This ppt has all the details about stomach cancer that will help oncology nursing students, as well as bsc and msc nursing students, and medical students.

1. STOMACH
CANCER
Presented by
Monika
M.Sc nursing 2nd year (oncology)
1

2. Statistics about stomach cancer
• Gastric cancer is the fifth most frequently diagnosed cancer and third
leading cause of cancer-related mortality in the world
• The American Cancer Society’s estimates for stomach cancer (also
known as gastric cancer) in the United States for 2022 are:
• About 26,380 new cases of stomach cancer (15,900 in men and 10,480
in women)
• About 11,090 deaths from this type of cancer (6,690 men and 4,400
women)
• Stomach cancer accounts for about 1.5% of all new cancers diagnosed
in the US each year.
2

3. Introduction
 Stomach cancer, also called gastric cancer, begins when cells in the
stomach start to grow out of control.
Stomach cancer mostly affects older people. The average age of people
when they are diagnosed is 68. About 6 of every 10 people diagnosed with
stomach cancer each year are 65 or older.
The lifetime risk of developing stomach cancer is higher in men (about 1 in
96) than in women (about 1 in 152). But each person's risk can be affected
by many other factors.
3

4. Stomach
The stomach is a sac-like organ that’s an
important part of the digestive system.
After food is chewed and swallowed, it
enters the esophagus, a tube that carries
food through the throat and chest to the
stomach.
The esophagus joins the stomach at
the gastroesophageal (GE) junction, which
is just beneath the diaphragm (the thin sheet
of breathing muscle under the lungs).
The stomach then starts to digest the food
by secreting gastric juice. The food and
gastric juice are mixed and then emptied into
the first part of the small intestine called
the duodenum.
4

5. Parts of the stomach
The stomach has 5 parts.
The first 3 parts make up the proximal
stomach:
Cardia: the first part, which is closest to the
esophagus
Fundus: the upper part of the stomach next
to the cardia
Body (corpus): the main part of the stomach,
between the upper and lower parts
5

6. Parts of the stomach Cont….
Some cells in these parts of the stomach make acid and pepsin (a
digestive enzyme), which combine to make the gastric juice that helps
digest food.
They also make a protein called intrinsic factor, which the body needs
to absorb vitamin B12.
• The lower 2 parts make up the distal stomach:
• Antrum: the lower portion (near the small intestine), where the food
mixes with gastric juice
• Pylorus: the last part of the stomach, which acts as a valve to control
the emptying of the stomach contents into the small intestine
6

7. The stomach wall has 5 layers
The innermost layer is the mucosa. This is where
stomach acid and digestive enzymes are made. Most
stomach cancers start in this layer. Next is a supporting
layer called the submucosa.
Outside of this is the muscularis propria, a thick layer of
muscle that helps move and mix the stomach contents.
The outer 2 layers, the subserosa and the
outermost serosa, wrap the stomach.
The layers are important in determining the stage (extent)
of the cancer, which can affect a person’s treatment options
and prognosis (outlook). As a cancer grows from the
mucosa into deeper layers, the stage becomes more
advanced and treatment might need to be more extensive.
7

8. Development of stomach cancer
Stomach cancers tend to develop slowly over many years.
Before a true cancer develops, pre-cancerous changes often
occur in the inner lining (mucosa) of the stomach. These early
changes rarely cause symptoms, so they often go undetected.
Cancers starting in different sections of the stomach can
cause different symptoms and tend to have different outcomes.
The cancer’s location can also affect treatment options.
For example, cancers that start at or grow into the GE junction
are usually staged and treated the same as cancers of the
esophagus. (For more information, see Esophagus Cancer.)
8

9. Types of stomach cancer
• Adenocarcinomas
• Most cancers of the stomach (about 90% to 95%) are
adenocarcinomas. These cancers develop from the gland cells in the
innermost lining of the stomach (the mucosa).
• There are 2 main types of stomach adenocarcinomas:
1) The intestinal type tends to have a slightly better prognosis
(outlook). The cancer cells are more likely to have certain gene
changes that might allow for treatment with targeted drug therapy.
2) The diffuse type tends to grow spread more quickly. It is less
common than the intestinal type, and it tends to be harder to treat.
9

