- 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.
- Most often, the patient presents with the same symptoms as gastric ulcer. Later, evaluation shows the lesion to be malignant.
- Gastric fullness (early satiety), dyspepsia lasting more than 4 weeks, progressive loss of appetite are initial symptoms.
- Stool samples are positive for occult blood.
- Vomiting may occur and may have coffee-ground appearance.
- Later manifestations include pain in black or epigastric area (often induced by eating, relieved by antacids or vomiting); weight loss; hemorrhage; gastric obstruction.
- Upper GI X-ray with contrast media may initially show suspicious ulceration that requires further evaluation.
- Endoscopy with biopsy and cytology confirms malignant disease.
- Imaging studies (bone scan, liver scan, CT scan) helps determining metastasis.
- Complete blood count (CBC) may indicate anemia from blood loss.
- 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.
- 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.
- Surgery may be combined with chemotherapy to provide palliation and prolong life.
- 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.
- 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.
- 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.