Download
gastric cancer pancreatic cancer and hepatobiliary cancers n.
Skip this Video
Loading SlideShow in 5 Seconds..
Gastric Cancer, Pancreatic Cancer, and Hepatobiliary Cancers PowerPoint Presentation
Download Presentation
Gastric Cancer, Pancreatic Cancer, and Hepatobiliary Cancers

Gastric Cancer, Pancreatic Cancer, and Hepatobiliary Cancers

355 Vues Download Presentation
Télécharger la présentation

Gastric Cancer, Pancreatic Cancer, and Hepatobiliary Cancers

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Gastric Cancer, Pancreatic Cancer, and Hepatobiliary Cancers

  2. Objectives The learner will be able to: • Identify the various risk factors, signs, and symptoms for specific types of gastrointestinal cancers. • Discuss care implications related to treatment for specific types of gastrointestinal cancers.

  3. Gastric Cancer (Stomach Cancer) • American Cancer Society (ACS) estimates for 2012: • 21,320 new cases of stomach cancer • 10,540 deaths from stomach cancer • Almost 2 out of 3 people found to have stomach cancer are older than age 65. • Slightly higher risk in men • Common throughout the world, much less common in the United States • Reasons may have to do with food storage and less use of salted and smoked foods. • May be because of the use of antibiotics to treat infections; these drugs can kill H. pylori, which may be a major cause of stomach cancer.

  4. Gastric Cancer: Risk Factors • Infection with Helicobacter pylori (H. pylori) • Age: Sharp increase after age 50 • Gender: More common in men • Ethnicity: More common in Latinos and African Americans than in Caucasians, and most common in Asian/Pacific Islanders • Where a person lives: High rates of stomach cancer in Japan • Diet: Increased risk with diets high in smoked foods, salted fish and meats, and pickled vegetables • Smoking doubles the risk. • Type A blood • Certain cancer syndromes • Family history of stomach cancer • Type of work: Workers in coal, metal, and rubber industries seem to have an increased risk.

  5. Gastric Cancer: Signs and Symptoms • Anorexia • Unintended weight loss • Abdominal pain • Vague discomfort in the abdomen, often above the navel • A sense of fullness just below the sternum after eating a small meal • Heartburn, indigestion, or ulcer-type symptoms • Nausea • Vomiting with or without blood • Ascites

  6. Gastric Cancer: Diagnosis • Upper endoscopy • Biopsy • Upper GI series • Endoscopic ultrasound • CT scan +/- needle biopsy • MRI • PET scan • Laparoscopy • Labs (CBC, chemistries, LFTs)

  7. Gastric Cancer: Staging and Five-Year Survival

  8. Gastric Cancer: Treatment • Surgery • Unresectability criteria include advanced locoregional disease, distant metastasis, or peritoneal seeding. • Chemotherapy and targeted therapy • Chemoradiotherapy pre- and/or postoperatively, or for metastatic or locally advanced disease • Without radiation pre- and/or postoperatively, or for metastatic or locally advanced disease • Radiation therapy • Chemoradiotherapy as above • Palliative control of symptoms

  9. Pancreatic Cancer • Tumors of the pancreas: • Most common are exocrine tumors; nearly all of these are adenocarcinomas. • Endocrine tumors are much less common. They are know as islet cell tumors or neuroendocrine tumors. • ACS estimates for 2012: • 49,920 new cases of pancreatic cancer • 37,390 deaths from pancreatic cancer

  10. Pancreatic Cancer: Risk Factors • Age: Risk increases with age, with almost 90% of patients > age 55. • Race: Risk higher in African Americans • Smoking: Risk 23 times higher in smokers • Obesity and lack of exercise • Diabetes • Chronic pancreatitis • Cirrhosis of the liver • Work exposure: Heavy exposure to certain pesticides, dyes, and chemicals may increase risk. • Family history • Gene mutations • Stomach problems: Too much stomach acid or H. pylori

  11. Pancreatic Cancer: Signs and Symptoms • Pain in the abdomen or in the middle of the back • Unexplained weight loss • Jaundice • Pale, bulky, or greasy stools due to blockage of pancreatic enzymes • Nausea, vomiting, and pain that worsens after eating • Swollen gallbladder • Blood clots • Fatty tissue changes • Diabetes

