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By ; Junaidi Sahamuddin

Middle East UniversityKUWAIT

Introduction

• Gastrointestinal cancer refers to malignant conditions of the Gastrointestinal tract.

• GI cancers do not discriminate between men and women.

• The symptoms relate to the organ affected and can include obstruction (leading to difficulty swallowing or defecating), abnormal bleeding or other associated problems.

• The treatment depends on the location of the tumor, as well as the type of cancer cell.

• These cancer can arise anywhere in the GI tract.

Anatomy and physiology

Definitions ;

• Gastro-Intestinal (GI) cancer is a term for the group of cancers that affect the digestive system. This includes cancers of the oesophagus, gallbladder, liver, pancreas, stomach and bowel (the bowel includes the small intestine, large intestine or colon and rectum).

Type of GI Cancer

Esophageal Cancer

Gastric Cancer

Appendic Cancer

Colorectal Cancer

Anal Cancer

Bile Duct cancer

Carsinoid Tumor

Rectal Cancer

• Gastro intestinal StromaTumors (GIST)

• Pancreatic Neuroendocrine tumors

• Pancreatic Cancer

• Liver Cancer

• Smal intestine Cancer

• Gallblader Cancer

Type of GI Cancer

Esophageal Cancer

Gastric Cancer

Pancreatic Cancer

Colorectal Cancer

Esophageal Cancer

Esophageal Cancer

• Esophageal cancer develops in the esophagus, a long tube that connects mouth to stomach.

• more than 18,000 Americans are diagnosed with esophageal cancer every year.

• Cancer of the esophagus has a much higher incidence (10 to 100 times higher) in other parts of the world, including China and northern Iran (American Cancer Society, 2009).

Types of Esophageal Cancer

• 1. Adenocarcinoma

• 2. Squamous Cell Carcinoma

Emory et al. Am J Surg Pathol. 1999;23:82.

Causes and Risk FactorsEsophageal Cancer

• Although we don't know exactly what causes esophageal cancer

Risk factors include:

Smoking Obesity

>> male Age over 70

Achalasia Barrett's esophagus

gastroesophageal reflux disease

alcohol consumption

Symptoms Esophageal Cancer

• Painful or difficult swallowing. Patients often report feeling like food is stuck in the throat or chest

• Weight loss and loss of appetite

• Pain in the middle of the chest behind the breastbone ; his can include chest pain, pressure or a feeling of burning in the throat

• Hoarseness and cough

• Persistent indigestion and heartburn

Diagnostic and TreatmentEsophageal Cancer

Diagnostic Treatment

Endoscopic surgery

biopsy and brushings radiation,

CT of the chest and abdomen

chemotherapy,

Positron emission tomography (PET)

Combination

Endoscopic ultrasound

Gastric Cancer

Gastric Cancer

• Stomach cancer, also called gastric cancer, is a disease that develops when cancer cells form in the lining of the stomach.

• More than 22,000 cases of stomach cancer are diagnosed in the United States each year.

• but it is a leading cause of cancer death especially in Japan, Eastern Europe, South America and regions of the Middle East.

Causes and Risk Factors for Gastric Cancer

• the exact causes unknown

Risk Factors for Gastric CancerPrevious or family history >> male

Smoking cigarettes Helicobacter pylori infection

Chronic gastritis Old age

A diet high in salted, smoked, or poorly preserved foods

A diet low in fruits and veggies

Symptoms of Stomach Cancer

Symptoms in early stages Symptoms in advanced stages

Indigestion and stomach discomfort

Trouble swallowing

A bloated feeling after eating Vomiting

Mild nausea Blood in the stool

Loss of appetite Weight loss for no known reason

Heartburn Stomach pain

Jaundice

Ascites (buildup of fluid in the abdomen)

Pathophysiology Stomach Cancer

Most gastric cancers are adenocarcinomas; they can occur anywhere in the stomach. The tumor infiltrates the surrounding mucosa, penetrating the wall of the stomach and adjacent organs and structures. The liver, pancreas, esophagus,

and duodenum are often already affected at the time of diagnosis. Metastasis through lymph to the peritoneal cavity occurs later in the disease

Diagnostic and Treatment Stomach Cancer

Diagnostic Treatment

Advanced stage may be palpable as a mass,

Ascites and hepatomegalysurgery

barium x-ray Chemotherapeutic,

Commonly used single-agent

CT of the chest abdomen and Pelvis

radiation

Endoscopic ultrasound

Cancer of the Pancreas

Cancer of the Pancreas

• Pancreatic cancer is a type of cancer that affects the pancreas, an organ that lies behind the stomach and in front of the spine.

• The second most prevalent cancer of the gastrointestinal area.

• about 46,000 cases are diagnosed each year in the United States

• In 2008, globally there were 280,000 new cases of pancreatic cancer reported and 265,000 deaths.

