STOMACH CANCER

DEFINITION
• Stomach cancer is characterized by a growth of cancerous cells within the lining
of the stomach.
• It is also called gastric cancer.
• This type of cancer is difficult to diagnose because most people typically don’t
show symptoms in the earlier stage.
INCIDENCE-
• The national cancer institute estimate there will be approximately 28000 new
cases of stomach cancer in 2017.
• The NCI also estimate that stomach cancer is 1.7% of new cases in the India.
• 5th most common cancer worldwide.
• 3rd leading cause of cancer related deaths.
ETIOLOGY & RISK FACTORS
• Infection with the H. pylori bacterium.
• Lymphoma (a group of blood cancer).
• High consumption of red meat.
• Smoking & alcohol abuse.
• A diet high in consumption of smoked & salted food.
• Previous stomach surgery
• Stomach polyps (abnormal growths of tissues that form on the lining of the stomach).
• People with a family history of the disease.
• Tumors in other parts of the digestive system.
• Genetics.
• Obesity.
• Lack of physical activity.
PATHOPHYSIOLOGY
Due to any etiological factors
|
New cells formation in the mucus membrane
|
Atrophy (Adenocarcinoma in the epithelial tissues)
|
Gastric Cancer
TNM CLASSIFICATION
• To- No evidence of primary tumor.
• Tis – Noninvasive carcinoma in-situ.
• T1 – Extension to sub-mucosa.
• T2 – Extension to serosa.
• T3 – Extension through serosa.
• T4 – Invasion of adjacent organs.
• No- No regional lymph node involvement.
• N1 – Metastasis in 1-6 regional lymph node.
• N2 – Metastasis in 7-15 regional lymph node.
• N3- Metastasis more than 15 regional lymph node.
• Mo- No distant metastasis.
STAGING OF GASTRIC CANCER
• Stage- 0- This is also called carcinoma in situ. The cancer is found only on the surface of the epithelium.
• Stage- Ia- The cancer has grown into the inner layer of the wall of stomach. It has no spread to any lymph nodes or
other organs.
• Stage- Ib- Two conditions.
1. The cancer has grown into the inner layer of the wall of the stomach. It has spread to 1-2 lymph nodes but not
elsewhere.
2. The cancer has grown into the outer muscular layers of the wall of the stomach. It has not spread to lymph node
or other organs.
• Stage- IIa- The cancer has grown into the inner layer of the wall of the stomach. It has spread to 3-6 lymph nodes
but not elsewhere.
• Stage- IIb- The cancer has grown into the inner layer of the wall of the stomach. It has spread to 7 or more lymph
nodes but not elsewhere.
• Stage- IIIa- The cancer has grown into the outer muscular layers of the stomach wall. It has spread to 7 or more
lymph nodes but not elsewhere.
• Stage- IIIb- The cancer has grown through all of the layers of the muscle into the connective tissue outside the
stomach but has not grown into the peritoneal lining or serosa.
• Stage-IV- It describes a cancer of any size that has spread to distant part of the body in addition to the area around
STAGING OF GASTRIC CANCER
CLINICAL MANIFESTATIONS
• Discomfort or pain in the stomach area.
• Difficulty in swallowing.
• Nausea/Vomiting
• Weight loss
• Poor appetite
• Feeling of fullness
• Heart burn.
• Vomiting with or without blood.
• Fatigue
• Iron deficiency anemia
• Blood in stool.
DIAGNOSTIC EVALUATION
• History collection
• Physical examination
• Upper GI endoscopy
• USG
• Biopsy
• CT scan
• MRI
• PET scan
• Lab test- CBC, LFT, RFT
DIAGNOSTIC EVALUATION
 MANAGEMENT
1. SURGERY-
• It is the most commonly treatment & is the only hope of cure for stomach cancer.
• The surgeon removes parts or all of the stomach as well as the surrounding lymph
node with the basic goal of removing all cancer & a margin of normal tissues.
• Endoscopic mucosal resection.
• Gastrectomy
• Billroth-I
• Billroth-II
2. Radiation therapy- Patient with stomach cancer usually receive external
beam radiation therapy. In some cases intra-operative radiotherapy is used.
 MANAGEMENT
3. CHEMOTHERAPY-
• 5- Fluorouracil with leucovorin (folinic acid).
• Cisplatin
• Carboplatin
• Paclitaxel
Prevention of stomach cancer-
• Take an occasional aspirin
• Don’t smoke & tobacco use
• Avoid red meat
• Get enough calcium & vitamin-D
• Exercise
 MANAGEMENT
4. IMMUNOTHERAPY-
• It is use of medicines that help a person own immune system find & destroy cancer cells.
• It can be used to treat some people with stomach cancer.
• Example- Pembrolizumab- It shrink some tumor or slow their growth.
NURSING MANAGEMENT-
• Monitor nutritional intake & weight patient regularly.
• Provide comfort measures.
• Administer analgesics & other medications as per order.
• Maintain nasogastric suction to remove fluids & gas in the stomach.
• Provide oral care to prevent dryness & ulceration.
• Keep the patient NBM as directed to promote gastric wound healing.
• Administered parentral nutrition if needed.
• Administer protein & vitamins supplements to faster wound repair & tissue healing