  12. Pancreatic Cancer: Diagnosis • History and physical exam • CT scan with guided needle biopsy • MRI • PET scan or PET/CT scan • Ultrasound • ERCP (endoscopic retrograde cholangiopancreatography) • Angiography • Blood tests (CBC, chemistries, LFTs) • Tumor markers: CA 19-9 and CEA • Biopsy

  13. Pancreatic Cancer: Staging and Five-Year Survival

  14. Pancreatic Cancer: Treatment • Surgery: Curative resections • Whipple procedure (pancreatoduodenectomy) • Distal pancreatectomy • Radiation therapy • Neoadjuvant for resectable/borderline resectable • As chemoradiotherapy for unresectable or locally advanced disease • Adjuvant postoperative therapy with chemoradiotherapy • Palliative • Chemotherapy and targeted therapy • Systemic chemo and targeted therapy is used in the neoadjuvant or adjuvant setting and in the management of locally advanced unresectable and metastatic disease.

  15. Pancreatic Cancer: Palliative and Supportive Care • Formal palliative medicine service evaluation when appropriate • For biliary or gastric outlet obstruction: • Stenting • Bypass procedures • J-tube or PEG tube • Pain • Celiac plexus neurolysis • Palliative chemoradiotherapy • Pancreatic insufficiency • Pancreatic enzyme replacement • Thromboembolic disease • Low molecular weight heparin (LMWH)

  16. Hepatobiliary Cancer • Hepatobiliary cancer • Hepatocellular carcinoma (HCC) • Biliary tract cancers • Intrahepatic cholangiocarcinomas • Extrahepaticcholangiocarcinomas • Gallbladder cancer • ACS estimates for 2012: • 28,720 new cases of primary liver cancer and bile duct cancer • 20,550 deaths from these cancers

  17. HCC: Risk Factors • Chronic viral hepatitis • Heavy alcohol use • Cirrhosis • Inherited metabolic diseases • Diabetes • Obesity • Aflatoxins • Vinyl chloride and thorium dioxide (Thorotrast) • Anabolic steroids • Arsenic

  18. HCC: Signs and Symptoms • Unexplained weight loss • Anorexia • Feeling full after a small meal • Nausea or vomiting • Fever • Hepatomegaly • Splenomegaly • Ascites • Pruritis • Jaundice

  19. HCC: Diagnosis • History and physical exam • Ultrasound • CT scan • MRI • Angiography • Laparoscopy • Lab tests: AFP (alpha-fetoprotein) may be elevated in liver cancer and LFTs.

  20. HCC: Staging • Several staging systems are used for liver cancer. • Following initial workup, patients are stratified into four categories: • Potential resectable or transplantable, operable by performance status or comorbidity • Unresectable disease • Inoperable by performance status or comorbidity with local disease only • Metastatic disease

  21. HCC: Prognosis • Patients with early-stage liver cancer treated with liver transplant have a five-year survival rate in the range of 60%70%. • Patients with early-stage liver cancer that can be completely resected have a five-year survival rate of over 50%. • Patients with unresectable disease have a five-year survival rate of 10%.

  22. HCC: Treatment • Surgery • Hepatic resection • Transplantation • Ablative procedures • Radiofrequency ablation (RFA) • Percutaneous ethanol injection (PEI) • Transarterial chemoembolization (TACE) • Transarterialradioembolization (TARE) • Systemic targeted therapy with sorafenib

  23. Bile Duct Cancer(Cholangiocarcinoma) • 2,0003,000 people in the United States develop bile duct cancer each year. • Much more common in Asia and the Middle East, mostly because of a common parasitic infection of the bile duct • Average age at time of diagnosis is 73 years. • Two out of three people with bile duct cancer are older than age 65 when diagnosed.

