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INTRODUCTION
ANATOMY OF GI
TRACT
Presentation tation of cancer related to g i tract
The gastrointestinal tract (GIT)
consists of a hollow muscular tube
starting from the oral cavity, where
food enters the mouth, continuing
through the pharynx, oesophagus,
stomach and intestines to the rectum
and anus, where food is expelled.
Presentation tation of cancer related to g i tract
The primary purpose of the
gastrointestinal tract is to
break food down into
nutrients, which can be
absorbed into the body to
provide energy
Basic structure
The wall is divided into four
    layers as follows:

        Mucosa
      Submucosa
   Muscularis externa
   Serosa/mesentery
Individual components of
the gastrointestinal system
• Oral cavity
• Salivary
  glands
• Parotids
• Submandib
  ular
• Sublingual
• Oesopha
  gus
• Stomach
• Small
  intestine
• Large
  intestine
• Liver
• Gall
  bladder
• Pancreas
The Strategy
• Digestive enzymes are
  secreted from cells lining
  the inner surfaces of
  various exocrine glands.
• The enzymes hydrolyze
the macromolecules in
food into small, soluble
molecules that can be
• absorbed into cells.
• IngestionThe Topology
• -Food placed in the mouth -Ground into finer
  particles by the teeth,
• -Moistened and lubricated by saliva
• -small amounts of starch are digested by
  the amylase present in saliva
• the resulting bolus of food is swallowed into
  the esophagus and
• carried by peristalsis to the stomach.
Presentation tation of cancer related to g i tract
• THE STOMACH

• The wall of the stomach is lined with millions
  of gastric glands, which together secrete
  400–800 ml of gastric juice at each meal.
  Several kinds of cells are found in the gastric
  glands
• parietal cells
• chief cells
• mucus-secreting cells
• hormone-secreting (endocrine) cells
• The Liver
• The liver secretes bile. Between meals it
  accumulates in the gall bladder. When
  food, especially when it contains fat,
  enters the duodenum, the release of the
  hormone cholecystokinin (CCK) stimulates
  the gall bladder to contract and discharge
  its bile into the duodenum.
• Bile contains:
• bile acids..
• bile pigments..
• The Hepatic Portal System
• Glucose is removed and converted into glycogen.
• Other monosaccharides are removed and converted into
  glucose.
• Excess amino acids are removed and deaminated.
    – The amino group is converted into urea.
    – The residue can then enter the pathways of cellular
      respiration and be oxidized for energy.
• The liver serves as a gatekeeper between the intestines and
  the general circulation.
• the liver releases more to the blood by converting
  its glycogen stores to glucose (glycogenolysis),
• converting certain amino acids into glucose (gluconeogenesis).
• The Pancreas
• The pancreas consists of clusters of endocrine cells
  (the islets of Langerhans) and exocrine cells whose
  secretions drain into the duodenum. Pancreatic fluid
  contains:
• sodium bicarbonate (NaHCO3).
• pancreatic amylase
• pancreatic lipase
• 4 "zymogens
• trypsin
• chymotrypsin.
• elastase.
• carboxypeptidase
• The Small Intestine
Digestion within the small intestine produces a
mixture of disaccharides, peptides, fatty acids,
and monoglycerides.
• The Large Intestine (colon)
• The large intestine receives the liquid residue
  after digestion and absorption are complete.
  This residue consists mostly of water as well as
  any materials that were not digested.
CONDITION NO-1
      ORAL CAVITY CANCER
• There are several types of oral cancers, but
  around 90% are squamous cell carcinomas
  originating in the tissues that line the mouth
  and lips. Oral or mouth cancer most
  commonly involves the tongue. It may also
  occur on the floor of the mouth, cheek
  lining, gingiva (gums), lips, or palate (roof of
  the mouth).
The Mouth


(Cavum Oris; Oral Or Buccal Cavity)
The cavity of the mouth is placed at the
commencement of the digestive tube . it is a
nearly oval-shaped cavity which consists of two
parts: an outer, smaller portion,
the vestibule, and an inner, larger part,
the mouth cavity proper.
Presentation tation of cancer related to g i tract
SIGN AND SYMPTOMS
     OF ORAL CANCER
• Common symptoms of oral cancer include:
• Patches inside your mouth or on your lips
  White patches (leukoplakia)
  –Mixed red and white patches
    (erythroleukoplakia)
  –Red patches (erythroplakia) are brightly
    colored
• A sore on your lip or in your mouth
  that won't heal
• Bleeding in your mouth
• Loose teeth
• Difficulty or pain when swallowing
• Difficulty wearing dentures
• A lump in your neck
• An earache
Diagnosis of oral
          cancer
•   HISTORY OF THE PATIENT
•   PHYSICAL EXAMINATION OF THE MOUTH
•   Biopsy
•   Dental x-rays
•   Chest x-rays:
•   CT scan:
•   MRI:
HISTORY OF THE PATIENT
PHYSICAL EXAMINATION
   OF THE MOUTH
BIOPSY
Dental x-rays
Chest x-rays
CT Scan OF MOUTH
MRI OF MOUTH
Treatment for oralcancer
• surgery, radiation therapy,
  or chemotherapy. Other health
  care include a dentist, speech
  pathologist, nutritionist,
  and mental healthcounselor.