10. 10

11. Types of stomach cancer cont…
Other types of cancer that can start in the stomach
1. Gastrointestinal stromal tumors (GISTs) These uncommon tumors
start in very early forms of cells in the wall of the stomach called
interstitial cells of Cajal. Some GISTs are much more likely than
others to grow into other areas or spread to other parts of the body.
2. Neuroendocrine tumors (NETs) start in cells in the stomach (or
other parts of the digestive tract) that act like nerve cells in some
ways and like hormone-making (endocrine) cells in others. Most
NETs tend to grow slowly and do not spread to other organs, but
some can grow and spread quickly.
11

12. Types Cont…
3. Lymphomas- These cancers start in immune system cells called
lymphocytes. Lymphomas usually start in other parts of the body, but
some can start in the wall of the stomach. The treatment and outlook
for these cancers depend on the type of lymphoma and other factors.
4. Other cancers
• Other types of cancer, such as squamous cell carcinomas, small cell
carcinomas, and leiomyosarcomas, can also start in the stomach, but
these cancers are very rare.
12

13. Risk factors
Gender- more common men> female
Age- can occur in younger people, but the risk goes up in older.
Geography- Worldwide, stomach cancer is more common in East
Asia, Eastern Europe, and South and Central America. This disease is
less common in Africa and North America.
Helicobacter pylori infection
• Infection with Helicobacter pylori (H pylori) bacteria seems to be a
major cause of stomach cancer, especially cancers in the lower (distal)
part of the stomach.
• Long-term infection of the stomach with this germ may lead to atrophic
gastritis and other pre-cancerous changes of the inner lining of the
stomach.
13

14. Risk factors cont….
Being overweight or obese- is linked with an increased risk of
cancers of the cardia
Diet- foods preserved by salting, such as salted fish and meat and
pickled vegetables. Eating processed, grilled, or charcoaled meats
regularly appears to increase risk of non-cardia stomach cancers
Alcohol & Tobacco use
Previous stomach surgery
Some types of stomach polyps (adenomas)
Pernicious anemia
14

15. Risk factors cont….
Hereditary diffuse gastric cancer (HDGC)- This syndrome is most often
caused by mutations in the CDH1 gene.
Lynch syndrome (hereditary non-polyposis colorectal cancer, or
HNPCC)- his syndrome is caused by mutations in one of the mismatch repair
(MMR) genes, such as MLH1 or MSH2. These genes normally help repair
DNA that has been damaged.
Li-Fraumeni syndrome is caused by a mutation in the TP53 gene.
Gastric adenoma and proximal polyposis of the stomach (GAPPS)- This
rare condition is caused by a mutation in a specific part of the APC gene.
Epstein-Barr virus (EBV) infection
Certain occupations- Workers in the coal, metal, and rubber industries
Having type A blood- For unknown reasons, people with type A blood have
a higher risk of getting stomach cancer.
15

16. Causes of Stomach Cancer
Pre-cancerous changes in the stomach- pre-cancerous can occur in
the inner lining of the stomach.
 In Atrophic gastritis
 intestinal metaplasia.
 Both atrophic gastritis and intestinal metaplasia can lead to having too
few gland cells, which would normally secrete substances that help
protect the cells in the stomach’s inner lining. Damage to the DNA
inside these cells can sometimes lead to dysplasia, in which the cells
become larger and very abnormal looking (more like cancer cells).
 Inherited versus acquired gene mutations
16

17. Causes cont…
Changes in genes (DNA) in stomach cancer cells-
 H pylori bacteria, particularly certain subtypes, can convert substances
in some foods into chemicals that cause mutations (changes) in the
DNA of the cells in the stomach lining. T
 his may help explain why certain foods such as preserved meats
increase a person’s risk for stomach cancer.
 On the other hand, some of the foods that might lower stomach cancer
risk, such as fruits and vegetables, contain antioxidants (like vitamins A
and C) that can block substances that damage a cell’s DNA.
 Cancers can be caused by DNA changes that keep oncogenes turned
on, or that turn off tumor suppressor genes.
17

18. 18

19. Signs and Symptoms
Early-stage stomach cancer (gastric cancer) rarely causes
symptoms.
Signs and symptoms, they can include:
• Poor appetite
• Weight loss (without trying)
• Abdominal (belly) pain
• Vague discomfort in the abdomen, usually above the navel
• Feeling full after eating only a small meal
• Heartburn or indigestion
19

