T12: Esophageal & Gastric Cancer Flashcards
esophageal cancer cause
unknown, Incidence ↑ with age, ↑ in non-Hispanic white men and Alaska Natives, and higher in men than in women
risk factors for esophageal cancer
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)
clinical manifestations of esophageal cancer
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
If tumor is in upper third of esophagus s/s
o Sore throat
o Choking
o Hoarseness (may be pressing on larynx)
o Esophageal Cancer
diagnostics for esophageal cancer
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
CEA
blood test that is a cancer marker
treatment for esophageal cancer
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
Esophagectomy
removal of part or all of esophagus
after esophagectomy: nutrition
· 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
gold standard for tube placement
x-ray
Esophagogastrostomy
resection of portion of esophagus and anastomosis of remaining portion to stomach
Photodynamic therapy
· 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
what is important after photodynamic therapy
Must avoid direct sunlight 4 weeks after
Endoscopic mucosal resection (EMR): for stage 1
· Removes superficial lesions or submucosal neoplasms
· Radiofrequency ablation used to kill cancer cells
· Option for some small, very early stage cancers
Dilation
increases (dilates) lumen of esophagus
nutritional therapy after surgery
-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
post op drainage color for esophagus surgery
- NG tube with bloody drainage for 8-12 hours
- Changes gradually to greenish yellow (bile)
NG tube should not be repositioned or reinserted without
surgeon’s approval, CALL DOC IF IT HAS MIGRATED
causes of gastric cancer
Infection, autoimmune, bile, anti-inflammatory agents, tobacco, smoked foods, salted meats, pickling, other cancers, first degree relatives
clinical manifestations of gastric cancer
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
gastric cancer intervention
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
POST-OP CARE FOR GASTRIC RESECTION SURGERY
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
supplement intrinsic factor with
Cobalamin
Monitor for Anastomosis failure and leaking content
- Fever, dyspnea
- This would result in peritonitis
- If you suspect a leak STOP FEEDING
DUMPING SYNDROME
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.
dumping syndrome is caused by increased fluid drawn into bowel, so…
RESTRICT FLUID WHEN EATING
nutrition teaching for dumping syndrome
· ↑ 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
symptoms of dumping syndrome
· Generalized weakness, sweating, palpitations, dizziness, abdominal cramps, borborygmi, urge to defecate
· Usually lasts less than 1 hour
POSTPRANDIAL HYPOGLYCEMIA
variant of dumping syndrome, OVERPRODUCTION OF INSULIN causing hypoglycemia
symptoms of postprandial hypoglycemia
sweating, weakness, mental confusion, palpitations, tachycardia, and anxiety
interventions for postprandial hypoglycemia
GIVE GLUCOSE
Bile reflux gastritis
sores in esophagus as result from acid production
intervention for bile reflux gastritis
PPI and H2 blockers
GASTRIC RESECTION SURGERY NUTRITIONAL THERAPY POSTOPERATIVELY
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
decompress the stomach through an
NG tube