1-Surgery
• Maxillectomy (can be done with or
  without Orbital exenteration)
• Mandibulectomy (removal of the mandible or
  lower jaw or part of it)
• Glossectomy (tongue removal, can be total, hemi
  or partial)
• Radical neck dissection
• Moh's procedure or CCPDMA
• Combinational e.g. glossectomy and laryngectomy
  done together.
• Feeding tube to sustain nutrition
• •partial   maxillectomy removes portions of maxilla, incisive
    bone, palatine bone ± portions of the zygomatic and
    lacrimal bones
•   •premaxillectomy: unilateral or bilateral with removal of
    incisive bone and perhaps rostral maxilla
•   •central maxillectomy: maxilla and portions of hard palate
    resected
•   •caudal maxillectomy: maxilla, hard palate, zygomatic, and
    lacrimal bones removed
•   •hemimaxillectomy: removal of entire maxilla on 1 side
    extending dorsally to ventral orbit
•   •orbitectomy: removal of orbit ± caudal maxilla and
    vertical mandibular ramus
•
Presentation tation of cancer related to g i tract
POSTOPERATIVE
     MANAGEMENT
• sedation may be required if anxious
  when cannot nose breathe
• •analgesic drug
• • nutrition-
• Cosmetic Appearance
COMPLICATIONS
•   Oronasal Fistula
•   Mucosal Ulceration on Labial Flap or Lateral Skin of Lip
•   Hemorrhage
•   Infection
•   Sneezing and Nasal Discharge
•   Epiphora
•   Other Complications
•   •prehension and mastication problems, pain, cosmetic
    alterations, dehiscence, infection, tumor recurrence,
    subcutaneous emphysema, and failure to nose breathe
•
2-Radiation therapy

• Internal radiation (implant
  radiation
• External radiation:
CONDITION-2
ESOPHAGEAL CANCER
• Esophageal cancer (or oesophageal
  cancer) is malignancy of the esophagus.
  There are various subtypes, primarily
  squamous cell cancer and
  adenocarcinoma , Squamous cell cancer
  arises from the cells that line the upper
  part of the esophagus. Adenocarcinoma
  arises from glandular cells that are
  present at the junction of the esophagus
  and stomach
• Classification
• Most esophageal cancers fall into one of two
  classes: squamous cell carcinomas, which are
  similar to head and neck cancer in their
  appearance and association with tobacco and
  alcohol consumption, and adenocarcinomas,
  which are often associated with a history of
  gastroesophageal reflux disease and Barrett's
  esophagus.
Signs and symptoms
• Dysphagia (difficulty swallowing) and
  odynophagia (painful swallowing
• Pain behind the sternum or in the
  epigastrium, often of a burning,
  heartburn-like nature, may be severe
• Another sign may be an unusually husky,
  raspy, or hoarse-sounding cough, a result
  of the tumor affecting the recurrent
  laryngeal nerve
• nausea and vomiting,
• regurgitation of food,
• coughing and an increased risk of aspiration
  pneumonia.
• The tumor surface may be fragile and bleed,
  causing hematemesis (vomiting up blood).
• upper airway obstruction
• superior vena cava syndrome
• Fistulas may develop between the esophagus
  and the trachea, increasing the pneumonia
  risk; this condition is usually heralded by
  cough, fever or aspiration.
• If the disease has spread
  elsewhere, this may lead to
  symptoms related to this: liver
  metastasis could cause jaundice
  and ascites,
• lung metastasis could cause
  shortness of breath, pleural
  effusions, etc.
Causes
• Barrett's esophagus is considered to be a risk
  factor for esophageal adenocarcinoma.
• There are a number of risk factors for
  esophageal cancer.
• Age - most patients are over 60, and the
  median in US patients is 67.
• Sex - the disease is more common in men.
• Heredity - it is more likely in people who have
  close relatives with cancer.
• Tobacco smoking and heavy alcohol
• Gastroesophageal reflux disease (GERD
• Human papillomavirus (HPV)
• Corrosive injury
• A medical history of other head and neck
  cancers increases
• Plummer-Vinson syndrome(anemia and
  esophageal webbing)
• Tylosis and Howel-Evans
  syndrome(hereditary thickening of the
  skin of the palms and soles)
• Radiation therapy for other conditions
  in the mediastinum
• Coeliac disease predisposes towards
  squamous cell carcinoma.
• Obesity
• Thermal injury as a result of drinking
  hot beverages
• Alcohol consumption in individuals
  predisposed to alcohol flush reaction
• Achalasia
PATHOPHYSIOLOGY

•OHP
Diagnosis
• Endoscopy and radial
  endoscopic
  ultrasound images of
  submucosal tumor in
  mid-esophagus.
CT with contrast, axial
       image.
barium swallow or barium
         meal
esophagogastroduodenosc
  opy (EGD, endoscopy
Biopsies taken of
suspicious lesions are then
  examined histologically
Computed tomography
   (CT) of the chest,
 abdomen and pelvis .