20. Signs and Symptoms cont…
• Nausea
• Vomiting, with or without blood
• Swelling or fluid build-up in the abdomen
• Blood in the stool
• Feeling tired or weak, as a result of having too few red blood
cells (anemia)
• Yellowing of the skin and eyes (jaundice), if the cancer spreads
to the liver
20

21. AJCC TNM STAGING SYSTEM
TX Main tumor cannot be assessed due to lack of information.
T0 No evidence of a primary tumor
TIS There is high grade dysplasia (very abnormal looking cells) in the stomach lining,
OR there are cancer cells only in the top layer of cells of the mucosa (innermost
layer of the stomach) that have not grown into deeper layers of tissue such as the
lamina propria
T1 The main tumor has grown from the top layer of cells of the mucosa into the next
layers below such as the lamina propria, the muscularis mucosa, or submucosa
T2 The main tumor is growing into the muscularis propria laye
T3 The main tumor is growing into the subserosa layer (T3)
T4a The main tumor has grown through the stomach wall into the serosa, but it has not
grown into any of the nearby organs or structures
T4b The main tumor has grown through the stomach wall and into nearby organs or
structures
21

22. NX Regional lymph nodes cannot be assessed due to lack of
information
N0 The cancer has not spread to nearby lymph nodes
N1 The cancer has spread to 1 to 2 nearby lymph nodes
N2 The cancer has spread to 3 to 6 nearby lymph nodes
N3a the cancer has spread to 7 to 15 nearby lymph nodes
N3b the cancer has spread to 16 or more nearby lymph nodes
M0 The cancer has not spread to distant parts of the body
M1 The cancer has spread to distant organs such as the liver,
lungs, brain, or the peritoneum (the lining of the space around
the digestive organs) 22

23. Stomach Cancer Stages According to
AJCC TNM staging system
AJCC STAGE STAGE GROUPING
0 Tis N0 M0
IA T1 N0 M0
IB T1 N1 M0, T2 N0 M0
IIA T above T2, N0-N3a, M0
IIB T1 N3a M0, T2 N2 MO, T3 N1 M0, T4a N0 M0
IIIA T above T2, Any N, M0 (T2 N3a M0, T3 N2 M0, T4a N1 M0, T4a N2
M0, T4b N0 M0)
IIIB T1 N3b M0, T2 N3b M0, T3 N3a M0, T4a N3a M0, T4b N1/N2 M0
IIIC T above T3, N3a/ N3b, M0
IV ANY T, ANY N, M1 23

24. Diagnosis
• Medical history- symptoms (such as eating problems, pain,
bloating, etc.) and possible risk factors to see if they might
suggest stomach cancer or another cause.
• Physical exam- can give information about possible signs of
stomach cancer or other health problems. Abdominal
examination for anything abnormal.
• Lab tests- blood test to look for anemia, blood in stool, vitamin
B12
24

25. Diagnosis cont….
• Upper endoscopy- also
called esophagogastroduodenoscopy or EGD) is the test most
often done.
• During this test, passes an endoscope, which is a thin, flexible,
lighted tube with a small video camera on the end, down your throat.
• This helps to see the inner lining of esophagus, stomach, and first
part of the small intestine.
• If abnormal areas are seen, biopsy samples can be removed using
instruments passed through the endoscope. The tissue samples are
sent to a lab, where they are looked at with a microscope to see if
they contain cancer.
25

26. Diagnosis cont….
Biopsy- most often done during upper endoscopy, removes
small pieces of the abnormal area.
• Some stomach cancers can start deep within the stomach wall,
which can make them hard to biopsy with standard endoscopy.
• If suspects cancer might be deeper in the stomach wall,
endoscopic ultrasound can be used to guide a thin, hollow
needle into the wall of the stomach to get a biopsy sample.
26

27. Diagnosis cont….
• Testing biopsy samples:
• HER2 (growth-promoting protein) testing- The biopsy sample is
usually tested for HER2 using either immunohistochemistry
(IHC) or fluorescent in situ hybridization (FISH).
• If the results are 0 or 1+, the cancer is HER2-negative, so drugs
targeting HER2 aren’t likely to be helpful.
• If the test comes back 3+, the cancer is HER2-positive, so
treatment with drugs targeting HER2 could be an option.
• When the result is 2+, the HER2 status of the cancer is not
clear, so it needs to be tested with FISH to clarify the result.
27

