Descriptive Definition
of Cancer of The Oesophagus
·
The oesophagusggt is a muscular tube
about 22.5 cm long equipped with both circular and longitudinal muscle fibers.
It conducts the ingested material into the stomach, wavelike contractions of
its wall expressing its contents into the gastric reservoir
·
Cancer also known as carcinoma is a
common term for neoplasm or tumours that are malignant
·
It is an abnormal growth of cells which
tend to proliferate in an uncontrolled way and in some cases to metastasize
(spread).
·
Its cause is not yet known
Predisposing Factors of
Cancer of the Oesophagus
·
Predisposing factors are:
o
Chronic trauma due to frequent use of
alcohol, tobacco, spicy foods, and poor oral hygiene
Signs And Symptoms Of
Cancer Of The Oesophagus
Signs and symptoms
·
Intermittent and increasing difficult in
swallowing first solid and later even liquids
·
Regurgitation of food and saliva
·
Haemorrhage may occur
·
Loss of weight and strength due to
starvation
Later
signs
·
Sub-sternal pain
·
Hiccough
·
Respiratory difficulty
·
Foul breath
Diagnosis is confirmed
by:
·
Oesophagogram
·
Hystologic examination of esophageal
washings and biopsy
·
Barium x-ray
·
Esophagoscopy
·
Bronchoscopy can be done to rule out
involvement of the trachea and possibility of removal
Management and Nursing
Care of a Patient with Cancer of the Oesophagus
Management and Nursing
care
·
Surgical removal of the growth
·
The portion of the esophagus that
contain the growth is removed followed by an esophagostrotomy
·
Radiation is done either after surgery
or before surgery.
·
Gastrotomy a palliative procedure which
is done if the growth is inoperable to permit the administration of food and
fluids.
Preoperative nursing
care
·
Administer high caloric and high protein
diet in liquid or solid form
·
Encourage good oral hygiene as
regurgitation leaves an unpleasant smell in the mouth
·
Acquaint the client with the equipment
he will find after waking up from anaethetic such as chest drainage,
nasogastric suction, parenteral fluids and sometimes a gastrostomy tube.
·
Provide the general preoperative care
Post
operative nursing care
·
Give the general postoperative care and
care as for any patient who has undergone chest operation
·
When patient starts taking oral feeds
observe for regurgitation and dyspnea
·
Check vital signs especially temperature
as it elevates if there is seepage of fluid through the operative site into the
mediasternum.
·
Start with semisoft food, soft and then
regular foods.
·
Observe for dyspnea if a part of stomach
has been drawn into the chest.
·
Alleviate dyspnoea by frequent feedings
of small amounts and by the patient remaining upright for 2 hours after eating.
Prognosis Incase of
Cancer of the Oesophagus
Prognosis
·
It is good if detected and removed early
and the continuity of the digestive system is easily maintained.
·
High mortality rate is because:
·
In older patients the incidence of
pulmonary and cardiovascular disorder is high.
·
Before significant symptoms occur the
tumour has already invaded surrounding structures.
·
The malignancy tends to spread to nearby
lymph nodes, the heart and the lungs
45-80%
of operated cases showed evidence of metastasis
Descriptive definition
and predisposing factors of cancer of the stomach
The
stomach is a distensible pouch situated between the oesophagus and the duodenum
and it distends to become a large hollow receptacle capable of holding about
1500 ml. during a meal
It
is a malignant growth of the gastric which affects mostly persons over 40 years
and occasionally in younger people
Causes
not yet known but heredity is a predisposing factor.
Signs and Symptoms of
Cancer of the Stomach
Signs and symptoms
·
Early symptoms not easy to be recognized
because most of the tumors start on the lesser curvature where they cause
little disturbance to the gastric functions
Most early signs are:
·
Progressive loss of appetite
·
The appearance of, or change in
gastrointestinal symptoms.
·
Appearance of blood in the stools
·
Vomiting or a feeling of fullness
immediately following a meal if it causes obstruction in the cardiac orifice
·
If the growth is near the pylorus
vomiting becomes a prominent symptom.
·
Vomiting of coffee ground vomitus, the
blood that leaks slowly from the cancer.
·
Gastric juice does not reveal free
hydrochloric acid
Later signs are:
·
Weight loss
·
Weakness
·
Anemia
·
Jaundice
·
Pain occurs very late in most cases when
there is no opportunity of curing it.
·
Since metastasis frequently occurs
before warning signs, dyspepsia of more than 4 weeks duration in any person
over 40 years calls for complete examination of the gastrointestinal tract.
Management and Nursing
Care of a Patient with Cancer of the Stomach
Management and Nursing
care
·
The only successful treatment is removal
of the tumour
·
The patient can be cured if the tumour
is localized only in the stomach
·
If it has spread to other organs,
effective palliation may be obtained by resection of the tumour.
Preoperative
care
Similar to any
abdominal surgery
·
Take blood for grouping and cross match
·
Correct the anaemia
·
Pre and post operative chest exercise to
avoid pulmonary complications
·
Instruct the patient to stop smoking
·
Correct fluid and electrolyte balance
·
The stomach should be emptied at least 3
hours preoperatively
·
If there is pyloric stenosis the stomach is emptied the
night of the operation
·
If the pyloric stenosis is severe the
stomach is aspirated for several days
·
Pass
a Nasogastric tube and leave it insitu
Nursing Care of a
Patient following Surgery
Partial Resection
·
Place patient in a modified Fowlers
position when awake for easy drainage of the stomach
·
Give analgesics as prescribed to allow
for deep breathing and productive coughing preventing pulmonary complication
·
Report any excessive bleeding from the
Nasogastric drainage.
·
Give nothing per oral
·
Clean the nostrils with an applicator
moistened in water
·
Give mouth washes frequently
·
Apply cool water sponges to the mouth
rather than ice which intensifies thirst
·
Give parenteral fluid to meet fluid and
nutritional needs as well as compensating for the fluid lost in the drainage
and vomitus
·
Keep an intake and output chart.
·
After removal of the Nasogastric tube
·
Restrict fluid per oral for several
hours
·
Start with small amounts of fluids
sparingly
·
Warm weak tea with sugar is preferred
·
Then bland food which should be added
gradually till patient can take 6 small meals a day and drink 120 ml. of fluid
between meals.
·
If the patient regurgitates he may be
eating too fast or too much. If there is gastric retention reinstitutes
Nasogastric suction.
·
Encourage the patient to get out of bed
on the first postoperative day.
·
Increase ambulation daily
·
Dressing can be reinforced if necessary
·
Report any undue drainage saturation.
Total Resection
Care
will be as for a patient postoperative abdominal surgical care and post
operative chest surgical care.
Remove
the Nasogastric tube as soon as there bowel sounds resume
Give
clear fluids and small feeds after 2 or 3 days if the temperature is normal
that is no anastomosis leakage.
Because
normal digestion is disturbed the patient will need nutritional supplementation
with vitamin and minerals.
Give
iron and vitamin B12
Post Operative
Complications and at Home Regimen
Post operative
complication
·
Shock
·
Vomiting
·
Hemorrhage
·
Pulmonary complications
·
Dumping syndrome
·
Diarrhea
·
Vitamin B12 deficiency
At home Regimen
·
Advice patient to continue increasing
the size of his meals and reduce the number until he can take three regular
meals in about 6 months
·
Gradual return to his activities
according to his ability may take about 3 months
·
Recommend adequate rest periods
·
Follow up visits where his questions may
be answered should be given
·
Dietary consultation may be required
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