Positron emission
  tomography
Management
Types of
      esophagectomy:
• The thoracoabdominal approach opens the
  abdominal and thoracic cavities together.
• The two-stage Ivor Lewis (also called Lewis-
  Tanner) approach involves an initial
  laparotomy and construction of a gastric
  tube, followed by a right thoracotomy to
  excise the tumor and create an
  esophagogastric anastomosis.
• The three-stage McKeown approach
  adds a third incision in the neck to
  complete the cervical anastomosis
• Laser
• Photodynamic therapy,
• Chemotherapy
• Radiotherapy
CONDITION NO-3

      STOMACH CANCER
• Stomach cancer, or gastric cancer,
  refers to cancer arising from any
  part of the stomach. Stomach
  cancer causes about 800,000
  deaths worldwide per year
Signs and symptoms
• Endoscopic image
  of linitis plastica, a
  type of stomach
  cancer where the
  entire stomach is
  invaded, leading
  to a leather
  bottle-like
  appearance with
  blood coming out
  of it.
• Discomfort or pain in the stomach
  area
• Difficulty swallowing
• Nausea and vomiting
• Weight loss
• Feeling full or bloated after a small
  meal
• Vomiting blood or having blood in
  the stool
• Stage 1 (Early)
• Indigestion or a burning
  sensation (heartburn)
• Loss of appetite, especially for
  meat
• Abdominal discomfort or
  irritation
• Stage 2 (Middle)
• Weakness and fatigue
• Bloating of the stomach,
  usually after meals
• Stage 3 (Late)
• Abdominal pain in the upper abdomen
• Nausea and occasional vomiting
• Diarrhea or constipation
• Weight loss
• Bleeding (vomiting blood or having blood in
  the stool) which will appear as black. This
  can lead to anemia.
• Dysphagia; this feature suggests a tumor in
  the cardia or extension of the gastric tumor
  in to the esophagus..
Causes
• Infection by Helicobacter pylori.
• gastritis, intestinal metaplasia and various
  genetic factors
• smoked foods, salted fish and meat, and
  pickled vegetables
• Nitrates and nitrites are substances
  commonly found in cured meats.
• Smoking increases the risk of developing
  gastric cancer
• consumption of alcohol.
• Alcohol along with tobacco smoking increase
  the risk of developing other cancers .
• Gastric cancer shows a male predominance
  in its incidence as up to three males are
  affected for every female
• Some researchers showed a correlation
  between Iodine deficiency or excess, iodine-
  deficient goitre and gastric cancer
Diagnosis
• To find the cause of symptoms,
  asks about the patient's medical
  history, does a physical exam,
  and may order laboratory
  studies. The patient may also
  have one or all of the following
  exams:
Gastroscopic exam
Computed tomography
biopsied
• Various blood
  tests may be
  done; including:
  Complete Blood
  Count (CBC) to
  check for
  anemia. Also, a
  stool test may be
  performed to
  check for blood
  in the stool.
Chest x-ray
• These are the stages of stomach cancer:
• Stage 0: The tumor is found only in the inner
  layer of the stomach. Stage 0 is also called
  carcinoma in situ.
• Stage I is one of the following:
   – The tumor has invaded only the submucosa.
     Cancer cells may be found in up to 6 lymph
     nodes.
   – Or, the tumor has invaded the muscle layer or
     subserosa. Cancer cells have not spread to
     lymph nodes or other organs.
• Stage II is one of the following:
  –The tumor has invaded only the
    submucosa. Cancer cells have spread to
    7 to 15 lymph nodes.
  –Or, the tumor has invaded the muscle
    layer or subserosa. Cancer cells have
    spread to 1 to 6 lymph nodes.
  –Or, the tumor has penetrated the outer
    layer of the stomach. Cancer cells have
    not spread to lymph nodes or other
• Stage III is one of the following:
   –The tumor has invaded the muscle layer
    or subserosa. Cancer cells have spread to
    7 to 15 lymph nodes.
   –Or, the tumor has penetrated the outer
    layer. Cancer cells have spread to 1 to 15
    lymph nodes.
   –Or, the tumor has invaded nearby organs,
    such as the liver, colon, or spleen. Cancer
    cells have not spread to lymph nodes or
    to distant organs.
• Stage IV is one of the following:
   –Cancer cells have spread to more than 15
    lymph nodes.
   –Or, the tumor has invaded nearby organs
    and at least 1 lymph node.
   –Or, cancer cells have spread to distant
    organs
Management

• Treatment for stomach cancer
  may include
  surgery,chemotherapy,
  and/or radiation therapy.
1-Surgery-----Total
          gastrectomy
• 2- Chemotherapy
• The use of chemotherapy to treat stomach cancer has no
  firmly established standard of care.
