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Nursing Care Plan for Gastric Cancer


Definition of Gastric Cancer

Gastric cancer is a malignant form of gastrointestinal neoplasms. Gastric carcinoma is a form of gastric neoplasms are the most common and causes about 2.6 % of all deaths from cancer (Cancer Facts and Figures, 1991).

Gastric cancer occurs in the small curvature or gastric antrum and adenocarcinoma. Other factors, in addition to high- acid foods that cause the incidence of gastric cancer include inflammation of the stomach, pernicious anemia, aclorhidria (no hydrochloride). Gastric ulcer, bacteria H. plylori, and offspring. (Suzanne C. Smeltzer).

Cancer of the stomach or abdominal malignant tumor is an adenocarcinoma. This cancer spreads to the lungs, lymph nodes and liver. Risk factors include chronic atrophic gastritis with intestinal metaplasia pernicious anemia, high alcohol consumption and smoking. (Nettina sandra, nursing practice guidelines).

Gastric cancer is a malignancy that occurs in the stomach, most are of the type adenocarcinoma. Other types of gastric cancer are leiomyosarcoma (smooth muscle cancer) and lymphoma. Gastric cancer is more common in the elderly. Less than 25 % of certain cancers occur in people under the age of 50 years (Osteen, 2003).


Etiology of Gastric Cancer

The exact cause of stomach cancer is unknown, but there are several factors that can increase the development of gastric cancer, include the following matters :

1. Predisposing Factors

a. Genetic factors
Approximately 10 % of patients with gastric cancer have a genetic link. Although still not fully understood, but the mutation of the E - cadherin gene was detected in 50 % of gastric cancer types. The presence of a family history of pernicious anemia and adenomatous polyps was also associated with a genetic condition in gastric cancer. (Bresciani, 2003).

b. Age factor
In this case found to be more common in the age of 50-70 years, but about 5 % of gastric cancer patients aged less than 35 years and 1 % less than 30 years. (Neugut, 1996)


2. Precipitation Factors

a. Consumption of pickled food, smoked or preserved.
Several studies explain the dietary intake of pickled food becomes a major factor increase in gastric cancer. The content of salt that goes into the stomach slows gastric emptying, thereby facilitating the conversion of nitrates into carcinogenic nitrosamines group in the stomach. Combined condition of delayed emptying of stomach acid and an increase in the composition of nitrosamines in the stomach contributed to the formation of gastric cancer (Yarbro, 2005).

b. H.pylori infection.
H. pylori is a bacterium that causes more than 90 % of duodenal ulcers and 80 % of gastric ulcers (Fuccio, 2007). These bacteria on the surface of the gastric ulcer, through the interaction between the bacterial membrane lectins, and specific oligosaccharides from glycoproteins membranes of gastric epithelial cells (Fuccio, 2009).

c. Socioeconomic.
Low socioeconomic conditions are reported to increase the risk of gastric cancer, but not specific.

d. Consume cigarettes and alcohol.
Patients with cigarette consumption of more than 30 cigarettes a day and combined with chronic alcohol consumption increases the risk of gastric cancer (Gonzalez, 2003).

e. NSAIDs.
Inflammatory gastric polyps can occur in patients taking NSAIDs in the long term and this (gastric polyps) may be a precursor of gastric cancer. Gastric polyps conditions will increase the risk of gastric cancer (Houghton, 2006).

f. Pernicious anemia.
This condition is a chronic disease with failure of absorption of cobalamin (vitamin B12), caused by a lack of intrinsic factor gastric secretion. The combination of pernicious anemia with H.pylori infection provides an important contribution to tumorigenesis in the stomach wall formation. (Santacrose, 2008).


Clinical Manifestations of Gastric Cancer

Early symptoms of gastric cancer is often uncertain because most of these tumors in the small curvature, which is only slightly causing interference function of the stomach. Several studies have shown that early symptoms such as pain that is relieved by antacids may resemble symptoms in patients with benign ulcer. Symptoms may include a progressive disease can not eat, anorexia, dyspepsia, weight loss, abdominal pain, constipation, anemia and nausea and vomiting (Harnawati).

Clinical symptoms were found among others (Davey, 2005) :
  • Anemia , vague gastrointestinal bleeding and resulted in an iron deficiency may be a presenting symptom of gastric carcinoma is the most common.
  • Weight loss, common and further illustrates metastatic disease.
  • Vomiting, an indication of the occurrence of gastric outflow obstruction.
  • Dysphagia.
  • Nausea.
  • Weakness.
  • Hematemesis.
  • Regurgitation.
  • Easily satisfied.
  • Enlarged abdominal ascites.
  • Abdominal cramps.
  • Real or faint blood in the stool.
  • The patient complained of discomfort in the stomach, especially after eating.

Complications of Gastric Cancer

1. Perforation

Perforation can occur acute and chronic perforation :
  • Acute Perforation. Perforation often occurs in : ulceration type of cancer that is located in the minor curvature, diantrum near the pylorus. Usually have symptoms similar to perforation of peptic ulcer. These perforations are often found in men (Hadi, 2002).
  • Chronic perforation. Perforations that occur frequently covered by the adjacent tissue, for example by omentum or is penetration. Usually more rare when compared with the complications of benign ulcer. Penetration may be found between layers or layer of omentum gastrohepatic bottom of the liver. What often happens is perforated and covered by the pancreas. With the penetration it will form a fistula, for example gastrohepatic, gastroenteric and gastrocolic fistula. (Hadi , 2002).
2. Haematemesis.
Massive hematemesis and melena occurred ± 5 % of carcinomas ventrikuli whose symptoms are similar as in massive bleeding so much blood is lost, causing hypochromic anemia. (Hadi, 2002).

3. Obstruction.
Can occur in the lower part of the stomach near the pylorus region are accompanied by complaints of vomiting (Hadi, 2002).

4. Adhesion.
If a tumor of the stomach wall can occur adhesion and infiltration of the surrounding organs and cause abdominal pain (Hadi , 2002)



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