28. Diagnosis cont….
Testing for other gene or protein changes:
• If the cells have a certain amount of an immune checkpoint protein
called PD-L1, treatment with an immune checkpoint inhibitor such as
pembrolizumab.
• If the cells have high levels of microsatellite instability (MSI-H) or
a defect in a mismatch repair gene (dMMR), treatment with an
immune checkpoint inhibitor.
• If the cells have a high tumor mutational burden (TMB-H),
meaning they have many gene mutations, treatment with an immune
checkpoint inhibitor.
• If the cells have changes in one of the NTRK genes, certain targeted
drugs for treatment
28

29. Diagnosis cont….
Imaging tests
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive
substances to create pictures of the inside of body. Imaging tests may
be done for a number of reasons, including:
• To help find out if a suspicious area might be cancer
• To learn how far cancer may have spread
• To help determine if treatment has been effective
Upper gastrointestinal (GI) series- X-Ray (barium)
Computed tomography (CT) scan= cross-sectional images of the
soft tissues. This can help determine the extent (stage) of the
cancer .
CT-guided needle biopsy 29

30. Diagnosis cont….
Endoscopic ultrasound- is often used to see how far a cancer
might have spread into the wall of the stomach, or into nearby
areas or nearby lymph nodes.
EUS-guided needle biopsy also can be used to help guide a
needle into a suspicious area to get biopsy sample.
Positron emission tomography (PET) scan- for this test
injected with a slightly radioactive form of sugar, which collects
mainly in cancer cells. The picture is not detailed like a CT or
MRI scan, but a PET scan can look for possible areas of cancer
spread in all areas of the body at once.
Magnetic resonance imaging (MRI)- can show detailed
images of soft tissues in the body. MRIs use radio waves and
strong magnets instead of x-rays. 30

31. Management of stomach cancer
1. Surgery
Surgery can be done for two main reasons:
• Surgery to remove the cancer
• Palliative surgery
Endoscopic resection
Endoscopic mucosal resection (EMR) and endoscopic
submucosal dissection (ESD) are procedures that can be used
to treat some very early-stage cancers, when the tumor is not
thought to have grown deeply into the stomach wall and the
chance of spread outside the stomach is very low.
31

32. Surgery cont….
Subtotal (partial) gastrectomy- Part of the stomach is
removed.
• sometimes along with part of the esophagus (in a proximal
gastrectomy)
• Or the first part of the small intestine (in a distal
gastrectomy).
• The remaining section of stomach is then reattached.
• Eating is much easier after surgery if only part of the
stomach is removed instead of the entire stomach.
32

33. Surgery cont….
Total gastrectomy
• This operation is done if the cancer has spread widely in the
stomach. It is also often advised if the cancer is in the upper
part of the stomach, near the esophagus.
• The surgeon removes the entire stomach, nearby lymph nodes,
and the omentum, and may remove the spleen and parts of the
esophagus, intestines, pancreas, or other nearby organs if the
cancer has reached them.
• The end of the esophagus is then attached to part of the small
intestine.
• This allows food to move down the intestinal tract.
• But people who have had their stomach removed can only eat a
small amount of food at a time.
33

34. Surgery cont….
Lymph node removal
• In either a subtotal or total gastrectomy, the nearby lymph nodes are
removed. This is known as a lymph node dissection or
lymphadenectomy
Palliative surgery for unresectable cancer
• For people with stomach cancer that can't be removed completely,
surgery can often still be used to help control the cancer or to help
prevent or relieve symptoms or complications.
Gastric bypass (gastrojejunostomy)
Subtotal gastrectomy
Feeding tube placement (gastrostomy tube or G tube in lower
part of stomach) or (jejunostomy tube or J tube in to small
intestine) Liquid nutrition can then be put directly into the tube.
34

35. Chemotherapy
 Chemotherapy (chemo) uses anti-cancer drugs that are injected
into a vein or given by mouth as pills.
 Chemo can be given before surgery for stomach cancer. This
is known as neoadjuvant treatment.
 Neoadjuvant treatment can often shrink the tumor and possibly
make surgery easier.
 Chemo may be given after surgery has been done to remove
the cancer. This is called adjuvant treatment.
 The goal of adjuvant chemo is to kill any areas of cancer that
may have been left behind but are too small to see.
 Chemo may help shrink the cancer or slow its growth, which
can relieve symptoms and help people live longer. 35