• Some drugs used in stomach cancer treatment have
  included:
• 5-FU (fluorouracil) or its analog capecitabine,
• BCNU (carmustine), methyl-CCNU (Semustine), and
• doxorubicin (Adriamycin), as well as Mitomycin C, and
• more recently cisplatin and taxotere, often using drugs in
  various combinations
•   3-Radiation therapy
•   Nutrition
•   Nutrition after stomach surgery
•   Some people have problems eating and drinking after
    stomach surgery. Liquids may pass into the small intestine
    too fast, which causes dumping syndrome. The symptoms
    are cramps, nausea, bloating, diarrhea, and dizziness. To
    prevent these symptoms, it may help to make the following
    changes:
•   Plan to have smaller, more frequent meals (some doctors
    suggest 6 meals per day)
•   Drink liquids before or after meals
•   Cut down on very sweet foods and drinks (such as cookies,
    candy, soda, and juices)
• Supportive care
• Stomach cancer and its treatment can lead to
  other health problems. You can have supportive
  care before, during, and after cancer treatment.
• Supportive care is treatment to control pain and
  other symptoms, to relieve the side effects of
  therapy, and to help you cope with the feelings
  that a diagnosis of cancer can bring. You may
  receive supportive care to prevent or control
  these problems and to improve your comfort
  and quality of life during treatment.
•
CONDITION NO-4

        Colorectal cancer
Colorectal cancer, commonly known as
bowel cancer, is a cancer from
uncontrolled cell growth in the colon or
rectum (parts of the large intestine), or in
the appendix. Symptoms typically include
rectal bleeding and anemia which are
sometimes associated with weight loss
and changes in bowel habits.
Signs and symptoms
• worsening constipation,
•   blood in the stool,
• weight loss,
• fever,
•  loss of appetite,
•  nausea or vomiting in someone over 50
  years
• While rectal bleeding or anemia are high-
  risk features in those over the age of 50,
Cause
• Greater than 75-95% of colon cancer occurs in
  people with little or no genetic risk.
• While some risk factors such as older age and male
  gender cannot be changed many can.
• A high fat, alcohol or red meat intake are risk
  factors for colorectal cancer .
• obesity,
• smoking
• a lack of physical exercise.
• Inflammatory bowel disease
Diagnosis
• Appearance of
  the inside of
  the colon
  showing one
  invasive
  colorectal
  carcinoma (the
  crater-like,
  reddish,
  irregularly
  shaped tumor).
• Diagnosis of colorectal cancer is via tumor
  biopsy typically done during
  sigmoidoscopy or colonoscopy.
• The extent of the disease is then usually
  determined by a CT scan of the chest,
  abdomen and pelvis.
• There are other potential imaging test
  such as PET and MRI which may be used in
  certain cases. Colon cancer staging is done
  next and based on the TNM system .
BIOPSY
COLONOSCOPY
/SIGMOIDOSCOPY
C T SCAN
MRI
PET SCAN
Prevention

•Change in Lifestyle
•Medication
• Screening
Management
• Surgery
• . This can either be done by an
  open laparotomy or sometimes
  laparoscopically. If there are only
  a few metastases in the liver or
  lungs they may also be removed.
• Chemotherapy
• . Chemotherapy drugs may include
  combinations of agents including
  fluorouracil, capecitabine, UFT,
  leucovorin, irinotecan, or oxaliplatin.

• Radiation
• Palliative care
•Follow-up
NURSES
RESPONCIBILITIES FOR
 THE TREATMENT FOR
CANCER RELATED TO G I
       TRACT
• Find the condition of the patient disease
  symptoms
• Watch the vital sign of the patient
• Watch the site of the operation for bleeding
  or infection
• Maintain proper position after surgery.
• Provide proper and safe environment after
  surgery.
• Maintain proper intravenous fluid therapy as
  per doctor order.
• Observe patient for any abnormal
• Common nursing
  diagnosis related to
  cancer of G I tract
  with nursing intervention
1)-knowledge deficit relted
   to disease condition
• Intervention-
• Determine present knowledge base and
  concerns regarding the diagnosis of disease.
• Discuss the treatment plan and explain the
  expected effects of treatment.
• Provide written information about cancer
  treatment and disease condition.
•
2) body image disturbance
• Intervention-
• Encourage patient to verbalize feeing both positive
  and negative about actual changes.
• Acknowledge the appropriateness of patient’s
  response to the change and loss of body fuction and
  control.
• Encourage the patient to look at, touch and care of
  the stoma.
• Identify and include family members in education and
  care of ostomy site.
• Identify at risk for unsuccessful adjustment to body
  image change as evidence by –
• 1 --lack of motivation
3) Altered nutrition less than body
           requirement
• Intervention-
• Assess nutritional status ,current, weight, appetite,
  food and caloric intake.
• Monitor serum level of the patient.
• Assess for sign and symptoms that interfere with
  nutritional intake.
• Educate the patient about the sign and symptoms
  of treatment that can interfere with adequate
  nutritional intake.
• Determine time of day when appetite may be
  greater.
4) Ineffective Airway clearance-
Intervention
Assess patient’s ability to swallow liquids and solid
foods
Assess breathing sound,rate and depth of
respiration at rest .
Assess patient’s ability to clear secretions,cough
mechanism and amount of sputum.
Administer oxyzen therapy as required.
Educate patient for self care of cough .
5)         Diarrhea
•   Intervention-
•   Assess hydration level of the patient.
•   Monitor intake and output
•   Provide law residue, bland, high protein diet.
    Avoid too hot and too cool diet.
•   Give fluids, avoid fluids such as orange juice,
    milk, alcoholic beverages.
