STOMACH CA

A disease in which malignant (cancer) cells form in the lining of the stomach

Nomal gastric mucosa

- Age - Median age 70
- Helicobacter pylori infection
- Sex - 2:1 Male: Female Acquisition of - Chronic gastritis (Atrophic type)
- Family History Helicobacter pylori - Hypochlahydria
- Blood type A group - Intestinal metaplasia
- Pernicious Anemia - Smoking & Alcohol Abuse
- Genomic Instability - Obesity
- Genetic Defect of CDH1 gene - Dietary Factors (Pickled/ Cured/ Processed)
- Hereditary Non-polyposis Colorectal Cancer (HPCC) - Occupational Exposure
- Familial gastric carcinoma syndrome - Low socioeconomic status

Asymptomatic Symptomatic
acquisition acquisition
- Stool antigen test
- Stool PCR test
- Urea breath test
- Upper endoscopy exam

Familial Sporadic Smoking and Alcohol Chronic H. pylori Infection

Higly Salted Foods (Accounts 80% of Gastric
Consumption
Cancer)

Loss of function mutation in Induces hypergastrinemia & Increase production of Ache or burning pain in
Sporadic Diffuse Type Sporadic Intestinal Type Chronic inflamation of gastric your stomach (abdomen),
the tumour suppressor gene endogenous mutations protaglandins that maintain
CHD1 gastric mucosal integrity mucusa Nausea, Bloating
Preventions of
Gastric Cancer Loss of E-Cadherin
Loss of function Gain of function mutation in the Promotes epithelial cell Irritates the Atrophic Gastritis - Proton pump inhibitors
mutation of APC gene gene encoding B-Catenin proliferation stomach lining - Bismuth subsalicylate
Loss of function - Histamine (h-2) blockers
Codes cell adhesion mutation in tumor
protein E-Cadherin supressor gene CDH1 Favours bacterial growth and Severe stomach
Dietary Modifictions continuation of chronic (abdominal pain) & Bloody
inflamation Headache
Screening & Eradication of and black tarry stools
Rash
H. pylori infection Increases H. pylori
Increase signaling via Dizziness
Wnt pathway colonization
Nausea
- Reduce intake of salt & salted foods Hypermethylation Silencing of CDH1 promoter Loss of appropriate glands Flatulence
- Avoid food that containes high nitrate (Mucosal atrophy) Constipation
level Mutation of TP53 Diarrhea
- Reduce intake of red meat
- Increase intake of fruits and
vegetables Decreases E-Cadherin
Loss of function - Physical exam and health history Transformation of the cells in the
expression
mutation in BAX gene & - Blood chemistry studies lining of upper digestive tract
CDKN2A - Complete blood count
- Upper endoscopy
BRCA2 Mutations
- Barium swallow Acute Pain
- CT Scan
Presence of abnormal cells within
- Biopsy
the tissues of the stomach.
- Assess characteristics of pain and
discomfort ; location, quality,
frequency, duration, etc.
GASTRIC CANCER - Reassure the patient that you
know, the pain is real and that you
will assist the patient in reducing
the pain.
- Collaboration in analgesic
administration to improve
The cancer has grown into the The cancer has grown into the The cancer has grown through all The cancer of any size that has circulation within the optimal pain
Cancer is found only on the inner layer of the wall of the outer muscular layers of the wall of of the layers of the muscle into the spread to distant parts of the body prescription.
surface of the epithelium stomach the stomach connective tissue outside the in addition to the area around the - Teach the patient new strategies to
stomach and has grown into stomach relieve pain and discomfort with
nearby organs or structures. distraction, imagination, relaxation.
The cancer has not grown into any The cancer has grown through all
It has not spread to any lymph It has spread to 1 to 2 lymph
other layers of the stomach nodes or other organs nodes but not elsewhere of the layers of the muscle into the
connective tissue outside the
It may or may not have spread to 1 It has spread to 7 or more lymph
stomach It has not spread to any lymph
to 6 lymph nodes but not to distant nodes but not to other parts of the Stage IV
nodes or distant parts of the body body
Stage 0 parts of the body

Stage IA Stage IB
It has not grown into the peritoneal It has not grown into the peritoneal
lining or serosa. It has spread to 1 to 2 Stage IIIA Stage IIIB Stage IIIC
- Surgery (total or subtotal lining or serosa or spread to any lymph
nodes or surrounding organs lymph nodes but not elsewhere
gastrectomy)
- Endoscopic mucosal resection - Third-line palliative therapy
- Surgery (total or subtotal gastrectomy) - First-line palliative therapy - Second-line palliative (radiation therapy) with
- Endoscopic mucosal resection Stage IIA Stage IIB includes immunotherapy therapy includes: chemotherapy drugs
- Chemotherapy combined with chemotherapy: - Chemotherapy. - Endoluminal laser therapy
- Chemoradiation therapy - Chemotherapy drugs - Chemotherapy Drugs or endoluminal stent
- A clinical trial of chemoradiation therapy

