Cancer Of The Stomach And Liver

Cancer of the Stomach • • • •

Cancer of the stomach is usually adenocarcinoma. It typically occurs in males and people older than age 40. Mostly occur in lesser curvature or antrum of the stomach and infiltrate surrounding mucosa, stomach wall, adjacent organs and structures. Prognosis is poor because most patients have metastases at the time of diagnosis.

Etiology      

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Diet – high in smoked food and lacking in fruits and vegetables Chronic inflammation of the stomach Pernicious anemia Achlorydria Gastric ulcers Helicobacter pylori bacteria ] Heredity

Clinical Manifestations  Early stages: symptoms may be absent or may resemble those of the patient with benign ulcers (eg, pain relieved with antacids)  Progressive disease: symptoms include: • Indigestion • Anorexia • Dyspepsia • Weight loss • Abdominal pain • Constipation • Anemia • Nausea and vomiting • Ascites Diagnostic Methods  Radiography of the upper gastrointestinal system with barium.  Endoscopy for biopsy and cytologic washings.

 CT scan, bone scan and liver scan to determine extent of metastasis.  Complete radiographic examination of the gastrointestinal tract if dyspepsia of more than 4 weeks’ duration in any person older than 40 years of age. Medical Management  Removal of gastric carcinoma; curative if tumor can be removed while still localized to the stomach.  Effective palliation (to prevent symptoms such as obstruction) by resection of the tumor; radical subtotal gastrectomy; total gastrectomy with anastomosis of the esophagus and jejunum  Chemotherapy  Radiation therapy Nursing Interventions Reducing anxiety  Provide relaxed, nonthreatening atmosphere  Advise about any procedure and treatment  Suggest patient to discuss feelings Promoting optimal nutrition  Encourage small, frequent feedings of non irritating foods to decrease gastric irritation  Ensure that food supplements are high in calories and vitamins A and C and iron.  Administer parenteral vitamin B12 indefinitely if total gastrectomy is performed  Monitor rate and frequency of IV  Record intake and output, amd daily weights  Administer antiemetics as prescribed Relieving pain  Administer analgesics as prescribed  Assess frequency, intensity and duration of pain to determine effectiveness of analgesic agent  Suggest non pharmacologic methods for pain relief (eg imagery, distraction, relaxation tapes, back rubs and massage)  Encourage periods of rest and relaxation.

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Cancer of the Liver • •

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Few cancers originate in the liver Primary Liver Tumors - usually are associated with chronic liver disease, Hepatitis B and C infections and cirrhosis Types:  Hepatocellular carcinoma (HCC) is by far the most common type of primary liver cancer.  Cholangiocellular carcinoma  Combined hepatocellular and cholangiocellular carcinoma.

Etiology •

Primary liver cancer (hepatocellular carcinoma)- alcohol abuse

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chronic infection with diseases such as hepatitis B and C

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hemochromatosis (too much iron in the liver)

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Cirrhosis (a scarring condition of the liver.

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SEX ( Men are more likely to get hepatocellular cancer than women)

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Anabolic steroids ( Male hormones used by athletes to increase muscle can slightly increase liver cancer risk with long-term use)

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Birth control pills

Clinical Manifestations • • • •

Early manifestations include pain (dull ache in the upper right quadrant, epigastrium or back), recent weight loss, loss of strength, anorexia and anemia Liver enlargement and irregular surface may be noted on palpation Jaundice is present only if larger bile ducts are occluded Ascites occurs if portal veins are obstructed or tumor tissue is seeded in the peritoneal cavity

Assessment and Diagnostic Methods

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Clinical signs and symptoms, history and physical examination PET scan CT scan MRI Arteriography Laparoscopy Biopsy Laboratory assessment      

Luekocytosis (increased WBC) Erythrocytosis (increased RBC) Hypercalcemia Hypoglycemia Hypocholesteronemia Elevated levels of alpha-fetoprotein (AFP)

Medical Management Radiation therapy  Intravenous injection of antibodies that specifically attack tumor-associated antigens  Percutaneous placement of high-intensity source for interstitial radiation therapy Chemotherapy  Systemic chemotherapy and regional infusion are used to administer antineoplastic agents  An implantable pump is used to deliver high-concentration chemotherapy to the liver through hepatic artery Percutaneous Biliary Drainage  Use to bypass biliary ducts obstructed by the liver, pancreatic or bile ducts in patients with inoperable tumors  Complications include sepsis, leakage of bile, hemorrhage and reobstruction of the biliary system Other nonsurgical treatments •

Hyperthermia: heat is directed to tumors to cause necrosis of the tumors while sparing normal tissue

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Cryosurgery: tumors are destroyed by liquid nitrogen at 196˚C Embolization of arterial blood flow to the tumor; effective in small tumors; alcohol injection may be used to cause tumor necrosis Immunotherapy; lymphocytes with antitumor reactivity are administered

Lobectomy  Removal of the lobe of the liver  Thoracoabdominal incision is used Liver Transplantation  Removal of the liver and replacement with healthy donor  Patient with small tumor have good prognosis Nursing Management  Assess problems related to cardiopulmonary involvement, vascular complications and respiratory and liver dysfunction  Give careful attention to metabolic abnormalities  Encourage early ambulation  Teach patients about signs of complications  Teach irrigation technique to avoid introducing bacteria

Selected Cancers leukemia breast oropharyngeal/ laryngeal bronchi/ lungs stomach liver prostate colorectal kidneys/ urinary bladder