•   Monitor serum level of patient.
•   Administer antidiarrheal treatment
•   Provide skin care to perineal area.
6) Altered oral mucous membrane
• Intervention
• Assess mucous membrain for
  pain,ulcers,lesions and dryness.
• Monitor oral intake.
• Encourage oral care.
• Teach patient for oral care protocol.
• Teach patient for sign and symptoms for
  bleeding.
• Keep lips moist and lubricanted.
• SUMMARY
• CONCLUSION
BIBLIOGRAPHY
• MICHAEL B. KASTAN,T/B OF CLINICAL ONCOLOGY,ELSEVIER,
• PAGENO-1179,1211TO1212,1431TO1459,1399TO1423,1477TO1525.
• DANIEL F. HAYES,T/B OF ONCOLOGY(AN EVIDENCE-BASED
  APPROACH),SPRINGER
• PAGE NO-12,704TO721
• BLACK,T/B OF MEDICAL SURGICAL NURSING,JAYPEE
• PAGE NO-
• WEBSITES
• WWW.ONCOLOGY.NURSING.OM
• WWW.CANCER.ORG
• WWW.WIKIPEDIYA.COM
• WWW.CANCERTREATMENT.COM
THANK YOU HVE A NICE
        DAY

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Presentation tation of cancer related to g i tract

  • 3. The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral cavity, where food enters the mouth, continuing through the pharynx, oesophagus, stomach and intestines to the rectum and anus, where food is expelled.
  • 5. The primary purpose of the gastrointestinal tract is to break food down into nutrients, which can be absorbed into the body to provide energy
  • 7. The wall is divided into four layers as follows: Mucosa Submucosa Muscularis externa Serosa/mesentery
  • 8. Individual components of the gastrointestinal system • Oral cavity • Salivary glands • Parotids • Submandib ular • Sublingual
  • 9. • Oesopha gus • Stomach • Small intestine • Large intestine
  • 10. • Liver • Gall bladder • Pancreas
  • 11. The Strategy • Digestive enzymes are secreted from cells lining the inner surfaces of various exocrine glands. • The enzymes hydrolyze the macromolecules in food into small, soluble molecules that can be • absorbed into cells.
  • 12. • IngestionThe Topology • -Food placed in the mouth -Ground into finer particles by the teeth, • -Moistened and lubricated by saliva • -small amounts of starch are digested by the amylase present in saliva • the resulting bolus of food is swallowed into the esophagus and • carried by peristalsis to the stomach.
  • 14. • THE STOMACH • The wall of the stomach is lined with millions of gastric glands, which together secrete 400–800 ml of gastric juice at each meal. Several kinds of cells are found in the gastric glands • parietal cells • chief cells • mucus-secreting cells • hormone-secreting (endocrine) cells
  • 15. • The Liver • The liver secretes bile. Between meals it accumulates in the gall bladder. When food, especially when it contains fat, enters the duodenum, the release of the hormone cholecystokinin (CCK) stimulates the gall bladder to contract and discharge its bile into the duodenum. • Bile contains: • bile acids.. • bile pigments..
  • 16. • The Hepatic Portal System • Glucose is removed and converted into glycogen. • Other monosaccharides are removed and converted into glucose. • Excess amino acids are removed and deaminated. – The amino group is converted into urea. – The residue can then enter the pathways of cellular respiration and be oxidized for energy. • The liver serves as a gatekeeper between the intestines and the general circulation. • the liver releases more to the blood by converting its glycogen stores to glucose (glycogenolysis), • converting certain amino acids into glucose (gluconeogenesis).
  • 17. • The Pancreas • The pancreas consists of clusters of endocrine cells (the islets of Langerhans) and exocrine cells whose secretions drain into the duodenum. Pancreatic fluid contains: • sodium bicarbonate (NaHCO3). • pancreatic amylase • pancreatic lipase • 4 "zymogens • trypsin • chymotrypsin. • elastase. • carboxypeptidase
  • 18. • The Small Intestine Digestion within the small intestine produces a mixture of disaccharides, peptides, fatty acids, and monoglycerides. • The Large Intestine (colon) • The large intestine receives the liquid residue after digestion and absorption are complete. This residue consists mostly of water as well as any materials that were not digested.
  • 19. CONDITION NO-1 ORAL CAVITY CANCER • There are several types of oral cancers, but around 90% are squamous cell carcinomas originating in the tissues that line the mouth and lips. Oral or mouth cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth).
  • 20. The Mouth (Cavum Oris; Oral Or Buccal Cavity) The cavity of the mouth is placed at the commencement of the digestive tube . it is a nearly oval-shaped cavity which consists of two parts: an outer, smaller portion, the vestibule, and an inner, larger part, the mouth cavity proper.