- Surgery (total or subtotal gastrectomy)

- Endoscopic mucosal resection
- Chemotherapy
- Chemoradiation therapy
- A clinical trial of chemoradiation therapy
- A clinical trial of chemotherapy and immunotherapy

Early Stages Advanced Stages

Cancer cells irritate the lining of The cancer can cause blockage in The cancer tends to Chemotherapy may alter
Chemotherapy and radiation to Tumor bleeding occurs The cancer cells spreads Swelling in the
the abdomen the stomach suppress appetite the normal bacterial flora
chest or upper abdomen to the liver organ oesophagus after surgery
that is present in the
intestines
Stops food from passing through Release hormones that Feces turns darker -
Lymph glands in the abdomen get may distort body's
Increased production of stomach the digestive system almost black Longer to chew and swallow, coughing
blocked and can't drain fluid perception of hunger Liver cells are damaged
acid Affects the digestion or choking while eating or drinking, or
properly
food sticking in your mouth or throat
Nausea Blood in the stool like a ball.
Indigestion and stomach
Unintentional weight loss
discomfort Buildup of fluid (ascites) in Stomach Pain Bilirubin level in the blood
the abdomen then increases
Dysphagia

Bloated Jaundice

Chemotherapy Drugs
- Surgery (total or subtotal gastrectomy) - Oxaliplatin plus 5-FU/leucovorin (FOLFOX), or
- Endoscopic mucosal resection Chemotherapy Drugs
oxaliplatin plus capecitabine (CAPOX) - Oxaliplatin plus 5-FU/leucovorin (FOLFOX), or
- Chemotherapy - FLOT (5-FU/leucovorin, oxaliplatin, and docetaxel) - Third-line palliative therapy oxaliplatin plus capecitabine (CAPOX)
- Chemoradiation therapy - Physical exam and health history - First-line palliative therapy - Second-line palliative
- Docetaxel or paclitaxel plus either 5-FU or (radiation therapy) with - Cisplatin plus either 5-FU or capecitabine
- A clinical trial of chemoradiation therapy - Blood chemistry studies capecitabine includes immunotherapy therapy includes:
- Complete blood count chemotherapy drugs - Irinotecan plus 5-FU/leucovorin (FOLFIRI)
- Cisplatin plus either 5-FU or capecitabine combined with chemotherapy: - Chemotherapy. - Endoluminal laser therapy - Physical exam and health history
- Upper endoscopy - Paclitaxel plus either cisplatin or carboplatin
- Paclitaxel and carboplatin - Chemotherapy drugs - Chemotherapy Drugs or endoluminal stent - Blood chemistry studies
- Barium swallow - Docetaxel plus cisplatin
- Complete blood count
- CT Scan - Epirubicin, either cisplatin or oxaliplatin, and either
- Upper endoscopy
- Biopsy 5-FU or capecitabine
- Barium swallow
- Docetaxel, 5-FU, and either cisplatin, carboplatin, or
- CT Scan
oxaliplatin
- Tiredness - Biopsy
- Feeling and being sick
- Hair loss
- Infections - Tiredness
- Anaemia - Feeling and being sick
- Bruising and bleeding - Hair loss
- Sore mouth - Infections
- Loss of appetite - Anaemia
- Bruising and bleeding
- Sore mouth
- Loss of appetite

Chronic/ Acute Pain Imbalanced Nutrition : Anxiety

Less than body requirements

- Monitor the patient's activity - Teach the patient the following - Provide a relaxed environment and
tolerace things : avoid the sight, smell, non-threatening.
- Instruct the patient and family on sounds unpleasant in the - Encourage active participation of
appropriate prescribed and environment during meal times. the patient and family in care and
over-the-counter medications - Suggest eating preferred and well treatment decisions.
- Instruct the patient and family on tolerated by the patients, better - Instruct the patient to discuss
cardiac risk factor modification food with high content of calories / personal feelings with the
- Instruct the patient and family on protein. Respect the patient?s food supporters of such clergy if
the exercise regimen, including preferences based on ethnicity. desired.
warm-up,endurance, and - Encourage adequate fluid intake,
cool-down, as appropriate but limit fluids at mealtime.
- Promote bed rest and activity - Increase fluid levels with food can
limitation lead to a state of satiety. Consider
the cold food, if desired.
- Collaborative provision of
commercial liquid diet by way of
enteral feeding through a tube,
elemental diet.

Legends:
ETIOLOGY PREDISPOSING PRECIPITATING DISEASE PROCESS PATHOGENESIS CLASSIFICATIONS SIGNS & SYMPTOMS DIAGNOSTIC TEST MEDICATION SIDE EFFECTS MEDICAL MGT NURSING Dx NURSING INTERVENTIONS LABORATORY FINDINGS PREVENTIONS

SUBMITTED BY:

SANG-AN, DARWIN JAY L.

DABLIO, NIKKA

BSN - 3B