Saturday, January 14, 2006

cancer, stomach

Ninety-five percent of malignant stomach neoplasms are adenocarcinomas. Thus, the term gastric cancer generally refers to adenocarcinoma of the stomach. Adenocanthoma, squamous-cell carcinoma, and carcinoid tumors also occur in the stomach.
Stomach cancer occurs more frequently in men than women, and occurs most often between the ages of 50 and 70. It usually occurs in the distal third and extends directly through the stomach wall into adjacent tissues, lymphatics, and other abdominal organs. It may metastasize through the bloodstream to the lungs or bones.
Heredity and chronic inflammation of the stomach appear to be causative factors. Early symptoms of gastric cancer are often vague. As the tumor enlarges it begins to obstruct either the pyloric or cardiac openings. The patient then may notice a prolonged feeling of fullness after eating, anorexia, weight loss, and weakness from anemia. The stool usually contains concealed (occult) blood. Pain is a late symptom.
Diagnosis is made by fluoroscopy (dynamic x-ray exam), gastroscopy (looking with a scope), and a barium swallow gastroscopy. Gastric analysis may show the absence of free hydrochloric acid. The treatment of cancer of the stomach is partial (subtotal) or total gastrectomy. The type of surgery depends on the location of the tumor and whether metastasis has occurred. Following a total gastrectomy, the jejunum is anastomased to the esophagus. A subtotal gastrectomy may be possible depending on the location and the size of the tumor. Retaining part of the stomach preserves a more normal function.
Patients with a total gastrectomy must eat frequent small meals because they are unable to tolerate large meals. They should eat easily digested foods. Injections of vitamin Bl2 are usually necessary for the rest of the patient's life, once the stomach is removed to prevent pernicous anemia. The intrinsic factor from the stomach necessary for absorption of vitamin B12 is no longer produced.
Scherer, J. C. Introductory Medical-Surgical Nursing. 3rd ed. Philadelphia: J. B. Lippincott Co., 1982.
Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.

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