  • 22. SIGN AND SYMPTOMS OF ORAL CANCER • Common symptoms of oral cancer include: • Patches inside your mouth or on your lips White patches (leukoplakia) –Mixed red and white patches (erythroleukoplakia) –Red patches (erythroplakia) are brightly colored
  • 23. • A sore on your lip or in your mouth that won't heal • Bleeding in your mouth • Loose teeth • Difficulty or pain when swallowing • Difficulty wearing dentures • A lump in your neck • An earache
  • 24. Diagnosis of oral cancer • HISTORY OF THE PATIENT • PHYSICAL EXAMINATION OF THE MOUTH • Biopsy • Dental x-rays • Chest x-rays: • CT scan: • MRI:
  • 25. HISTORY OF THE PATIENT
  • 26. PHYSICAL EXAMINATION OF THE MOUTH
  • 30. CT Scan OF MOUTH
  • 32. Treatment for oralcancer • surgery, radiation therapy, or chemotherapy. Other health care include a dentist, speech pathologist, nutritionist, and mental healthcounselor.
  • 33. 1-Surgery • Maxillectomy (can be done with or without Orbital exenteration) • Mandibulectomy (removal of the mandible or lower jaw or part of it) • Glossectomy (tongue removal, can be total, hemi or partial) • Radical neck dissection • Moh's procedure or CCPDMA • Combinational e.g. glossectomy and laryngectomy done together. • Feeding tube to sustain nutrition
  • 34. • •partial maxillectomy removes portions of maxilla, incisive bone, palatine bone ± portions of the zygomatic and lacrimal bones • •premaxillectomy: unilateral or bilateral with removal of incisive bone and perhaps rostral maxilla • •central maxillectomy: maxilla and portions of hard palate resected • •caudal maxillectomy: maxilla, hard palate, zygomatic, and lacrimal bones removed • •hemimaxillectomy: removal of entire maxilla on 1 side extending dorsally to ventral orbit • •orbitectomy: removal of orbit ± caudal maxilla and vertical mandibular ramus •
  • 36. POSTOPERATIVE MANAGEMENT • sedation may be required if anxious when cannot nose breathe • •analgesic drug • • nutrition- • Cosmetic Appearance
  • 37. COMPLICATIONS • Oronasal Fistula • Mucosal Ulceration on Labial Flap or Lateral Skin of Lip • Hemorrhage • Infection • Sneezing and Nasal Discharge • Epiphora • Other Complications • •prehension and mastication problems, pain, cosmetic alterations, dehiscence, infection, tumor recurrence, subcutaneous emphysema, and failure to nose breathe •
  • 38. 2-Radiation therapy • Internal radiation (implant radiation • External radiation:
  • 40. • Esophageal cancer (or oesophageal cancer) is malignancy of the esophagus. There are various subtypes, primarily squamous cell cancer and adenocarcinoma , Squamous cell cancer arises from the cells that line the upper part of the esophagus. Adenocarcinoma arises from glandular cells that are present at the junction of the esophagus and stomach
  • 41. • Classification • Most esophageal cancers fall into one of two classes: squamous cell carcinomas, which are similar to head and neck cancer in their appearance and association with tobacco and alcohol consumption, and adenocarcinomas, which are often associated with a history of gastroesophageal reflux disease and Barrett's esophagus.
  • 42. Signs and symptoms • Dysphagia (difficulty swallowing) and odynophagia (painful swallowing • Pain behind the sternum or in the epigastrium, often of a burning, heartburn-like nature, may be severe • Another sign may be an unusually husky, raspy, or hoarse-sounding cough, a result of the tumor affecting the recurrent laryngeal nerve
  • 43. • nausea and vomiting, • regurgitation of food, • coughing and an increased risk of aspiration pneumonia. • The tumor surface may be fragile and bleed, causing hematemesis (vomiting up blood). • upper airway obstruction • superior vena cava syndrome • Fistulas may develop between the esophagus and the trachea, increasing the pneumonia risk; this condition is usually heralded by cough, fever or aspiration.
  • 44. • If the disease has spread elsewhere, this may lead to symptoms related to this: liver metastasis could cause jaundice and ascites, • lung metastasis could cause shortness of breath, pleural effusions, etc.
  • 45. Causes • Barrett's esophagus is considered to be a risk factor for esophageal adenocarcinoma. • There are a number of risk factors for esophageal cancer. • Age - most patients are over 60, and the median in US patients is 67. • Sex - the disease is more common in men. • Heredity - it is more likely in people who have close relatives with cancer. • Tobacco smoking and heavy alcohol
  • 46. • Gastroesophageal reflux disease (GERD • Human papillomavirus (HPV) • Corrosive injury • A medical history of other head and neck cancers increases • Plummer-Vinson syndrome(anemia and esophageal webbing) • Tylosis and Howel-Evans syndrome(hereditary thickening of the skin of the palms and soles)
  • 47. • Radiation therapy for other conditions in the mediastinum • Coeliac disease predisposes towards squamous cell carcinoma. • Obesity • Thermal injury as a result of drinking hot beverages • Alcohol consumption in individuals predisposed to alcohol flush reaction • Achalasia
  • 49. Diagnosis • Endoscopy and radial endoscopic ultrasound images of submucosal tumor in mid-esophagus.
  • 50. CT with contrast, axial image.
  • 51. barium swallow or barium meal
  • 52. esophagogastroduodenosc opy (EGD, endoscopy
  • 53. Biopsies taken of suspicious lesions are then examined histologically
  • 54. Computed tomography (CT) of the chest, abdomen and pelvis .
