T12: Esophageal & Gastric Cancer

Question 1

esophageal cancer cause

Answer 1

unknown, Incidence ↑ with age, ↑ in non-Hispanic white men and Alaska Natives, and higher in men than in women

Question 2

risk factors for esophageal cancer

Answer 2

o Barrett’s esophagus
o GERD (because of erosion of cells)
o Smoking
o Excessive alcohol intake
o Obesity
o History of achalasia (a condition in which there is delayed emptying of the lower esophagus, difficulty swallowing)

Question 3

clinical manifestations of esophageal cancer

Answer 3

o Symptom onset is late
o Progressive dysphagia is most common symptom
- Initially with only meat, then with soft foods, and eventually with liquids
o Odynophagia: burning, squeezing pain while swallowing
o Pain, choking, heartburn, hoarseness, cough, anorexia, weight loss, regurgitation

Question 4

If tumor is in upper third of esophagus s/s

Answer 4

o Sore throat
o Choking
o Hoarseness (may be pressing on larynx)
o Esophageal Cancer

Question 5

diagnostics for esophageal cancer

Answer 5

o Endoscopy with biopsy (necessary for definitive diagnosis)
o Endoscopic ultrasonography (EUS) (important tool to stage)
o Esophagogram (barium swallow)
o Bronchoscopic examination (detects involvement of lung)
o CT & MRI
o CEA: blood test that is a cancer marker
o CBC, platelets

Question 6

CEA

Answer 6

blood test that is a cancer marker

Question 7

treatment for esophageal cancer

Answer 7

o Best results with multimodal therapy (depends on the staging of the cancer)
-CHEMO AND CORTICOSTEROIDS TO DECREASE INFLAMMATION, PPI AND H2 BLOCKERS TO DECREASE GASTRIC ACID

Question 8

Esophagectomy

Answer 8

removal of part or all of esophagus

Question 9

after esophagectomy: nutrition

Answer 9

· Need feeding tube or enteral nutrition (pure liquid formula)
o Care for feeding tube: check gastric residuals
o Oral care, FLUSH TUBE AFTER ANY MEDICATION

Question 10

gold standard for tube placement

Answer 10

x-ray

Question 11

Esophagogastrostomy

Answer 11

resection of portion of esophagus and anastomosis of remaining portion to stomach

Question 12

Photodynamic therapy

Answer 12

· Inject IV porfimer (Photofrin), which is absorbed by cancer tissue
· Light transmitted through an endoscopic fiber reacts with porfimer, starting a reaction that destroys cancer cells

Question 13

what is important after photodynamic therapy

Answer 13

Must avoid direct sunlight 4 weeks after

Question 14

Endoscopic mucosal resection (EMR): for stage 1

Answer 14

· Removes superficial lesions or submucosal neoplasms
· Radiofrequency ablation used to kill cancer cells
· Option for some small, very early stage cancers

Question 15

Dilation

Answer 15

increases (dilates) lumen of esophagus

Question 16

nutritional therapy after surgery

Answer 16

-After surgery, parenteral fluids given
- Jejunostomy, gastrostomy, or esophagostomy feeding tube may be placed
- Swallowing study may be done before patient can have oral fluids
- When permitted, water (30-60 mL) is given hourly
- Gradual progression to small, frequent, bland meals
- Maintain upright position (so that they don’t aspirate)
- Observe for intolerance of feeding (by doing gastric residual

Question 17

post op drainage color for esophagus surgery

Answer 17

• NG tube with bloody drainage for 8-12 hours
• Changes gradually to greenish yellow (bile)

Question 18

NG tube should not be repositioned or reinserted without

Answer 18

surgeon’s approval, CALL DOC IF IT HAS MIGRATED

Question 19

causes of gastric cancer

Answer 19

Infection, autoimmune, bile, anti-inflammatory agents, tobacco, smoked foods, salted meats, pickling, other cancers, first degree relatives

Question 20

clinical manifestations of gastric cancer

Answer 20

o Weight loss
o Pale weak fatigue
o Indigestion
o Abdominal discomfort or pain
o Anemia-chronic blood loss
o Early satiety (false fullness because of the cancer)
o Stool guaiac (blood that you cannot see) POSITIVE

Question 21

gastric cancer intervention

Answer 21

o Surgery-resections and removal, Billroth, total gastrectomy, invasion of other organs, transverse colon resection
- FEEDING TUBE INTO THE JEJUNUM
o Chemotherapy and Targeted therapies
o Radiation-reduce recurrence or palliative to reduce tumor size

Question 22

POST-OP CARE FOR GASTRIC RESECTION SURGERY

Answer 22

o Chest tubes for esophageal resection if needed
o NG tube to LIS
o Monitor for Anastomosis failure and leaking content
o Dumping syndrome (short gut syndrome) care and monitoring
o Malabsorption-Vit C, D, K, B complex and 12 (duodenal absorption), SUPPLEMENT THEM

Question 23

supplement intrinsic factor with

Answer 23

Cobalamin

Question 24

Monitor for Anastomosis failure and leaking content

Answer 24

• Fever, dyspnea
• This would result in peritonitis
• If you suspect a leak STOP FEEDING

Question 25

DUMPING SYNDROME

Answer 25

Begins 15-30 minutes after eating Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia.

Question 26

dumping syndrome is caused by increased fluid drawn into bowel, so...

Answer 26

RESTRICT FLUID WHEN EATING

Question 27

nutrition teaching for dumping syndrome

Answer 27

· ↑ Fluid drawn into bowel lumen, SO RESRICT FLUID WHEN EATING · REST AFTER EATING do not stimulate · DECREASE CARBS/SUGAR THEY EAT, this draws fluid into the intestine · Give feeding BOLUS

Question 28

symptoms of dumping syndrome

Answer 28

· Generalized weakness, sweating, palpitations, dizziness, abdominal cramps, borborygmi, urge to defecate · Usually lasts less than 1 hour

Question 29

POSTPRANDIAL HYPOGLYCEMIA

Answer 29

variant of dumping syndrome, OVERPRODUCTION OF INSULIN causing hypoglycemia

Question 30

symptoms of postprandial hypoglycemia

Answer 30

sweating, weakness, mental confusion, palpitations, tachycardia, and anxiety

Question 31

interventions for postprandial hypoglycemia

Answer 31

GIVE GLUCOSE

Question 32

Bile reflux gastritis

Answer 32

sores in esophagus as result from acid production

Question 33

intervention for bile reflux gastritis

Answer 33

PPI and H2 blockers

Question 34

GASTRIC RESECTION SURGERY NUTRITIONAL THERAPY POSTOPERATIVELY

Answer 34

o Patient should be advised to reduce drinking fluid (4 oz) with meals -Small, dry feedings daily (6 small feedings/day) - Low carbohydrates - Restricted sugar with meals - Moderate amounts of protein and fat

Question 35

decompress the stomach through an

Answer 35

NG tube