  24. Bile Duct Cancer: Risk Factors • Certain diseases of the liver or bile ducts • Primary sclerosing cholangitis • Ulcerative colitis • Bile duct stones • Choledochal cysts • Cirrhosis of the liver • Other abnormalities of the bile ducts • Liver fluke infections • Age • Obesity • Family history

  25. Bile Duct Cancer: Signs and Symptoms • Jaundice • Itching • Light colored stools/dark urine • Abdominal pain • Anorexia/weight loss • Fever • Nausea/vomiting

  26. Bile Duct Cancer: Diagnosis • History and physical exam • Labs: CBC, chems, LFTs, tumor markers CEA, CA 19-9 • Ultrasound • Endoscopic or laparoscopic • CT scan • CT-guided biopsy • MRI • PET scan • Cholangiography • ERCP (endoscopic retrograde cholangiopancreatography) • MRCP (magnetic resonance cholangiography) • PTCP (percutaneous transhepatic cholangiography) • Angiography • Laparoscopy • Cholangioscopy

  27. Bile Duct Cancer: Stage and Survival

  28. Bile Duct Cancer: Treatment • Surgery • Biliary drainage by ERCP or percutaneous approach with stent placement • Chemotherapy • Fluoropyrimidines (5-fluorouracil, capecitabine) • Gemcitabine • Cisplatin • Chemoradiotherapy

  29. Gallbladder Cancer • ACS estimates 6,000 new cases of gallbladder cancer in 2012. • More common in women • Incidence increases with age, with most cases being diagnosed in the seventh decade.

  30. Gallbladder Cancer: Risk Factors • Gallstones • Porcelain gallbladder • Female sex • Obesity • Older age • Ethnicity and geography • Choledochal cysts • Abnormalities of the bile ducts • Gallbladder polyps • Typhoid

  31. Gallbladder Cancer: Signs and Symptoms • Abdominal pain • Nausea and vomiting • Jaundice • Gallbladder enlargement • Less common: • Anorexia • Weight loss • Abdominal swelling • Severe itching • Black, tarry stools

  32. Gallbladder Cancer: Diagnosis • History and physical exam • Labs: CBC, chems, LFTs, tumor markers CEA, CA 19-9 • Ultrasound • Endoscopic or laparoscopic • CT scan • CT-guided biopsy • MRI • PET scan • Cholangiography • ERCP (endoscopic retrograde cholangiopancreatography) • MRCP (magnetic resonance cholangiography) • PTCP (percutaneous transhepatic cholangiography) • Angiography • Laparoscopy • Cholangioscopy

  33. Gallbladder Cancer: Staging and Survival

  34. Gallbladder Cancer: Treatment • Surgery • Biliary drainage by ERCP or percutaneous approach with stent placement • Chemotherapy • Fluoropyrimidines (5-fluorouracil, capecitabine) • Gemcitabine • Cisplatin • Chemoradiotherapy

  35. Common Symptoms of Upper GI Cancers • Anorexia • Weight loss • Nausea and vomiting • Fatigue • Pain

  36. Toxicities/Complications of Chemotherapy • GI: Nausea, vomiting, mucositis, anorexia, and diarrhea may occur. • Myelosuppression • Neurotoxicity, both acute and chronic, with oxaliplatin • Chronic neurotoxicity with cisplatin and the taxanes • Hand-foot syndrome with infusional 5-FU and capecitabine • Hypersensitivity can occur with oxaliplatin later in therapy (dose #7 or later).

  37. Nursing Interventions • Myelosuppression: Growth factors, education on prevention of infection • GI: • Nausea/vomiting: Administer antiemetics, assess efficacy; dietary education; fluids • Mucositis: Assess oral cavity, advise on oral care protocol. • Diarrhea: Education on how to use antidiarrheal agents, fluids, low-residue diet • Peripheral neuropathy • Education and support to preserve patient safety

  38. Conclusions • Gastric cancer, pancreatic cancer, and hepatobiliary cancers can cause debilitating symptoms. • Nursing interventions can alleviate many of these symptoms, leading to a better quality of life for patients.

