Stomach and Colorectal Cancer PDF

NCM 112 A | MEDICAL - SURGICAL NURSING Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberations, Acute and Chronic STOMACH & COLORECTAL CANCER GROUP 4: ABAD, KAYE AIZZLE TARROZA...

NCM 112 A | MEDICAL - SURGICAL NURSING Care of Clients with Problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberations, Acute and Chronic STOMACH & COLORECTAL CANCER GROUP 4: ABAD, KAYE AIZZLE TARROZA ENRIQUEZ, ALYNNA NODADO MACROHON, ABBY GAIL ELUMBA AGUILO, TOM ALEXEEV MALABAS HAMSALI, AMIRNADEER JAILANI REBOLLOS, STACEY ORICCO REYES DELA TORRE, DEXTER CAÑETE KADJIM, MARDIYA HARUN VACARO, JAN ANDRE VILLACRUZ STOMACH CANCER STOMACH CANCER Malignant/Cancerous cells in the stomach 4 types of stomach cancer: Adenocarcinoma (most common, 90%!) Lymphoma Carcinoid Tumor Leiomyosarcoma STOMACH CANCER Lymphoma Lymphocytes in MALT Appear as diffuse Lymphocytes B-cells proliferate STOMACH CANCER Carcinoid Tumor Neuroendocrine Cells Polyp in Mucosa G-cells STOMACH CANCER Leiomyosarcoma Smooth Muscle Cells Very rare!!! STOMACH CANCER Adenocarcinoma Columnar Glandular Epithelium Comprising more than 90% of all gastric cancers STOMACH CANCER Environmental Risk Factors Host Risk Factors Males are more commonly affected Previous gastric surgery 6th to 8th decade of life Pernicious Anemia H Pylori Hypertrophic gastropathy / Diet rich in nitrosamines; Menetrier disease particularly smoked meat and fish Autoimmune/atrophic Smoking and tobacco gastritis/gastric ulcer/dysplasia Genetic Risk Factors Blood group A Mutations of genes STOMACH CANCER Classification Depth of Invasion Macroscopic growth pattern Microscopic types Early Advanced Flat Intestinal Diffuse Confined to Invades into Exophytic mucosa muscularis Ulcerated and/or propria or Diffuse submucosa beyond STOMACH CANCER Mini Pathogenesis INTESTINAL TYPE DIFFUSE TYPE increased signaling via the Wnt E-cadherin loss pathway STOMACH CANCER Morphology INTESTINAL TYPE DIFFUSE TYPE Bulky tumors Not bulky! frequently grows along broad Infiltrative cohesive bonds Evokes desmoplastic response to form either an exophytic mass or Linitis plastica an ulcerated tumor PATHOPHYSIOLOGY NORMAL GASTRIC MUCOSA CHRONIC GASTRITIS CHRONIC ATHROPIC GASTRITIS INTESTINAL METAPLASIA DYSPLASIA GASTRIC CANCER CLINICAL MANIFESTATIONS Early-stage symptoms (often Advanced-stage symptoms: vague): Persistent abdominal pain, especially in the upper Indigestion or heartburn. abdomen. Loss of appetite. Nausea and vomiting (sometimes with blood). Mild epigastric discomfort. Unexplained weight loss. Fatigue and weakness. Anemia (pallor, dizziness) due to chronic blood loss. Hematemesis (vomiting blood) or melena (black, tarry stools). Early satiety (feeling full quickly). Swelling or fluid buildup in the abdomen (ascites). CLINICAL MANIFESTATIONS Signs of metastasis: Enlarged lymph nodes, especially Virchow’s node (left supraclavicular). Sister Mary Joseph’s nodule (umbilical metastasis). Krukenberg tumor (ovarian metastasis). Blumer’s shelf (palpable mass in the rectum from metastasis). DIAGNOSTIC TESTS Gastroscopy (Endoscopy): A flexible tube with a camera is used to examine the stomach lining. It allows for tissue sampling (biopsy) to detect cancer cells. This is the most common diagnostic method and is minimally invasive. Barium Swallow (Upper GI Series): X-rays are taken after the patient swallows a barium solution, which highlights abnormalities in the stomach and esophagus. Imaging Tests: CT Scans: Provide detailed cross-sectional images of the stomach to check for tumor spread. PET-CT Scan: Detect cancer activity using a radioactive tracer to pinpoint areas of high glucose metabolism typical of cancer cells. DIAGNOSTIC TESTS Endoscopic Ultrasound (EUS): Combines endoscopy and ultrasound to evaluate the tumor's size and depth and check for lymph node involvement. Biopsy: Tissue collected during gastroscopy is examined microscopically for cancer cells. Further testing, such as HER2 protein analysis, can guide treatment. Blood Tests: While not standalone diagnostic tools, blood tests can assess general health and indicate tumor markers in some cases. MEDICAL MANAGEMENT Total Gastrectomy - The entire stomach is removed along with the duodenum, the lower portion of the esophagus, supporting mesentery, and lymph nodes. Esophagojejunostomy - reconstruction of the GI tract is performed by anastomosing the end of the jejunum to the end of the esophagus. Radical subtotal gastrectomy - is performed for a resectable tumor in the middle and distal portions of the stomach. Billroth I - involves a limited resection and offers a lower cure rate than the Billroth II. Billroth II - is a wider resection that involves removing approximately 75% of the stomach and decreases the possibility of lymph node spread or metastatic recurrence. Proximal subtotal gastrectomy - may be performed for a resectable tumor located in the proximal portion of the stomach or cardia. A total gastrectomy or an esophagogastrectomy is usually performed in place of this procedure to achieve a more extensive resection. Chemotherapy may offer further control of the disease or palliation. Commonly used single-agent chemotherapeutic medications include 5-fluorouracil (5-FU), cisplatin (Platinol), doxorubicin (Adriamycin), etoposide (Etopophos), and mitomycin-C (Mutamycin). Radiation therapy