Incidence

Common in India and Japan 35 45 age common Aetiology Predisposing factors chronic inflammation of the stomach, pernicious anaemia, achlorhydria, the presence of H.pylori Heredity Spirit Deficiency of antioxidants

Pathophysiology
Most gastric cancers are adenocarcinoma

Can occur in any portion of the stomach

Tumour infiltrates the surrounding Penetrates the wall of the stomach and the surrounding structures

Metasatasis through lymph to the peritoneal cavity occurs later in the disease

Gastric Cancer Symptoms & Signs

A loss of appetite, dyspepsia (liberal use of gastroscope advised)

Difficulty in swallowing particularly difficulty that increases over time

Vague abdominal fullness Abdominal fullness prematurely after meals, early satiety Nausea and vomiting Excessive belching

 Breath odor
Excessive gas (flatus)

Vomiting blood anaemia

Abdominal pain Weight loss A decline in general health Constipation

 Pain relieved with antacids resembles the pain benign ulcers. Symptoms of progressive disease will be seen

Treatment
No successful treatment If operable the tumour can be removed by radical total gastrectomy with oesophagojejunal anastomosis.

Palliative rather than radical surgery is performed if there is metastsis to other vital organs, such as liver to relieve symptoms of obstruction or dysphagia.

Chemotherapy
5-Fluorouracil, doxorubicin (Adriamycin), and mitomycin-C

Radiotherapy
Radiation therapy for palliation

Assessment
Tumour markers (blood analysis for antigens indicative of colon cancer) such as carcinoembryonic antigen, CA 19-9, and CA50 may help to determine the effectiveness of treatment. The levels have to decrease by treatment

Complications
Gastric outlet obstruction Haematemesis Thrombophlebitis (Trousseaus sign) and deep vein thrombosis; these are the effects of the cancer on thrombotic and haemastatic mechanisms.

Spread of the stomach carcinoma Direct spread penetrates involves adjacent organs Lymphatic spread permeation emboli supraclavicular nodes (Trosiers sign) Blood borne metastases liver lung bone Transperitoneal spread common after reaching serosa incurable ascites rectal shelf ovaries involved Krukenbergs tumours) umbilical involvement called sister Josephs nodule.

Cancer specimen

Cancer in the antrum of the stomach

Antral Carcinoma bleeding into the cavity

Carcinomatous growth

Prepyloric Carcinoma

Barium study filling defect caused by cancer stomach

Ulcerated Cancer Stomach

Cancer Stomach Barium Study

Ulcerous carcinoma

Nursing Process : The Patient with Gastric Cancer

Assessment History nutritional intake and status weight food tolerance appetite any relief of pain with antacids any H.pylori infection smoking drinking psychological status Nursing diagnosis Anxiety related to the disease and the anticipated treatment Altered nutrition, anorexia Pain due to cancer Anticipated grieving related to the diagnosis of cancer Knowledge deficit regarding self-care activities

Planning and goals

Reducing anxiety Attaining optimal nutrition Relieving pain Adjusting to the diagnosis and to anticipated lifestyle changes

Nursing Interventions A relaxed non threatening atmosphere is provided where the patient can express his anger, fear, anxiety etc. Encouraged to eat small frequent portions of non irritating foods to decrease gastric irritation vitamin supplements Relieve pain analgesic administeredcontinuous infusion of an opioid for severe pain Provide psychological support encouraged to express emotions to participate in treatment decisions

Services of clergy, psychiatric clinical nurse specialists, psychologists, social workers, and psychiatrists are made available
Spend time with the patient

Promoting home and community based care

Teach self care taking medications

Continuing care

Need for continuing care at home stressed. Care supervised. Complications reported
Evaluation

Status of emotional aspect nutrition pain drive for self care activity etc are evaluated