Chapter 5 today

Cancer of the Stomach

  • Overview of Gastric Cancer

Also known as stomach cancer.

  • At its peak in the 1930s, it was the leading cause of death.

  • Historical Context:

Peak rates thought to be related to the prohibition era which led to harmful alcohol production (moonshine).

  • Current Trends:

Incidence and mortality rates higher outside of the United States, particularly in less developed regions.

Highest rates found in Japan, China, Southern and Eastern Europe, South and Central America.

Epidemiology

  • Demographics:

  • Primarily affects elderly populations.

Nearly two-thirds of cases occur in individuals over 65 years old.

Average age of diagnosis is 69 years.

  • Types of Cancer:

Adenocarcinoma is the primary type affecting the pyloric area of the stomach.

Increasing occurrences of distal and proximal tumors noted.

Metastasis

  • Possible metastasis sites include:

Lymph nodes

Liver

Spleen

Pancreas

Esophagus

Risk Factors and Etiology

  • Causative Agents:

No single agent identified as causative.

  • Development likely begins with nonspecific mucosal injury due to:

Aging

Autoimmune diseases

Repeated exposure to irritants: bile, anti-inflammatory agents, smoking.

  • Other risk factors:

Polyps

Pernicious anemia

Hypochlorhydria (deficiency of hydrochloric acid)

Chronic atrophic gastritis

Gastric ulcers

  • Diet Influence:

  • Diets high in salt, smoked, and preserved foods (nitrites and nitrates) increase gastric cancer risk.

Recommendations to avoid nitrates and nitrites, e.g., processed meats like bacon.

Importance of fresh fruits, vegetables, and whole grains to reduce cancer risk.

Clinical Manifestations

  • Early Symptoms:

  • May be vague such as:

Epigastric discomfort

Indigestion

Early satiety (feeling full quickly)

Postprandial fullness

Ulcer-like pain not responding to therapy.

Patients may appear pale and lethargic, with possible anemia, poor appetite, and significant weight loss (cachexia).

  • Objective Data:

Weight loss

Hematemesis (vomiting blood)

Diarrhea, including blood in stools.

Symptoms of anemia due to chronic blood loss from mucosal erosion.

Diagnostic Procedures

  • Endoscopic Examination:

Gastroscopy allows direct visualization of gastric mucosa.

Enables biopsy collection for staging cancer.

  • Ascites Presence:

Indicates poor prognosis often due to metastatic liver disease.

  • Blood Tests:

Carcinoembryonic antigen (CEA) test: not specific to gastric cancer but elevated in various cancers.

Additional marker tests include RCA1919.

Treatment Options

  • Dependent on cancer staging:

  • Multi-modal approach may involve surgery, chemotherapy, and radiation.

  • Surgical options include:

Radical gastrectomy

Partial gastrectomy (illustrated variations in textbooks).

Total gastrectomy (removal of the entire stomach).

Dumping Syndrome

  • Definition and Cause:

  • Rapid gastric emptying of undigested food into the small intestine causing:

Distention of the duodenum and jejunum, increased motility, and hypoglycemic episodes.

  • Symptoms:

Diaphoresis

Vomiting

Epigastric pain

Explosive diarrhea

Borborygmi (rumbling sounds).

  • Occurrence Rate:

Approximately 30-50% of patients post-surgery experience dumping syndrome.

Nutritional Management for Dumping Syndrome

  • Dietary Changes:

Eat six small, high-protein, high-fat meals daily, low in carbohydrates.

Avoid fluids during meals.

Consideration of anticholinergic agents to reduce motility.

Recommend reclining for one hour following meals.

  • Patient Educations:

Compliance is essential for symptom management.

The symptoms are often self-limiting and may resolve within months to a year post-surgery.

Complications

  • Pernicious Anemia:

Often develops after total or extensive gastrectomy due to inadequate Vitamin B12 absorption.

Must monitor B12 levels and administer replacements via injections, nasal spray, or sublingually (oral forms ineffective post-surgery).

  • Wound Healing Issues:

Risk of dehiscence and evisceration post-surgery; education on splinting the abdomen to manage strain.

  • Postoperative Nurtition:

Emphasis on maintaining nutritional status prior to surgery (high protein intake).

Monitoring for weight loss and managing intravenous fluids (TPN) during early recovery.

Chemotherapy and Radiation

  • Therapeutic Use:

Based on the stage of the disease; chemotherapy and radiation are often recommended together.

Gastric Surgery and Metastasis

  • Artificial Stomach Creation:

Post-total gastrectomy, a small pouch from the small intestine may form an artificial stomach.

Nutritional needs are supported through TPN initially and later potentially by oral feeding once recovery allows.

Human Aspect in Care

  • Importance of considering patient life impact and emotional well-being throughout treatment.

Examples of patient gratitude and anecdotal connections highlight the human experience behind medical care.

Nurses should engage with patients as individuals and recognize the significant emotional and psychological aspects of care.

Celiac Disease

  • Overview:

Caused by gluten intolerance; recognized as an autoimmune disorder that worsens many conditions.

Relieving symptoms involves strictly avoiding gluten.

  • Symptoms of Celiac Disease May Include:

Behavioral: Mood swings, anxiety, depression.

Skin issues: Acne, eczema, rashes.

Gastrointestinal: Bloating, constipation, diarrhea, stomach pain.

Nutritional Deficiencies: Iron, B12, vitamin D, calcium.

Other: Chronic fatigue, weight fluctuations, joint pain, infertility issues, migraines.

  • Diagnosis:

Serology tests for antibodies and intestinal biopsy via endoscopy when the patient is still consuming gluten.

  • Dietary Management:

Avoid foods containing wheat, rye, and barley; gluten-free options are available in abundance today.

Conclusion

Engaging with patient narratives enhances the nurse's understanding of how medical conditions impact individuals outside their clinical presentations.

Continual education about dietary impacts and medical responses is crucial to successful patient management in gastric and intestinal disorders.