is mainly used for palliation in patients with obstruction, GI bleeding secondary to tumor, and significant pain. Assessment of tumor markers (blood analysis for antigens indicative of cancer) such as carcinoembryonic antigen (CEA), carbohydrate antigen (CA 19-9), and CA 50 may help determine the effectiveness of treatment. If these values were elevated before treatment, they should decrease if the tumor is responding to the treatment (Gao, Zhang, Du, et al., 2007). NURSING MANAGEMENT ASSESSMENT Diet History Psychosocial Assessment Physical Exam NURSING DIAGNOSIS Anxiety related to the disease and anticipated treatment Imbalanced nutrition, less than body requirements, related to early satiety or anorexia Pain related to tumor mass Anticipatory grieving related to the diagnosis of cancer Deficient knowledge regarding self-care activities PLANNING AND GOALS The major goals for the patient may include reduced anxiety, optimal nutrition, relief of pain, and adjustment to the diagnosis and anticipated lifestyle changes. NURSING INTERVENTIONS Reducing Anxiety A relaxed, nonthreatening atmosphere is provided so the patient can express fears, concerns, and possibly anger about the diagnosis and prognosis. Encourages the family or significant other to support the patient, offering reassurance and supporting positive coping measures. Advise the patient about any procedures and treatments so that the patient knows what to expect. Promoting Optimal Nutrition Eat small, frequent portions of nonirritating foods Food supplements should be high in calories, as well as vitamins A, C and iron If a total gastrectomy is performed, injection of vitamin B12 will be required for life Monitor IV therapy and nutritional status and records intake, output, and daily weights Assess for signs of dehydration (thirst, dry mucous membranes, poor skin turgor, tachycardia, decreased urine output) Review the results of daily laboratory studies to note any metabolic abnormalities (sodium, potassium, glucose, blood urea nitrogen). Antiemetics are administered as prescribed. Relieving Pain Administers analgesic agents as prescribed. A continuous IV infusion of an opioid may be necessary for postoperative or severe pain. Assess frequency, intensity, and duration of the pain to determine the effectiveness of the analgesic agent. Suggest nonpharmacologic methods for pain relief, such as position changes, imagery, distraction, relaxation exercises (using relaxation audiotapes), back rubs, massage, and periods of rest and relaxation. Providing Psychosocial Support Helps express fears, concerns, and grief about the diagnosis.  Offer emotional support and involves family members and significant others whenever possible. Project an empathetic attitude and spend time with the patient. Promoting Home and Community-Based Care TEACHING PATIENTS SELF-CARE. Patient and family teaching include information about diet and nutrition, treatment regimens, activity and lifestyle changes, pain management, and possible complications. Consultation with a dietitian is essential to determine how the patient’s nutritional needs can best be met at home. T Teach the patient or caregiver about administration of enteral or parenteral nutrition.  If chemotherapy or radiation is prescribed, the nurse provides explanations to the patient and family about what to expect and the need for transportation to appointments for treatment. CONTINUING CARE. Reinforce nutritional counseling and supervise the administration of any enteral or parenteral feedings. Teach patient to record daily intake, output, and weight and explain strategies to manage pain, nausea, vomiting, or other symptoms. Teach patient to recognize and report signs and symptoms of complications that require immediate attention or any symptoms that become progressively worse. Assist patient, family, or significant other with decisions regarding end-of-life care and make referrals as warranted. EVALUATION 1. Reports less anxiety Expresses fears and concerns about surgery Seeks emotional support 2. Attains optimal nutrition Eats small, frequent meals high in calories, iron, and vitamins A and C Complies with enteral or parenteral nutrition as needed 3. Has decreased pain 4. Performs self-care activities and adjusts to lifestyle changes Resumes normal activities within 3 months Alternates periods of rest and activity Manages enteral feedings 5. Prepares for the dying process Acknowledges disease process Reports control of symptoms Verbalizes fears and concerns about dying; involves family/caregiver in discussions Completes advance directives, and other appropriate documents COLORECTAL CANCER COLORECTAL CANCER It refers to the cancer that occur in the colon and rectum. It both has malignant and benign growths, including adenomatous polyps, which have the potential to become malignant. 5-Year Survival Rate: 90% when detected early. Prevalence: Colorectal cancers are currently the third leading site of malignancy in the Philippines. The incidence has 20,736 in 2022, both sexes. Death: 10,692. Globally, it is the third most common malignancy but ranks second in cancer-related mortality, behind lung cancer. COLORECTAL CANCER Colorectal Adenocarcinoma Most common type (over 90%). Mucinous Adenocarcinoma: Contains 60% mucus; more aggressive (10–15% of cases). Signet Ring Cell Adenocarcinoma: Rare (