gastric cancer, risk factors, staging, TNM classification, pathophysiology, signs, symptoms, diagnosis, treatment, nursing interventions.

1. Prepared by
Mehwish Jamil
GASTRIC CANCER

3. • incidence of gastric or stomach cancer continues to decrease in the United States, it
still accounts for more than 11,000 deaths annually (American Cancer Society, 2009).
• Prognosis: prognosis is generally poor; the diagnosis is usually made late because
most patients are asymptomatic during the early stages of the disease.

4. RISK FACTOR/ CAUSES
• Age (between 40 and 70 years of age)
• Gender
• Diet appears to be a significant factor: A diet high in smoked, salted, or pickled foods and
low in fruits and vegetables may increase the risk of gastric cancer
• Chronic gastritis
• H.pylori infection
• pernicious anemia, smoking, achlorhydria, gastric ulcers,
• previous subtotal gastrectomy (more than 20 years ago),
• Genetics(blood group A)

6. PATHOPHYSIOLOGY

7. STAGING
• Stage1 cancer has just begun to affect the inner stomach.
• Stage2 cancer has begun to penetrate toward the outer layer of
stomach . Nearby lymph nodes may be involved.
• Stage3 cancer has progressed farther through tissue layers of
stomach or more distant lymph nodes may be involved.
• Stage4 cancer has penetrated all tissue layers of stomach or
distant lymph nodes may be involved.
• Stage5 cancer has affected all nearby tissues and organs.
Cancer have been carried through lymph system to other distant
body parts. This is known as metastasis. Mainly to liver, lungs,
bones.

11. SYMPTOMS
 Symptoms of progressive disease include:
• dyspepsia (indigestion), early satiety, weight loss(62%),
abdominal pain just above the umbilicus(52%), loss or decrease
in appetite,
• bloating after meals
• nausea and vomiting(34%)
• Symptoms are similar to those of peptic ulcer disease.

12. SIGNS
• Sister Mary Joseph’s nodules(periumbilical node)
• Left Supraclavicular node(virchows)
• Left axillary node(Irish)
• Enlarged ovary(krukenburg’s)
• ascites

13. DIAGNOSIS
 Tests and procedures used to diagnose stomach cancer include:
• upper endoscopy
• Biopsy
• Imaging tests. Imaging tests used to look for stomach cancer
include CT scans and a special type of X-ray exam called a
barium swallow.

14. CONTI…
 Determining the extent (stage) of stomach cancer:
• Blood tests
• Endoscopic ultrasound
• Exploratory surgery
• Imaging tests. Tests may include CT and positron emission
tomography (PET).

15. TREATMENT
• Treatment options for stomach cancer depend on the cancer's
location, stage and aggressiveness.
• Surgery:
• The goal of surgery is to remove all of the cancer and some
of the healthy tissue around it.
 Operations used for stomach cancer include:

16. a. Removing early-stage tumors from the stomach lining:
Procedures to cut away cancer from the inside lining
of the stomach include endoscopic mucosal resection and
endoscopic sub mucosal resection.
b. Removing part of the stomach (subtotal gastrectomy).
During subtotal gastrectomy, the surgeon removes the part of the
stomach affected by cancer and some of the healthy tissue around
it. This operation may be an option if your stomach cancer is
located in the part of the stomach nearest the small intestine.

17. c. Removing the entire stomach (total gastrectomy). Total
gastrectomy involves removing the entire stomach and some
surrounding tissue. The esophagus is then connected directly to
the small intestine to allow food to move through your digestive
system. Total gastrectomy is used most often for stomach cancers
that affect the body of the stomach and those that are located in
the gastro esophageal junction.
d. Removing lymph nodes to look for cancer
e. Surgery to relieve signs and symptoms

18. Chemotherapy
 Chemotherapy can be given before surgery to help shrink
the cancer so that it can be more easily removed.
Chemotherapy is also used after surgery to kill any cancer
cells that might remain in the body. Chemotherapy is often
combined with radiation therapy.
 Chemotherapy may be used alone or with targeted drug
therapy in people with advanced stomach cancer.

19. Radiation therapy
 Radiation therapy uses high-powered beams of energy,
such as X-rays and protons, to kill cancer cells. The energy
beams come from a machine that moves around you as you
lie on a table.
 For advanced stomach cancer that can't be removed with
surgery, radiation therapy may be used to relieve side
effects, such as pain or bleeding, caused by a growing
cancer.

20. Targeted drug therapy
 Targeted drug treatments focus on specific weaknesses
present within cancer cells. By blocking these weaknesses,
targeted drug treatments can cause cancer cells to die. For
stomach cancer, targeted drugs are usually combined with
chemotherapy for advanced cancers or cancer that comes
back after treatment.

21. Immunotherapy
 Immunotherapy is a drug treatment that helps your immune
system to fight cancer. Your body's disease-fighting
immune system might not attack cancer because the cancer
cells produce proteins that make it hard for the immune
system cells to recognize the cancer cells as dangerous.
Immunotherapy works by interfering with that process.

22. SUPPORTIVE (PALLIATIVE) CARE
 Palliative care is specialized medical care that focuses on
providing relief from pain and other symptoms of a serious
illness. Palliative care specialists work with you, your family and
your other doctors to provide an extra layer of support that
complements your ongoing care. Palliative care can be used
while undergoing aggressive treatments, such as surgery,
chemotherapy or radiation therapy.
 When palliative care is used along with all of the other
appropriate treatments, people with cancer may feel better and
live longer.
 Palliative care is provided by a team of doctors, nurses and
other specially trained professionals. Palliative care teams aim
to improve quality of life for people with cancer and their
families. This form of care is offered alongside curative or other
treatments you may be receiving.

23. Nursing interventions

24. NURSING INTERVENTION
• Monitor nutritional intake and weigh patient regularly.
• Monitor CBC and serum vitamin B12 levels to detect
anemia, and monitor albumin and prealbumin levels to
determine if protein supplementation is needed.
• Provide comfort measures and administer analgesics
as ordered.
• Frequently turn the patient and encourage deep
breathing to prevent pulmonary complications, to
protect skin, and to promote comfort.
• Maintain nasogastric suction to remove fluids and gas
in the stomach and prevent painful distention.

25. CONTI…
• Provide oral care to prevent dryness and ulceration.
• Keep the patient nothing by mouth as directed to promote
gastric wound healing. Administer parenteral nutrition, if
ordered.
• When nasogastric drainage has decreased and bowel sounds
have returned, begin oral fluids and progress slowly.
• Avoid giving the patient high-carbohydrate foods and fluids with
meals, which may trigger dumping syndrome because of
excessively rapid emptying of gastric contents.
• Administer protein and vitamin supplements to foster wound
repair and tissue building

26. • Eat small, frequent meals rather than three large meals.
• Reduce fluids with meals, but take them between meals.
• Stress the importance of long term vitamin B12 injections after
gastrectomy to prevent surgically induced pernicious anemia.
• Encourage follow-up visits with the health care provider and
routine blood studies and other testing to detect complications
or recurrence.