  • 55. Positron emission tomography
  • 57. Types of esophagectomy: • The thoracoabdominal approach opens the abdominal and thoracic cavities together. • The two-stage Ivor Lewis (also called Lewis- Tanner) approach involves an initial laparotomy and construction of a gastric tube, followed by a right thoracotomy to excise the tumor and create an esophagogastric anastomosis.
  • 58. • The three-stage McKeown approach adds a third incision in the neck to complete the cervical anastomosis • Laser • Photodynamic therapy, • Chemotherapy • Radiotherapy
  • 59. CONDITION NO-3 STOMACH CANCER • Stomach cancer, or gastric cancer, refers to cancer arising from any part of the stomach. Stomach cancer causes about 800,000 deaths worldwide per year
  • 60. Signs and symptoms • Endoscopic image of linitis plastica, a type of stomach cancer where the entire stomach is invaded, leading to a leather bottle-like appearance with blood coming out of it.
  • 61. • Discomfort or pain in the stomach area • Difficulty swallowing • Nausea and vomiting • Weight loss • Feeling full or bloated after a small meal • Vomiting blood or having blood in the stool
  • 62. • Stage 1 (Early) • Indigestion or a burning sensation (heartburn) • Loss of appetite, especially for meat • Abdominal discomfort or irritation
  • 63. • Stage 2 (Middle) • Weakness and fatigue • Bloating of the stomach, usually after meals
  • 64. • Stage 3 (Late) • Abdominal pain in the upper abdomen • Nausea and occasional vomiting • Diarrhea or constipation • Weight loss • Bleeding (vomiting blood or having blood in the stool) which will appear as black. This can lead to anemia. • Dysphagia; this feature suggests a tumor in the cardia or extension of the gastric tumor in to the esophagus..
  • 65. Causes • Infection by Helicobacter pylori. • gastritis, intestinal metaplasia and various genetic factors • smoked foods, salted fish and meat, and pickled vegetables • Nitrates and nitrites are substances commonly found in cured meats. • Smoking increases the risk of developing gastric cancer
  • 66. • consumption of alcohol. • Alcohol along with tobacco smoking increase the risk of developing other cancers . • Gastric cancer shows a male predominance in its incidence as up to three males are affected for every female • Some researchers showed a correlation between Iodine deficiency or excess, iodine- deficient goitre and gastric cancer
  • 67. Diagnosis • To find the cause of symptoms, asks about the patient's medical history, does a physical exam, and may order laboratory studies. The patient may also have one or all of the following exams:
  • 71. • Various blood tests may be done; including: Complete Blood Count (CBC) to check for anemia. Also, a stool test may be performed to check for blood in the stool.
  • 73. • These are the stages of stomach cancer: • Stage 0: The tumor is found only in the inner layer of the stomach. Stage 0 is also called carcinoma in situ. • Stage I is one of the following: – The tumor has invaded only the submucosa. Cancer cells may be found in up to 6 lymph nodes. – Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have not spread to lymph nodes or other organs.
  • 74. • Stage II is one of the following: –The tumor has invaded only the submucosa. Cancer cells have spread to 7 to 15 lymph nodes. –Or, the tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 1 to 6 lymph nodes. –Or, the tumor has penetrated the outer layer of the stomach. Cancer cells have not spread to lymph nodes or other
  • 75. • Stage III is one of the following: –The tumor has invaded the muscle layer or subserosa. Cancer cells have spread to 7 to 15 lymph nodes. –Or, the tumor has penetrated the outer layer. Cancer cells have spread to 1 to 15 lymph nodes. –Or, the tumor has invaded nearby organs, such as the liver, colon, or spleen. Cancer cells have not spread to lymph nodes or to distant organs.
  • 76. • Stage IV is one of the following: –Cancer cells have spread to more than 15 lymph nodes. –Or, the tumor has invaded nearby organs and at least 1 lymph node. –Or, cancer cells have spread to distant organs
  • 77. Management • Treatment for stomach cancer may include surgery,chemotherapy, and/or radiation therapy.
  • 78. 1-Surgery-----Total gastrectomy • 2- Chemotherapy • The use of chemotherapy to treat stomach cancer has no firmly established standard of care. • Some drugs used in stomach cancer treatment have included: • 5-FU (fluorouracil) or its analog capecitabine, • BCNU (carmustine), methyl-CCNU (Semustine), and • doxorubicin (Adriamycin), as well as Mitomycin C, and • more recently cisplatin and taxotere, often using drugs in various combinations
  • 79. 3-Radiation therapy • Nutrition • Nutrition after stomach surgery • Some people have problems eating and drinking after stomach surgery. Liquids may pass into the small intestine too fast, which causes dumping syndrome. The symptoms are cramps, nausea, bloating, diarrhea, and dizziness. To prevent these symptoms, it may help to make the following changes: • Plan to have smaller, more frequent meals (some doctors suggest 6 meals per day) • Drink liquids before or after meals • Cut down on very sweet foods and drinks (such as cookies, candy, soda, and juices)
  • 80. • Supportive care • Stomach cancer and its treatment can lead to other health problems. You can have supportive care before, during, and after cancer treatment. • Supportive care is treatment to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with the feelings that a diagnosis of cancer can bring. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life during treatment. •
  • 81. CONDITION NO-4 Colorectal cancer Colorectal cancer, commonly known as bowel cancer, is a cancer from uncontrolled cell growth in the colon or rectum (parts of the large intestine), or in the appendix. Symptoms typically include rectal bleeding and anemia which are sometimes associated with weight loss and changes in bowel habits.
