:
 Perform bowel preparation to decrease ammonium intoxication
 Administer vitamin K to decrease risk of bleeding
 Post-operative:
 Administer 10% glucose for first 48 hrs to avoid rapid blood sugar drop
 Monitor for hyper/hypoglycemia
 Assess for bleeding (hemorrhage is most threatening complication)
 Assess for signs of hepatic encephalopathy

22. Cancer of the small intestine, colon & rectum
 Cancer of the small intestine is very rare
 Adenocarcinoma is the most common type of colon
cancer
 Colon carcinoma is more common in men and
incidence high after 50 yrs of age; Second most
common site for cancer in men and women; usually
occurs between age 50 to 60 yrs
 Tumor- narrowing of lumen of bowel, ulcerations,
necrosis or perforation

23. Causes
 Chronic ulcerative colitis
 Diverticulosis
 Familial polyps
 High fat low fiber diet

24. Assessment findings
 Alternate diarrhea and constipation
 Abdominal cramps, discomfort or pain, distension
 Weakness, anorexia, weight loss, pallor
 Ribbon or pencil type stool, tenesmus
 Frank or occult blood positive in stool
 Digital rectal examination indicates a palpable mass

25. Diagnosis
 Stool for occult blood positive
 Hb and HCT decreased
 CEA+ve
 Sigmoidoscopy reveal a mass
 Biopsy
 Barium enema show a colon mass
 Digital rectal examination

26. Treatment
 Chemotherapy
 Radiation therapy
 Surgery: Types of surgery varies depending on
location and extent of of lesion

27. Nursing interventions
 Nursing interventions common to all bowel surgery
1. In addition to routine pre-op care:
 Ensure adherence to dietary restrictions
i. Offer clear liquids only one day before surgery
ii. Provide high-calorie, low residue diet 3-5 days before
surgery
 Assist with bowel preparation
i. Administer antibiotics 3-5 days pre-op to decrease bacteria
in intestine
ii. Administer enemas to further cleanse the bowel
 Administer vitamins C, K(decreased by bowel
cleansing) to prevent post-op complications

28. 2. In addition to routine post-op care
 Promote elimination
i. Asses for signs of returning peristalsis
ii. Monitor characteristics of initial stools
 Monitor and maintain fluid and electrolyte balance
 Additional nursing interventions specific to
abdominoperineal resection
 Reinforce and change perineal dressings as needed
 Record type, amount, color of drainage
 Irrigate with normal saline
 Provide warm seitz baths 4 times /day
 Cover wound with dry dressing

29.  Additional nursing interventions specific to colostomy
1. Prevent skin breakdown
 Cleanse skin around stoma with mild soap and
water and pat dry
 Use a skin barrier to protect skin around the stoma
 Assess skin regularly for irritation
 Avoid the use of adhesives on irritated skin
2. Control odor, maintain pleasant environment
 change pouch/seal whenever necessary
 Empty or clean bag frequently, and provide
ventilation afterwards; use deodorizer in bag/room
if needed
 Avoid gas-producing foods eg cabbage, onion, eggs
etc

30.  Promote adequate stomal drainage
 Assess stoma for color and intactness
 Expect mucoid/serosanguinous drainage during the forst 24 hrs, then
liquid type
 Assess for flatus indicate return of intestinal function
 Monitor for changing consistency of fecal drainage
 Irrigate colostomy as needed
 Position client on toilet or in high Fowler’s if client on bed rest
 Full irrigation bag with desired amount of water (500-1000ml) and
hang bag to the bottom is at shoulder height
 Remove air from tubing and lubricate the tip of the catheter or cone
 Remove old pouch and clean skin and stoma with water
 Gently dilate stoma and insert the irrigation catheter or cone snugly
 Open tubing and allow fluid to enter the bowel
 Remove catheter or cone and allow fecal contain to drain
 Observe and record amount and catheter of fecal return

31.  Promote adequate nutrition
 Assess return of peristalsis
 Advance diet as tolerated, add new foods gradually
 Avoid constipating food
 Provide at least 2500 ml liquid/day
 Encourage client to discuss concerns and feeling about
surgery
 Provide client teaching and discharge planning concerning:
a. Recognition of complications and need to report immediately
 Changes in odor, color, consistency of stools
 Bleeding from the stoma
 Persistent constipation/ diarrhea
 Changes in the counter of the stoma
 Persistent leakage around the stoma
 Skin irritation despite treatment
b. Proper procedure for colostomy irrigation (no irrigation in
ileostomy