gastric cancer

1. .
By ; Junaidi Sahamuddin
Middle East University
KUWAIT

2. Introduction
• Gastrointestinal cancer refers to malignant conditions of
the Gastrointestinal tract.
• GI cancers do not discriminate between men and women.
• The symptoms relate to the organ affected and can include
obstruction (leading to difficulty swallowing or defecating),
abnormal bleeding or other associated problems.
• The treatment depends on the location of the tumor, as well
as the type of cancer cell.
• These cancer can arise anywhere in the GI tract.

3. Anatomy and physiology

4. Definitions ;
• Gastro-Intestinal (GI) cancer is a term for the
group of cancers that affect the digestive
system. This includes cancers of the
oesophagus, gallbladder, liver, pancreas,
stomach and bowel (the bowel includes the
small intestine, large intestine or colon and
rectum).

5. Type of GI Cancer
Esophageal Cancer
Gastric Cancer
Appendic Cancer
Colorectal Cancer
Anal Cancer
Bile Duct cancer
Carsinoid Tumor
Rectal Cancer
• Gastro intestinal Stroma
Tumors (GIST)
• Pancreatic
Neuroendocrine tumors
• Pancreatic Cancer
• Liver Cancer
• Smal intestine Cancer
• Gallblader Cancer

6. Type of GI Cancer
Esophageal Cancer
Gastric Cancer
Pancreatic Cancer
Colorectal Cancer

7. Esophageal Cancer

8. Esophageal Cancer
• Esophageal cancer develops in the
esophagus, a long tube that connects mouth
to stomach.
• more than 18,000 Americans are diagnosed
with esophageal cancer every year.
• Cancer of the esophagus has a much higher
incidence (10 to 100 times higher) in other
parts of the world, including China and
northern Iran (American Cancer Society,
2009).

9. Types of Esophageal Cancer
• 1. Adenocarcinoma
• 2. Squamous Cell Carcinoma

10. Causes and Risk Factors
Esophageal Cancer
• Although we don't know exactly what causes
esophageal cancer
Risk factors include:
Smoking Obesity
>> male Age over 70
Achalasia Barrett's esophagus
gastroesophageal reflux
disease
alcohol consumption

11. Symptoms Esophageal Cancer
• Painful or difficult swallowing. Patients often report
feeling like food is stuck in the throat or chest
• Weight loss and loss of appetite
• Pain in the middle of the chest behind
the breastbone ; his can include chest pain, pressure
or a feeling of burning in the throat
• Hoarseness and cough
• Persistent indigestion and heartburn

12. Diagnostic and Treatment
Esophageal Cancer
Diagnostic Treatment
Endoscopic surgery
biopsy and brushings radiation,
CT of the chest and
abdomen
chemotherapy,
Positron emission
tomography (PET)
Combination
Endoscopic ultrasound

13. Gastric Cancer

14. Gastric Cancer
• Stomach cancer, also called gastric cancer, is a
disease that develops when cancer cells form
in the lining of the stomach.
• More than 22,000 cases of stomach cancer are
diagnosed in the United States each year.
• but it is a leading cause of cancer death
especially in Japan, Eastern Europe, South
America and regions of the Middle East.

15. Causes and Risk Factors for
Gastric Cancer
• the exact causes unknown
Risk Factors for Gastric Cancer
Previous or family history >> male
Smoking cigarettes Helicobacter pylori
infection
Chronic gastritis Old age
A diet high in salted,
smoked, or poorly
preserved foods
A diet low in fruits and
veggies

16. Symptoms of Stomach Cancer
Symptoms in early stages Symptoms in advanced stages
Indigestion and stomach
discomfort
Trouble swallowing
A bloated feeling after eating Vomiting
Mild nausea Blood in the stool
Loss of appetite Weight loss for no known
reason
Heartburn Stomach pain
Jaundice
Ascites (buildup of fluid in the
abdomen)

17. Pathophysiology Stomach Cancer
Most gastric cancers are adenocarcinomas; they
can occur anywhere in the stomach. The tumor
infiltrates the surrounding mucosa, penetrating
the wall of the stomach and adjacent organs and
structures. The liver, pancreas, esophagus,
and duodenum are often already affected at the
time of diagnosis. Metastasis through lymph to
the peritoneal cavity occurs later in the disease

18. Diagnostic and Treatment
Stomach Cancer
Diagnostic Treatment
Advanced stage may be
palpable as a mass,
Ascites and hepatomegaly
surgery
barium x-ray
Chemotherapeutic,
Commonly used single-
agent
CT of the chest abdomen
and Pelvis
radiation
Endoscopic ultrasound

19. Cancer of the Pancreas

20. Cancer of the Pancreas
• Pancreatic cancer is a type of cancer that affects
the pancreas, an organ that lies behind the
stomach and in front of the spine.
• The second most prevalent cancer of the
gastrointestinal area.
• about 46,000 cases are diagnosed each year in
the United States
• In 2008, globally there were 280,000 new cases
of pancreatic cancer reported and 265,000
deaths.

