T12: Esophageal & Gastric Cancer Flashcards

1
Q

esophageal cancer cause

A

unknown, Incidence ↑ with age, ↑ in non-Hispanic white men and Alaska Natives, and higher in men than in women

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2
Q

risk factors for esophageal cancer

A

o Barrett’s esophagus
o GERD (because of erosion of cells)
o Smoking
o Excessive alcohol intake
o Obesity
o History of achalasia (a condition in which there is delayed emptying of the lower esophagus, difficulty swallowing)

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3
Q

clinical manifestations of esophageal cancer

A

o Symptom onset is late
o Progressive dysphagia is most common symptom
- Initially with only meat, then with soft foods, and eventually with liquids
o Odynophagia: burning, squeezing pain while swallowing
o Pain, choking, heartburn, hoarseness, cough, anorexia, weight loss, regurgitation

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4
Q

If tumor is in upper third of esophagus s/s

A

o Sore throat
o Choking
o Hoarseness (may be pressing on larynx)
o Esophageal Cancer

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5
Q

diagnostics for esophageal cancer

A

o Endoscopy with biopsy (necessary for definitive diagnosis)
o Endoscopic ultrasonography (EUS) (important tool to stage)
o Esophagogram (barium swallow)
o Bronchoscopic examination (detects involvement of lung)
o CT & MRI
o CEA: blood test that is a cancer marker
o CBC, platelets

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6
Q

CEA

A

blood test that is a cancer marker

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7
Q

treatment for esophageal cancer

A

o Best results with multimodal therapy (depends on the staging of the cancer)
-CHEMO AND CORTICOSTEROIDS TO DECREASE INFLAMMATION, PPI AND H2 BLOCKERS TO DECREASE GASTRIC ACID

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8
Q

Esophagectomy

A

removal of part or all of esophagus

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9
Q

after esophagectomy: nutrition

A

· Need feeding tube or enteral nutrition (pure liquid formula)
o Care for feeding tube: check gastric residuals
o Oral care, FLUSH TUBE AFTER ANY MEDICATION

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10
Q

gold standard for tube placement

A

x-ray

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11
Q

Esophagogastrostomy

A

resection of portion of esophagus and anastomosis of remaining portion to stomach

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12
Q

Photodynamic therapy

A

· Inject IV porfimer (Photofrin), which is absorbed by cancer tissue
· Light transmitted through an endoscopic fiber reacts with porfimer, starting a reaction that destroys cancer cells

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13
Q

what is important after photodynamic therapy

A

Must avoid direct sunlight 4 weeks after

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14
Q

Endoscopic mucosal resection (EMR): for stage 1

A

· Removes superficial lesions or submucosal neoplasms
· Radiofrequency ablation used to kill cancer cells
· Option for some small, very early stage cancers

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15
Q

Dilation

A

increases (dilates) lumen of esophagus

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16
Q

nutritional therapy after surgery

A

-After surgery, parenteral fluids given
- Jejunostomy, gastrostomy, or esophagostomy feeding tube may be placed
- Swallowing study may be done before patient can have oral fluids
- When permitted, water (30-60 mL) is given hourly
- Gradual progression to small, frequent, bland meals
- Maintain upright position (so that they don’t aspirate)
- Observe for intolerance of feeding (by doing gastric residual

17
Q

post op drainage color for esophagus surgery

A
  • NG tube with bloody drainage for 8-12 hours
  • Changes gradually to greenish yellow (bile)
18
Q

NG tube should not be repositioned or reinserted without

A

surgeon’s approval, CALL DOC IF IT HAS MIGRATED

19
Q

causes of gastric cancer

A

Infection, autoimmune, bile, anti-inflammatory agents, tobacco, smoked foods, salted meats, pickling, other cancers, first degree relatives

20
Q

clinical manifestations of gastric cancer

A

o Weight loss
o Pale weak fatigue
o Indigestion
o Abdominal discomfort or pain
o Anemia-chronic blood loss
o Early satiety (false fullness because of the cancer)
o Stool guaiac (blood that you cannot see) POSITIVE

21
Q

gastric cancer intervention

A

o Surgery-resections and removal, Billroth, total gastrectomy, invasion of other organs, transverse colon resection
- FEEDING TUBE INTO THE JEJUNUM
o Chemotherapy and Targeted therapies
o Radiation-reduce recurrence or palliative to reduce tumor size

22
Q

POST-OP CARE FOR GASTRIC RESECTION SURGERY

A

o Chest tubes for esophageal resection if needed
o NG tube to LIS
o Monitor for Anastomosis failure and leaking content
o Dumping syndrome (short gut syndrome) care and monitoring
o Malabsorption-Vit C, D, K, B complex and 12 (duodenal absorption), SUPPLEMENT THEM

23
Q

supplement intrinsic factor with

A

Cobalamin

24
Q

Monitor for Anastomosis failure and leaking content

A
  • Fever, dyspnea
  • This would result in peritonitis
  • If you suspect a leak STOP FEEDING
25
Q

DUMPING SYNDROME

A

Begins 15-30 minutes after eating
Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia.

26
Q

dumping syndrome is caused by increased fluid drawn into bowel, so…

A

RESTRICT FLUID WHEN EATING

27
Q

nutrition teaching for dumping syndrome

A

· ↑ Fluid drawn into bowel lumen, SO RESRICT FLUID WHEN EATING
· REST AFTER EATING do not stimulate
· DECREASE CARBS/SUGAR THEY EAT, this draws fluid into the intestine
· Give feeding BOLUS

28
Q

symptoms of dumping syndrome

A

· Generalized weakness, sweating, palpitations, dizziness, abdominal cramps, borborygmi, urge to defecate
· Usually lasts less than 1 hour

29
Q

POSTPRANDIAL HYPOGLYCEMIA

A

variant of dumping syndrome, OVERPRODUCTION OF INSULIN causing hypoglycemia

30
Q

symptoms of postprandial hypoglycemia

A

sweating, weakness, mental confusion, palpitations, tachycardia, and anxiety

31
Q

interventions for postprandial hypoglycemia

A

GIVE GLUCOSE

32
Q

Bile reflux gastritis

A

sores in esophagus as result from acid production

33
Q

intervention for bile reflux gastritis

A

PPI and H2 blockers

34
Q

GASTRIC RESECTION SURGERY NUTRITIONAL THERAPY POSTOPERATIVELY

A

o Patient should be advised to reduce drinking fluid (4 oz) with meals
-Small, dry feedings daily (6 small feedings/day)
- Low carbohydrates
- Restricted sugar with meals
- Moderate amounts of protein and fat

35
Q

decompress the stomach through an

A

NG tube