36. Chemotherapy cont….
Many different chemo drugs can be used to treat stomach cancer,
including:
• 5-FU (fluorouracil), often given along with leucovorin (folinic acid)
• Capecitabine
• Carboplatin
• Cisplatin
• Docetaxel
• Epirubicin
• Irinotecan
• Oxaliplatin
• Paclitaxel
36

37. Chemotherapy cont….
Earlier stage cancers, some common drug combinations used
before and/or after surgery include:
• Oxaliplatin plus 5-FU/leucovorin (FOLFOX), or oxaliplatin plus
capecitabine (CAPOX)
• FLOT (5-FU/leucovorin, oxaliplatin, and docetaxel)
• Docetaxel or paclitaxel plus either 5-FU or capecitabine
• Cisplatin plus either 5-FU or capecitabine
• Paclitaxel and carboplatin
• When chemo is given with radiation after surgery, a single drug
such as 5-FU or capecitabine may be used.
37

38. Chemotherapy cont….
Advanced stomach cancer, many of the same combinations of drugs can be
used, although often prefer combinations of 2 drugs rather than 3 to try to reduce
side effects. Some of the most commonly used combinations include:
• Oxaliplatin plus 5-FU/leucovorin (FOLFOX), or oxaliplatin plus capecitabine
(CAPOX)
• Cisplatin plus either 5-FU or capecitabine
• Irinotecan plus 5-FU/leucovorin (FOLFIRI)
• Paclitaxel plus either cisplatin or carboplatin
• Docetaxel plus cisplatin
• Epirubicin, either cisplatin or oxaliplatin, and either 5-FU or capecitabine
• Docetaxel, 5-FU, and either cisplatin, carboplatin, or oxaliplatin
• If a person isn’t healthy enough to get a combination of chemo drugs, a single
drug, such as 5-FU, capecitabine, docetaxel, or paclitaxel, might be used instead.
38

39. Chemotherapy cont….
Side effects of chemo
Chemo drugs attack cells in the body that are dividing quickly, which
can lead to side effects. These depend on the type and dose of drugs,
and the length of treatment. Side effects from chemo can include:
• Nausea and vomiting
• Loss of appetite
• Hair loss
• Diarrhea or constipation
• Mouth sores
• Increased chance of infection (from a shortage of white blood cells)
• Easy bleeding or bruising (from a shortage of platelets)
• Fatigue and shortness of breath (from a shortage of red blood cells)
39

40. Chemotherapy cont….
• Nerve damage (neuropathy): Cisplatin, oxaliplatin, docetaxel, and
paclitaxel can damage nerves. This can sometimes lead to
symptoms (mainly in the hands and feet) such as pain, burning or
tingling sensations, sensitivity to cold or heat, or weakness.
• Heart damage: Epirubicin and some other drugs can damage the
heart if used for a long time or in high doses.
• Hand-foot syndrome can occur during treatment with capecitabine
or 5-FU (when given as an infusion). This starts out as redness in
the hands and feet, which can then progress to pain and sensitivity
in the palms and soles. If it worsens, blistering, calluses, or skin
peeling can occur, sometimes leading to painful sores.
• Diarrhea is a common side effect with many chemo drugs, but it can
be particularly bad with irinotecan. It needs to be treated right away
— at the first sign of loose stools — to prevent severe dehydration. 40

41. Targeted drug therapy
• As researchers have learned more about the changes in cells
that cause cancer, they have developed newer drugs that
specifically target these changes. Targeted drugs work
differently from standard chemotherapy.
• Cancers with increased levels of HER2 are called HER2-
positive. Drugs that target the HER2 protein can often be
helpful in treating these cancers. EgTrastuzumab, For stomach
cancer, it is typically given once every 2 or 3 weeks along with
chemo.
41

42. Targeted drug therapy cont.….
• Drugs that target VEGF- One of the proteins that tells cells in
the body to make new blood vessels is called VEGF. The VEGF
protein does this by attaching to cell surface proteins called
VEGF receptors.
• Ramucirumab is a monoclonal antibody that binds to a VEGF
receptor. This keeps VEGF from binding to cells and telling
them to make more blood vessels. This can help slow or stop
the growth of some cancers.
• Ramucirumab is used to treat advanced stomach cancer,
most often after at least one chemo drug (or combination) stops
working.
• This drug is given as infusion into a vein (IV), typically once
every 2 weeks. It can be given by itself or along with chemo. 42

