1. GASTRIC CARCINOMA

2. Pathophysiology Adenocarcinoma characterized as intestinal or diffuse Spreads through stomach into the gastric wall to the –Lymph nodes –Liver –Pancreas –Transverse colon –Omentum –Peritoneum –Ovaries –Pelvic cul-de-sac –Through portal vein into lungs, liver, and bone –Advanced stage: stomach muscle

3. Etiology H. pylori: 80 percent of gastric carcinomas result from H. pylori due to the result of free radicals Dietary nitrates (bacteria in stomach breaks down nitrites to compounds that are carcinogenic in animals) Hypochlorhydria: occurs in gastric atrophy and promotes bacterial growth in stomach Foods such as starch, pickled vegetables, salted fish and meat, smoked foods and salt People who smoke cigarettes or use alcohol are 3-5 times more likely

4. Etiology cont. Epstein-Barr virus is now implicated as a cause Pernicious anemia Chronic atrophic gastritis Gastric polyp Achlorhydria Barrett’s esophagus Having had a Billroth 2 procedure Genetic factors include: –First degree relatives –Type A blood

5. Incidence/Prevalence 3 rd most common GI malignancy (after colorectal and pancreatic) 14 th cause of cancer related death in U.S. 85-95% are caused by adenocarcinoma 15% are caused by Non-Hodgkin’s lymphoma & leiomysosarcomas

6. Anatomy of the stomach

7. location 37% in the proximal third of the stomach 30% in the distal stomach 20% in the midsection Remaining 13% in the entire stomach

8. Onset Insidious (slowly developing) Usually discovered in advanced stages Men>Women Occurs between the ages of 50-70 Increased mortality in –Japanese –Costa Ricans –Chileans –Native Americans –African Americans –Scandinavians

9. Assessment History: –High risk foods –Alcohol/tobacco use –Treated for H. Pylori infection –Gastritis, pernicious anemia, gastric surgery, polyps –Immediate family dx gastric cancer –Blood type

10. Physical Assessment Early gastric cancer –Indigestion –Abdominal discomfort initially relieved with antacids –Feeling of fullness –Epigastric, back, or retrosternal pain –NOTE: most people will show no clinical manifestations

11. Physical Assessment cont. Advanced stage: –Nausea/vomiting –Obstructive symptoms –Iron deficiency/anemia –Palpable epigastric mass –Enlarged lymph nodes –Weakness/fatigue –Progressive weight loss

12. Labs Decreased hematocrit and hemoglobin Macrocytic or microcytic anemia (decreased vit.B12 and iron absorption) Stool positive for occult blood In Advanced stages: Hypoalbuminemia Bilirubin and alkaline phosphate will be abnormal Increased level of carcinoembryonic antigen

13. Radiographic assessment Double contrast upper GI series C.T. Esophagogastroduodenoscopy (EGD) Endoscopic ultrasound (EUS) Other findings include –Polypoid mass –Ulcer crater –Thickened fibrotic gastric wall

14. Interventions Meds: chemotherapy –Fluruorouracil (5-FU) –Doxorubicin –Mitomycin-C –Cisplatin –Etopide (best results when used in combination with each other) Side Effects include nausea/vomiting and bone marrow suppression

15. Interventions cont. Radiation –Used most commonly for pre-op –Used in specific hospitals for intra-op –Does not increase survival after operations Side Effects include skin integrity, fatigue, anorexia, and diarrhea

16. Surgical Interventions Surgery is the preferred method of treatment –Curative: Total gastrectomy Subtotal gastrectomy –Palliative: To relieve patients pain and ease their suffering

17. Nursing Interventions Teach: –s/s of dumping syndrome –Eat small, frequent meals –No liquids with meals (one hour before or after) –Increase protein, fat, and caloric intake –Decrease carbohydrates –Increase Iron, Vit B12, and folate –Dressing changes –Side effects of chemo/radiation –Always provide emotional support

18. Gastric Carcinoma

19. Questions? True or False: Lab findings have shown stool positive for occult blood, decreased hematocrit and hemoglobin, and hypoalbuminemia in patients with gastric carcinoma True or False: Most people will show many signs and symptoms indicating gastric cancer True or False: People who have had gastritis are at a higher risk of developing gastric ca.

20. Grading Criteria Joint effort by Elaine M. Lund and Monique Kolin