Assessment

HISTORY. Gastric cancer may not produce symptoms until the disease is very advanced. About one-third of the patients report a long history of dyspepsia (painful digestion). The most common initial symptoms are mild epigastric discomfort, loss of appetite, nausea, and a sense of fullness or gas pains. Patients may also report experiencing unusual tiredness, abdominal pains, constipation, weight loss, and a bad taste in the mouth. Massive GI bleeding is unusual, although chronic bleeding may occur, which results in a positive occult blood test. Patients with advanced gastric cancer report the classic symptoms of anemia, such as fatigue and activity intolerance, as well as vomiting (coffee-ground or sometimes containing frank blood), anorexia, abdominal pain, dyspepsia, and dysphagia (difficulty swallowing).

PHYSICAL EXAMINATION. In the early stages of gastric cancer, the patient usually appears healthy. In later stages, patients may appear weak, pale, dyspneic, and fatigued from anemia; they are thin and seem to be malnourished. Only 37% of patients have a palpable abdominal mass. Observe for abdominal swelling and ascites (poor prognostic sign), and palpate for hepatomegaly secondary to liver or peritoneal metastases. Some patients may have palpable lymph nodes, especially the supraclavicular and axillary nodes. Gastric cancer is frequently staged using the TNM classification system (T: primary tumor, N: lymph node, M: distant metastasis).

358 Gastric Cancer

PSYCHOSOCIAL. Survival rates after treatment for gastric cancer remain discouraging (5-year survival rate is 23% for all gastric cancers), and patients with gastric cancer have special psychosocial concerns. Assess their support systems and their ability to cope with major lifestyle changes. As appropriate, assess their transition through the various stages of death and dying.

Diagnostic Highlights

General Comments: The presence of lactic acid and a high lactate dehydrogenase level in the gastric juice are suggestive of cancer. Often, in patients with gastric cancer, plasma tumor markers (CEA, CA 19-9) are elevated. Positive fecal occult blood tests are associated with the chronic bleeding that is related to gastric cancer.

General Comments: The presence of lactic acid and a high lactate dehydrogenase level in the gastric juice are suggestive of cancer. Often, in patients with gastric cancer, plasma tumor markers (CEA, CA 19-9) are elevated. Positive fecal occult blood tests are associated with the chronic bleeding that is related to gastric cancer.

Test

Normal Result

Abnormality with Condition

Explanation

Upper GI series

Normal upper GI tract

Presence of cancer in the

Identifies size and location

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