43. Targeted drug therapy cont.….
• TRK inhibitors- A very small number of stomach cancers have
changes in one of the NTRK genes. This causes them to make
abnormal TRK proteins, which can lead to abnormal cell growth
and cancer.
• Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are drugs
that target the TRK proteins.
• These drugs are taken as pills, once or twice daily.
43

44. Immunotherapy
• Immunotherapy is the use of medicines to help a person's own
immune system find and destroy cancer cells more effectively.
• Immune checkpoint inhibitors- it uses “checkpoint” proteins on
immune cells, which act like switches that need to be turned on (or
off) to start an immune response. Cancer cells sometimes use these
checkpoints to avoid being attacked by the immune system.
• Drugs that target these checkpoints (called immune checkpoint
inhibitors) can be used to treat some people with stomach cancer
44

45. Immunotherapy cont.…
• PD-1 inhibitors
• Nivolumab (Opdivo) and pembrolizumab (Keytruda) are drugs that
target PD-1, a protein on immune system cells called T cells. The PD-1
protein normally helps keep T cells from attacking other cells in the
body. By blocking PD-1, these drugs boost the immune response
against cancer cells. This can shrink some tumors or slow their
growth.
• Nivolumab can be used in people with advanced stomach cancer,
typically along with chemotherapy.
• This drug is given as an intravenous (IV) infusion, usually once every 2
or 3 weeks.
45

46. Immunotherapy cont.…
• Pembrolizumab can be used to treat advanced stomach cancer, typically after other
treatments including chemotherapy have been tried, and if the cancer cells have any of the
following:
• A high level of microsatellite instability (MSI-H) or a defect in a mismatch repair gene
(dMMR)
• A high tumor mutational burden (TMB-H), meaning they have many gene mutations
• serious side effects occur less often. These can include:
• Infusion reactions: This is like an allergic reaction, and can include fever, chills, flushing of
the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing.
• Autoimmune reactions: These drugs work by basically removing one of the safeguards on
the body’s immune system. Sometimes this causes the immune system to attack other parts
of the body, which can lead to serious or even life-threatening problems in the lungs,
intestines, liver, hormone-making glands, kidneys, skin, or other organs.
• If serious side effects do occur, treatment may need to be stopped and you may get high
doses of corticosteroids to suppress your immune system. 46

47. Radiation therapy
When is radiation therapy used?
• For some earlier stage cancers, radiation can be used along
with chemotherapy (chemo) before surgery to try to shrink the
cancer and make it easier to remove. (This combination is
known as chemoradiation.)
• After surgery, radiation therapy can be used along with chemo to
try to kill any cancer cells that weren't removed during the surgery.
This may help delay or prevent recurrence of the cancer.
• For cancers that can't be removed by surgery, radiation therapy
can sometimes be used to help slow the growth of the cancer and
ease symptoms, such as pain, bleeding, or eating problems.
47

48. Radiation therapy cont…..
Side effects from radiation therapy for stomach cancer can include:
• Skin problems, ranging from redness to blistering and peeling, in
areas the radiation passed through
• Nausea and vomiting
• Diarrhea
• Fatigue
• Low blood cell counts
• These usually go away within a few weeks after the treatment is
finished.
• When radiation is given with chemotherapy, side effects are often
worse.
48

49. 49

50. Nursing management
• Plan to have smaller, more frequent meals a day.
• Drink liquids before or after meals
• Cut down on very sweet foods and drinks such as cookies,
candy, soda, and juices.
• Help the patient and the family cope positively with the disease.
• Listen when the patient airs out their concerns regarding the
treatments, side effects and hospital stay.
• Encourage them to ask for clarifications when they are in doubt
or when they need facts regarding the disease process.
50

51. Nursing management cont….
• Monitor nutritional intake and weigh patient regularly.
• Monitor CBC and serum vitamin B12 levels to detect anemia, and
monitor albumin and pre albumin 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.
51