  • 82. Signs and symptoms • worsening constipation, • blood in the stool, • weight loss, • fever, • loss of appetite, • nausea or vomiting in someone over 50 years • While rectal bleeding or anemia are high- risk features in those over the age of 50,
  • 83. Cause • Greater than 75-95% of colon cancer occurs in people with little or no genetic risk. • While some risk factors such as older age and male gender cannot be changed many can. • A high fat, alcohol or red meat intake are risk factors for colorectal cancer . • obesity, • smoking • a lack of physical exercise. • Inflammatory bowel disease
  • 84. Diagnosis • Appearance of the inside of the colon showing one invasive colorectal carcinoma (the crater-like, reddish, irregularly shaped tumor).
  • 85. • Diagnosis of colorectal cancer is via tumor biopsy typically done during sigmoidoscopy or colonoscopy. • The extent of the disease is then usually determined by a CT scan of the chest, abdomen and pelvis. • There are other potential imaging test such as PET and MRI which may be used in certain cases. Colon cancer staging is done next and based on the TNM system .
  • 89. MRI
  • 92. Management • Surgery • . This can either be done by an open laparotomy or sometimes laparoscopically. If there are only a few metastases in the liver or lungs they may also be removed.
  • 93. • Chemotherapy • . Chemotherapy drugs may include combinations of agents including fluorouracil, capecitabine, UFT, leucovorin, irinotecan, or oxaliplatin. • Radiation • Palliative care
  • 95. NURSES RESPONCIBILITIES FOR THE TREATMENT FOR CANCER RELATED TO G I TRACT
  • 96. • Find the condition of the patient disease symptoms • Watch the vital sign of the patient • Watch the site of the operation for bleeding or infection • Maintain proper position after surgery. • Provide proper and safe environment after surgery. • Maintain proper intravenous fluid therapy as per doctor order. • Observe patient for any abnormal
  • 97. • Common nursing diagnosis related to cancer of G I tract with nursing intervention
  • 98. 1)-knowledge deficit relted to disease condition • Intervention- • Determine present knowledge base and concerns regarding the diagnosis of disease. • Discuss the treatment plan and explain the expected effects of treatment. • Provide written information about cancer treatment and disease condition. •
  • 99. 2) body image disturbance • Intervention- • Encourage patient to verbalize feeing both positive and negative about actual changes. • Acknowledge the appropriateness of patient’s response to the change and loss of body fuction and control. • Encourage the patient to look at, touch and care of the stoma. • Identify and include family members in education and care of ostomy site. • Identify at risk for unsuccessful adjustment to body image change as evidence by – • 1 --lack of motivation
  • 100. 3) Altered nutrition less than body requirement • Intervention- • Assess nutritional status ,current, weight, appetite, food and caloric intake. • Monitor serum level of the patient. • Assess for sign and symptoms that interfere with nutritional intake. • Educate the patient about the sign and symptoms of treatment that can interfere with adequate nutritional intake. • Determine time of day when appetite may be greater.
  • 101. 4) Ineffective Airway clearance- Intervention Assess patient’s ability to swallow liquids and solid foods Assess breathing sound,rate and depth of respiration at rest . Assess patient’s ability to clear secretions,cough mechanism and amount of sputum. Administer oxyzen therapy as required. Educate patient for self care of cough .
  • 102. 5) Diarrhea • Intervention- • Assess hydration level of the patient. • Monitor intake and output • Provide law residue, bland, high protein diet. Avoid too hot and too cool diet. • Give fluids, avoid fluids such as orange juice, milk, alcoholic beverages. • Monitor serum level of patient. • Administer antidiarrheal treatment • Provide skin care to perineal area.
  • 103. 6) Altered oral mucous membrane • Intervention • Assess mucous membrain for pain,ulcers,lesions and dryness. • Monitor oral intake. • Encourage oral care. • Teach patient for oral care protocol. • Teach patient for sign and symptoms for bleeding. • Keep lips moist and lubricanted.
  • 105. BIBLIOGRAPHY • MICHAEL B. KASTAN,T/B OF CLINICAL ONCOLOGY,ELSEVIER, • PAGENO-1179,1211TO1212,1431TO1459,1399TO1423,1477TO1525. • DANIEL F. HAYES,T/B OF ONCOLOGY(AN EVIDENCE-BASED APPROACH),SPRINGER • PAGE NO-12,704TO721 • BLACK,T/B OF MEDICAL SURGICAL NURSING,JAYPEE • PAGE NO- • WEBSITES • WWW.ONCOLOGY.NURSING.OM • WWW.CANCER.ORG • WWW.WIKIPEDIYA.COM • WWW.CANCERTREATMENT.COM
  • 106. THANK YOU HVE A NICE DAY