21. Pancreatic Cancer Causes and Risk
Factors
• we cannot pinpoint what the causes
Risk Factors
Smoker 2 to 3 times
more developed than
non smoker
Race. African-American
are diagnosed more
frequently
Age >> 50 y/o Having Diabetes.
Chronic Pancreatitis. Family History.
Obesity

22. Symptoms of Pancreatic Cancer
• Jaundice (yellowing of the skin and whites of the
eyes)
• Light-colored stools
• Dark urine
• Pain in the upper or middle abdomen and back
• Weight loss for no known reason
• Loss of appetite
• Feeling very tired

23. Type of Pancreatic Cancer
• Exocrine Cancer
– Ampullary cancer
– Adenosquamous carcinoma
– Squamous cell carcinoma
– Signet ring carcinoma
– Pancreatoblastoma
• Endocrine Cancer/neuroendocrine tumors.
– Gastrinoma
– Insulinoma
– Glucagonoma

24. Diagnostic and Treatment
Pancreatic Cancer
Diagnostic Treatment
GI x-ray surgery
Spiral (helical) CT
80-90% accurate
radiation,
ERCP chemotherapy,
MRI Combination
Endoscopic ultrasound
Biopsy

25. Colorectal Cancer

26. Colorectal Cancer
• Colorectal cancer is the development
of cancer in the colon or rectum.
• In the United States, almost 150,000 new cases
and 52,000 deaths from colorectal cancer occur
annually (American Cancer Society [ACS], 2008).
• In Europe the five-year survival rate for colorectal
cancer is less than 60%.
• Globally more than 1 million people get
colorectal cancer every year

27. Causes and Risk Factors for
Colorectal Cancer
• the exact causes unknown
Risk Factors for Gastric Cancer
Previous or family history >> male
Smoking cigarettes Genital cancer or breast
cancer
lack of physical exercis Old age
History of gastrectomy.
colon cancer. adenomatous
polyps, inflammatory bowel
disease
Diet high intake of
fat, alcohol or red meat and
low-fiber diet

28. Symptoms Colorectal Cancer
• The symptoms are greatly determined by the
location of the tumor, the stage of the disease.
• The most common presenting symptom is ;
– worsening constipation.
– blood in the stool, decrease in stool caliber (thickness),
– loss of appetite, loss of weight.
– Nausea or vomiting .
– rectal bleeding.
– Anemia/
– weight loss.
– change in bowel habit

29. Pathophysiology
• Cancer of the colon and rectum is predominantly
(95%) adenocarcinoma (ie, arising from the
epithelial lining of the intestine) (ACS, 2008).
• It may start as a benign polyp but may become
malignant, invade and destroy normal tissues,
and extend into surrounding structures.
• Cancer cells may migrate away from the primary
tumor and spread to other parts of the body
(most often to the liver, peritoneum, and lungs)
(Field & Lipton, 2007).

30. Diagnostic and Treatment
Colorectal Cancer
Diagnostic Treatment
sigmoidoscopy surgery
barium enema radiation
Colonoscopy with biopsy
or cytology smears.
chemotherapy
Carcinoembryonic antigen
(CEA) studies
Palliative care
Endoscopic ultrasound

31. Nursing Management
• Maintaining Optimal Nutrition
• Providing Emotional Support
• Relieving Pain
• Preparing the Patient for Surgery and
Postoperative Care
• Maintaining Optimal Nutrition
• Providing Wound Care
• Monitoring and Managing Complications
• Removing and Applying the Colostomy Appliance
31

32. Nursing Care Plan
the major nursing diagnoses may include the following:
• Imbalanced nutrition, less than body requirements,
related to nausea and anorexia
• Risk for deficient fluid volume related to vomiting and
dehydration
• Anxiety related to impending surgery and the diagnosis
of cancer
• Pain related to tumor mass
• Impaired skin integrity related to the surgical incisions
(abdominal and perianal), the formation of a stoma,
and frequent fecal contamination of peristomal skin
32

33. Nursing Care Plan
• Disturbed body image related to colostomy
• Ineffective sexuality patterns related to presence
of ostomy and changes in body image and self-
concecpt
• Risk for ineffective therapeutic regimen management
related to knowledge deficit concerning the
diagnosis, the surgical procedure, and self-care after
discharge
• Anticipatory grieving related to the diagnosis of
cancer
• Deficient knowledge regarding self-care activities
33

34. Reference ;
1. Suzanne C, Brenda G, Janice L, Kerry H. Brunner and Suddarth Medical
and Surgical Nursing, Twelfth Edition, Lippincot William & Wilkins, 2010.
2. Linda S, Paula D. Understanding Medical and Surgical Nursing, Third
Edition, page: 1138, FA Davis 2007.
3. http://emedicine.medscape.com/article/1145144-overview.
4. http://en.wikipedia.org/wiki/Gastrointestinal_cancer
5. http://onlinelibrary.wiley.com/doi
34