52. Nursing management cont….
• 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.
52

53. Discharge and Home Healthcare
Guidelines
• Teach the patient the importance of compliance with palliative
and follow-up care. Be sure the patient understands all
medications, including the dosage, route, action, and adverse
effects.
• Teach the patient the signs and symptoms of infection and how
to care for the incision. Instruct the patient to notify the
physician if signs of infection occur.
• Encourage the patient to seek psychosocial support through
local support groups (e.g., I Can Cope),clergy, or counseling
services. If appropriate, suggest hospice services.
• Teach the patient methods to enhance nutritional intake to
maintain ideal body weight.
53

54. Cont…
• Several small meals a day may be tolerated better than three
meals a day.
• Take liquid supplements and vitamins as prescribed. Refer the
patient to the dietitian for a consultation. T
• each family members and friends prevention strategies.
• Strategies include increasing the intake of fresh fruits and
vegetables that are high in vitamin C; maintaining adequate
protein intake; and decreasing intake of salty, starchy, smoked,
and nitrite- preserved foods.
54

55. Survival rates of stomach cancer
• SEER = Surveillance, Epidemiology, and End Results
• These numbers apply only to the stage of the cancer when
it is first diagnosed.
SEER stage 5-year relative survival rate
Localized 70%
Regional 32%
Distant 6%
All SEER stages combined 32% 55

56. Prevention
There is no sure way to prevent stomach cancer, but there are things that
could lower the risk.
• Diet, nutrition- includes plenty of colorful fruits and vegetables and whole
grains, and avoids or limits red and processed meats, sugar-sweetened
beverages, and highly processed foods.. Citrus fruits (such as oranges,
lemons, and grapefruit)
• Avoiding or limiting alcohol
• Getting to and staying at a healthy weight
• Getting regular physical activity
• Avoid smoking
• Treating H pylori infection
• Using aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen or naproxen seems to lower the risk of stomach cancer.
56

57. Patient education
To help maintain good health, survivors should also:
● Get to and stay at a healthy weight.
● Stay physically active and limit time spent sitting or lying down.
● Follow a healthy eating pattern that includes plenty of fruits,
vegetables, and whole grains, and that limits or avoids red and
processed meats, sugary drinks, and highly processed foods.
● Avoid or limit alcohol. If you do drink, have no more than 1 drink per
day for women or 2 per day for men.
57

58. References
• https://www.cancer.org/cancer/stomach-cancer/detection-diagnosis-
staging/detection.html
• https://www.cancer.org/cancer/stomach-cancer/detection-diagnosis-
staging/signs-symptoms.html
• https://www.cancer.org/cancer/stomach-cancer/detection-diagnosis-staging/how-
diagnosed.html
• https://www.cancer.org/cancer/stomach-cancer/detection-diagnosis-
staging/staging.html
• https://www.cancer.org/cancer/stomach-cancer/detection-diagnosis-
staging/survival-rates.html
• https://www.cancer.org/cancer/stomach-cancer/after-treatment.html
• https://www.cancer.org/cancer/stomach-cancer/treating/by-stage.html
• https://www.cancer.org/cancer/stomach-cancer/treaing/radiation-therapy.html
• https://www.cancer.org/cancer/stomach-cancer/treating/immunotherapy.html
58

59. References Cont…
• https://www.cancer.org/cancer/stomach-cancer/treating/targeted-therapies.html
• https://www.cancer.org/cancer/stomach-cancer/treating/chemotherapy.html
• https://www.cancer.org/cancer/stomach-cancer/treating/types-of-surgery.html
• https://www.cancer.org/cancer/stomach-cancer/treating.html
• https://www.cancer.org/cancer/stomach-cancer/detection-diagnosis-staging/how-diagnosed.html
• https://www.cancer.org/cancer/stomach-cancer/about.html
• https://www.cancer.org/cancer/stomach-cancer/about/key-statistics.html
• https://www.cancer.org/cancer/stomach-cancer/causes-risks-prevention/risk-factors.html
• https://www.cancer.org/cancer/stomach-cancer/causes-risks-prevention/what-causes.html
• https://www.cancer.org/cancer/stomach-cancer/causes-risks-prevention/prevention.html
• https://nursingcrib.com/nursing-notes-reviewer/medical-surgical-nursing/stomach-cancer-gastric-
cancer/#:~:text=Nursing%20Management%3A%201%20Plan%20to%20have%20smaller%2C%20more,drinks%
20such%20as%20cookies%2C%20candy%2C%20soda%2C%20and%20juices.
• https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/gastric-cancer/
• Role of radiation therapy in gastric adenocarcinoma - PMC (nih.gov) 59