Pancreatic Cancer Causes and Risk Factors

• we cannot pinpoint what the causes

Risk Factors

Smoker 2 to 3 times more developed than non smoker

Race. African-American are diagnosed more frequently

Age >> 50 y/o Having Diabetes.

Chronic Pancreatitis. Family History.

Obesity

Symptoms of Pancreatic Cancer

• Jaundice (yellowing of the skin and whites of the eyes)

• Light-colored stools

• Dark urine

• Pain in the upper or middle abdomen and back

• Weight loss for no known reason

• Loss of appetite

• Feeling very tired

Type of Pancreatic Cancer

• Exocrine Cancer– Ampullary cancer

– Adenosquamous carcinoma

– Squamous cell carcinoma

– Signet ring carcinoma

– Pancreatoblastoma

• Endocrine Cancer/neuroendocrine tumors.– Gastrinoma

– Insulinoma

– Glucagonoma

Diagnostic and TreatmentPancreatic Cancer

Diagnostic Treatment

GI x-ray surgery

Spiral (helical) CT 80-90% accurate

radiation,

ERCP chemotherapy,

MRI Combination

Endoscopic ultrasound

Biopsy

Colorectal Cancer

Colorectal Cancer

• Colorectal cancer is the development of cancer in the colon or rectum.

• In the United States, almost 150,000 new cases and 52,000 deaths from colorectal cancer occur annually (American Cancer Society [ACS], 2008).

• In Europe the five-year survival rate for colorectal cancer is less than 60%.

• Globally more than 1 million people get colorectal cancer every year

Causes and Risk Factors for Colorectal Cancer

• the exact causes unknown

Risk Factors for Gastric Cancer

Previous or family history >> male

Smoking cigarettes Genital cancer or breast cancer

lack of physical exercis Old age

History of gastrectomy. colon cancer. adenomatouspolyps, inflammatory bowel disease

Diet high intake of fat, alcohol or red meat andlow-fiber diet

Symptoms Colorectal Cancer

• The symptoms are greatly determined by the location of the tumor, the stage of the disease.

• The most common presenting symptom is ;– worsening constipation.– blood in the stool, decrease in stool caliber (thickness),– loss of appetite, loss of weight.– Nausea or vomiting .– rectal bleeding.– Anemia/– weight loss.– change in bowel habit

Pathophysiology

• Cancer of the colon and rectum is predominantly (95%) adenocarcinoma (ie, arising from the epithelial lining of the intestine) (ACS, 2008).

• It may start as a benign polyp but may become malignant, invade and destroy normal tissues, and extend into surrounding structures.

• Cancer cells may migrate away from the primary tumor and spread to other parts of the body (most often to the liver, peritoneum, and lungs) (Field & Lipton, 2007).

Diagnostic and TreatmentColorectal Cancer

Diagnostic Treatment

sigmoidoscopy surgery

barium enema radiation

Colonoscopy with biopsy or cytology smears.

chemotherapy

Carcinoembryonic antigen (CEA) studies

Palliative care

Endoscopic ultrasound

Nursing Management

• Maintaining Optimal Nutrition

• Providing Emotional Support

• Relieving Pain

• Preparing the Patient for Surgery and Postoperative Care

• Maintaining Optimal Nutrition

• Providing Wound Care

• Monitoring and Managing Complications

• Removing and Applying the Colostomy Appliance

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Nursing Care Plan

the major nursing diagnoses may include the following:

• Imbalanced nutrition, less than body requirements,related to nausea and anorexia

• Risk for deficient fluid volume related to vomiting anddehydration

• Anxiety related to impending surgery and the diagnosisof cancer

• Pain related to tumor mass • Impaired skin integrity related to the surgical incisions

(abdominal and perianal), the formation of a stoma,and frequent fecal contamination of peristomal skin

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Nursing Care Plan

• Disturbed body image related to colostomy

• Ineffective sexuality patterns related to presence

of ostomy and changes in body image and self-concecpt

• Risk for ineffective therapeutic regimen management

related to knowledge deficit concerning the diagnosis, the surgical procedure, and self-care after discharge

• Anticipatory grieving related to the diagnosis of cancer

• Deficient knowledge regarding self-care activities

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Reference ;1. Suzanne C, Brenda G, Janice L, Kerry H. Brunner and Suddarth Medical

and Surgical Nursing, Twelfth Edition, Lippincot William & Wilkins, 2010.

2. Linda S, Paula D. Understanding Medical and Surgical Nursing, ThirdEdition, page: 1138, FA Davis 2007.

3. http://emedicine.medscape.com/article/1145144-overview.

4. http://en.wikipedia.org/wiki/Gastrointestinal_cancer

5. http://onlinelibrary.wiley.com/doi

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