Week 5 - Gastric Cancer

Question 1

what is gastric cancer

Answer 1

• an adenocarcinoma of the stomach wall

- can occur in any portion of the stomach

Question 2

what causes gastric cancer

Answer 2

• no specific causative agent `

Question 3

what factors contribute to development of gastric cancer (5)

Answer 3

• genetics
• diet
• more prevalent in men
• H. pylori
• polyps

Question 4

what diet can contribute to gastric cancer (5)

Answer 4

• smoked food
• spicy food
• salty food
• NSAID use
• alcohol

Question 5

what are symptoms of gastric cancer (6)

Answer 5

• S&S anemia
• S&S of PUD
• S&S of indigestion
• weight loss, dysphagia, constipation (d/t epigastric distress)

Question 6

what are S&S of anemia (5)

Answer 6

• pale
• weakness
• fatigue
• dizziness
• SOB

Question 7

what are some S&S of indigestion (2)

Answer 7

• vague epigastric fullness

- feelings of early satiety after meals

Question 8

what does NV, and hematemesis in gastric cancer indicate (2)

Answer 8

• gastric outlet obstruction

- or impending hemorrhage

Question 9

what can be used to diagnose gastric cancer (5)

Answer 9

• xray
• endoscopic exam **
• upper GI barium studies
• blood chem studies
• tumour markers

Question 10

what is the treatment of choice for gastric cancer

Answer 10

• surgical removal of the tumour

Question 11

preop management of gastric cancer focuses on (5)

Answer 11

correction of:

• nutritional deficits
• treatment of anemia
• replacement of blood vol
• gastric decompression
• if in transverse colon and requires partial colon resection, prep the bowel

Question 12

what is used to treat anemia in gastric cancer

Answer 12

• transfusion of packed RBC

Question 13

describe prep for the bowel if gastric ca surgery involves the transverse colon and partial colon resection is required (3)

Answer 13

• low residue diet
• enemas
• use of ab to reduce intestinal bacteria

Question 14

what is the surgical aim of treatment for gastric ca

Answer 14

• remove as much of the stomach as necessary to remove the tumour and a margin of normal tissue

Question 15

what type of surgery can be done gastric cancer

Answer 15

• subtotal gastrectomy (Billroth 1 &2 = same as care discussed in PUD)
• total gastrectomy with esophagojejunostomy

Question 16

what is a total gastrectomy with esophagojejunostomy

Answer 16

• removal of stomach

- with anastomosis of lower end of the esophagus to the jejenum

Question 17

when is adjuvant therapy used for gastric ca

Answer 17

• if pt cannot physically withstand surery

- when surgical cure is not feasible

Question 18

what adjuvant therapy is used w surgery

Answer 18

• chemo

- radiation

Question 19

describe postop care for a subtotal gastrectomy for gastric ca

Answer 19

• similar to that with Billroth 1&2

Question 20

describe postop care for a total gastrectomy with esophagojejunostomy (5)

Answer 20

• will have NG ( will have minimal drainage)
• will have chest tubes (bc enter thru chest wall)
• clear fluids initiated after several days, gradually work up to solid foods
• delayed postop wound healing (d/t poor nutrition)
• IV or oral replacement of vitamins

Question 21

what is a pt at risk for post total gastrectomy (5)

Answer 21

• dumping syndrome
• postprandial hypoglycemia
• weight loss
• poor nutrition status
• vitamin deficiency

Question 22

describe patient teaching after surgery for gastric cancer (3)

Answer 22

• same dietary measures as after PUD
• teach wound care
• teach abt comfort measures for pain & med regimen for analgesics