Week 6 - Esophageal Cancer Flashcards
what is esophageal cancer
- rare malignant neoplasm of the esophagua
what are 2 main risk factors for esophageal cancer
- excessive alcohol intake
- smoking
what are other risk factors for esophageal cancer (7)
- diet low in fruits & veggies
- certain minerals & vitamins
- lye (in strong cleaners)
- hx of achalsia
- hx of gerd
- hx of hiatal hernia (can cause gerd)
- hx of barrets esophagus (comp of gerd)
describe symptoms of esophageal cancer (2)
- late onset
- relates to extent of tumour
list symptoms of esophageal cancer (4)
- progressive dysphagia
- globus sensation
- pain
- weight loss
where is pain located in esophageal cancer (3)? where may it radiate to (3)
- substernal
- epigastric
- back areas
radiate to:
- neck
- jaw
- ears
- shoulders
if the tumour is located in the upper third of the esophagus, what symptoms might be present (3)
- sore throat
- choking
- hoarseness
what are 4 complications of esophageal cancer
- hemorrhage
- esophageal perforation w fistula formation
- esophageal obstruction (if get big enough)
- metastasis
how can esophageal cancer cause hemorrhage
- if cancer erodes thru esophagus into the aorta
where can esophageal perforation w fistual formation occur in esophageal cancer (2)
- into the lung
- or trachea
what are common sites of metastasis w esophageal cancer (2)
- liver
- lung
what diagnostic studies can be used for esophageal cancer (6)
- barium swallow w fluoroscopy
- endoscopy w biopsy (definitive**)
- endoscopic US
- bronchoscopic exam
- CTI
- MRI
treatment for esophageal cancer has best result w…
combo of:
- surgery
- radiation
- chemo
what 3 types of surgeries can be done for esophageal cancer
- esophagectomy
- esophagogastrostomy
- esophagoenterostomy
what is an esophagectomy
- removal of part or all of esophagu
what is an esophagogastrostomy
- resection of a portion of the esophagus and anastomosis of remaining portion to the stomach
what is an esophagoenterostomy
- resection of a portion of the esophagus and anastomosis of a segment of colon to the remaining portion
surgical approaches for esophageal cancer
- thoracic
- or both abdominal & thoracic
a tumour in the ___ part of the esophagus usually indicates radiation
- upper third (cervical section)
a tumour in the lower third of the esophagus usually indicates ___
surgery
palliative therapy for esophageal cancer usually consists of? (2)
- restoration of the swallowing function
- maintenance of nutrition and hydration
what can be used to relive obstruction in esophageal cancer (3)
- dilation
- stent placement
- or both
what can be used in combo w dilation for esophageal cancer (2)
- endoscopic laser therapy
- or vaporization
what nutritional therapy is indicated after esophageal surgery
- NPO until ordered
- parental fluids after surgery
- fluids after BS returned –> 30-60 mL/hr with gradual progression to small, bland meals
describe nursing interventiosn r/t nutrition after esophageal surgery (3)
- position in upright position to prevent regurg
- observe for signs of intolernance to food
- observe for signs of leakage into mediastinum
what symptoms could indicate leakage of food/liquids into the mediastinum post op (3)
- pain
- increased temp
- abdominal distension
what may be performed to help feed the pt post-op
gastrostomy
describe preop care for a pt with esophageal cancer (7)
- general preop teaching and prep
- high cal, high protein diet (many malnourished d/t dysphagia, inability to ingest adequate amt of food & liquids before surgery) –> may be liquid form, IV, TPN
- instruct on how to keep I&O record
- assess S&S of fluid & electrolyte imbalance
- meticulous oral care
- teaching about chest tubes (if thoracic approach used), IVs, NG tubes, gastrostomy feeding, turning
- teach abt DB&C
describe postop care for esophageal cancer (8)
- usually have NG tube
- NPO until ordered
- assess drainage
- maintenance of tube
- oral & nasal care
- emphasis on preventing resp complications
- semi-fowler/fowler pstn (prevent reflux & aspiration)
- once eating & drinking, upright position for 2h after eating to assist GI tract
describe drainage postopw
- bloody for 8-12 h
- eventually becomes greenish yellow
what postop care can be done to prevent resp complications postop (2)
- turning and deep breathing q2h
- use incentive spirometer
what is imp to note regarding the NG tube postop
- do not reposition!
what should you do if the NG tube is not draining
- flush w 20-30 mL NS
- if still not, call Dr
nursing care for esophageal cancer focuses on (7)
- emotional support
- diet
- meds
- decreasing complication for cancer treatments (radiation, chemo, sx)
- assessment of supports
- home care (wound care)
- gastrostomy teaching