  39. References Adams, L.A., Cunningham, R.S., & Belansky, H. (2009). Anorexia. In L.H. Eaton & J.M. Tipton (Eds.), Putting evidence into practice: Improving oncology patient outcomes (pp. 2536).Pittsburgh, PA: Oncology Nursing Society. Aiello-Laws, L.B., Ameringer, S.W., & Eaton, L.H. (2009). Pain. In L.H. Eaton & J.M. Tipton (Eds.), Putting evidence into practice: Improving oncology patient outcomes (pp. 215234).Pittsburgh, PA: Oncology Nursing Society. American Cancer Society. (2012a). Bile duct (cholangiocarcinoma) cancer. Retrieved from http://www.cancer.org/Cancer/BileDuctCancer/DetailedGuide/index American Cancer Society. (2012b). Gallbladder cancer. Retrieved from http://www.cancer.org/Cancer/GallbladderCancer/DetailedGuide/index American Cancer Society. (2012c). Liver cancer overview. Retrieved from http://www.cancer.org/Cancer/LiverCancer/OverviewGuide/index American Cancer Society. (2012d). Pancreatic cancer overview. Retrieved from http://www.cancer.org/Cancer/PancreaticCancer/OverviewGuide/index American Cancer Society. (2012e). Stomach cancer overview. Retrieved from http://www.cancer.org/Cancer/StomachCancer/OverviewGuide/index American Joint Committee on Cancer. (2010). AJCC cancer staging handbook (7th ed.). New York, NY: Springer.

  40. References (cont.) Eaton, L.H., & Tipton, J.M. (Eds.). (2009). Putting evidence into practice: Improving oncology patient outcomes. Pittsburgh, PA: Oncology Nursing Society. Friend, P.J., Johnston, M.P., & Eaton, L.H. (2009). Chemotherapy-induced nausea and vomiting. In L.H. Eaton & J.M. Tipton (Eds.), Putting evidence into practice: Improving oncology patient outcomes (pp. 63-83). Pittsburgh, PA: Oncology Nursing Society. Griffen-Sobel, J.P. (Ed.). (2007). Gastrointestinal cancers. Pittsburgh, PA: Oncology Nursing Society. Harris, D.J., Eilers, J.G., & Eaton, L.H. (2009). Mucositis. In L.H. Eaton & J.M. Tipton (Eds.), Putting evidence into practice: Improving oncology patient outcomes (pp. 193213).Pittsburgh, PA: Oncology Nursing Society. Mitchell, S.A., Beck, S.L., & Eaton, L.E. (2009). Fatigue. In L.H. Eaton & J.M. Tipton (Eds.), Putting evidence into practice: Improving oncology patient outcomes (pp. 149174). Pittsburgh, PA: Oncology Nursing Society. Muehlbauer, P., Thorpe, D., & Belansky, H. (2009). Diarrhea. In L.H. Eaton & J.M. Tipton (Eds.), Putting evidence into practice: Improving oncology patient outcomes (pp. 119134). Pittsburgh, PA: Oncology Nursing Society. National Comprehensive Cancer Network. (2012a). NCCN Clinical Practice Guidelines in Oncology: Gastric cancer [v.2.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf

  41. References (cont.) National Comprehensive Cancer Network. (2012b). NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary cancers [v.2.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf National Comprehensive Cancer Network. (2012c). NCCN Clinical Practice Guidelines in Oncology: Pancreatic adenocarcinoma [v.2.2012]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf Samuel-O’Garro, L., & Suozzo, S.H. (2007). Symptom management in gastrointestinal cancers. In J. Griffen-Sobel (Ed.), Gastrointestinal cancers (pp. 7588). Pittsburgh, PA: Oncology Nursing Society. Shields, S. (2011). Characteristics of cytotoxic agents. In M. Polovich, J.M. Whitford, & M. Olsen (Eds.), Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed., pp. 3855). Pittsburgh, PA: Oncology Nursing Society. Steinberg, M. (2011). Characteristics of targeted therapies. In M. Polovich, J.M. Whitford, & M. Olsen (Eds.), Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed., pp. 6272). Pittsburgh, PA: Oncology Nursing Society. Zitella, L., Gobel, B.H., & O’Leary, C. (2009). Prevention of infection. In L.H. Eaton & J.M. Tipton (Eds.), Putting evidence into practice: Improving oncology patient outcomes (pp. 267283). Pittsburgh, PA: Oncology Nursing Society.