Gastric Cancer

• It is also called malignant tumor of the stomach.
• It is usually an adenocarcinoma.
• It spreads rapidly to the lungs, lymph nodes, and liver.
• Risk factors include chronic atrophic gastritis with intestinal metaplasia; pernicious anemia or having had gastric resections (greater than 15 years prior); and adenomatous polyps.
• This cancer is most common in men older than age 40 and in blacks.
• Complications are hemorrhage and dumping syndrome from surgery or widespread metastasis and death.

Assessment:

1. Most often, the patient presents with the same symptoms as gastric ulcer. Later, evaluation shows the lesion to be malignant.
2. Gastric fullness (early satiety), dyspepsia lasting more than 4 weeks, progressive loss of appetite are initial symptoms.
3. Stool samples are positive for occult blood.
4. Vomiting may occur and may have coffee-ground appearance.
5. Later manifestations include pain in black or epigastric area (often induced by eating, relieved by antacids or vomiting); weight loss; hemorrhage; gastric obstruction.

Diagnostic Evaluation:

1. Upper GI X-ray with contrast media may initially show suspicious ulceration that requires further evaluation.
2. Endoscopy with biopsy and cytology confirms malignant disease.
3. Imaging studies (bone scan, liver scan, CT scan) helps determining metastasis.
4. Complete blood count (CBC) may indicate anemia from blood loss.

Surgical Interventions:

1. The only successful treatment of gastric cancer is gastric resection, surgical removal of part of the stomach with involved lymph nodes; postoperative staging is done and further treatment may be necessary.
2. Surgical options include proximal or distal subtotal gastric resection; total gastrectomy (includes adjacent organs such as tail of pancreas, portion of liver, duodenum); or palliative surgery such as subtotal gastrectomy with gastroenterostomy to maintain continuity of the GI tract.
3. Surgery may be combined with chemotherapy to provide palliation and prolong life.

Nursing Interventions:

1. Monitor nutritional intake and weigh patient regularly.
2. Monitor CBC and serum vitamin B12 levels to detect anemia, and monitor albumin and prealbumin levels to determine if protein supplementation is needed.
3. Provide comfort measures and administer analgesics as ordered.
4. Frequently turn the patient and encourage deep breathing to prevent pulmonary complications, to protect skin, and to promote comfort.
5. Maintain nasogastric suction to remove fluids and gas in the stomach and prevent painful distention.
6. Provide oral care to prevent dryness and ulceration.
7. Keep the patient nothing by mouth as directed to promote gastric wound healing. Administer parenteral nutrition, if ordered.
8. When nasogastric drainage has decreased and bowel sounds have returned, begin oral fluids and progress slowly.
9. Avoid giving the patient high-carbohydrate foods and fluids with meals, which may trigger dumping syndrome because of excessively rapid emptying of gastric contents.
10. Administer protein and vitamin supplements to foster wound repair and tissue building.
11. Eat small, frequent meals rather than three large meals.
12. Reduce fluids with meals, but take them between meals.
13. Stress the importance of long term vitamin B12 injections after gastrectomy to prevent surgically induced pernicious anemia.
14. Encourage follow-up visits with the health care provider and routine blood studies and other testing to detect complications or recurrence.

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