Interventions for GI Cancers

Medical and Surgical Interventions:

Type of Cancer	Treatments	Nursing Responsibilities
Oral	Partial resection (mandibulectomy, glossectomy or hemiglossectomy) Radical neck dissection Chemotherapy Radiation	Maintain airway- Fowler's, tracheostomy care Provide nutrition- Parenteral feedings first 24-48 hours, Enteral via gastrostomy tube Enhance communication - practice methods prior to surgery, refer to speech therapist if necessary Pain management Psychosocial support for body image disturbances
Esophageal	Esophagectomy with/without graft Endoscopy – photodynamic or laser therapy Radiation Esophageal dilation	Same as for radical neck for airway and nutrition Avoid manipulation of NG tube to protect sutures. NG drainage is bloody for 8-10 hours then gradual change to greenish yellow. Maintain semi or Fowlers to prevent reflux as grafts have no sphincters Prevent respiratory complications- spirometer, turn Nutrition – parenteral fluids, J-tube, or PEG. Gradual return to oral feedings progressing from water to bland. Observe for signs of leakage of feeding. Psychosocial support for grieving if terminal
Stomach	Total gastrectomy with esophagojejunostomy (fundus) Billiroth I or II (antrum or pyloric) Chemotherapy Palliative radiation	NG tube – Billroth - monitor patency and function to prevent damage to sutures, notify MD if dislodged; monitor drainage - initial is bright red changing to dark then greenish-yellow in 2-3 days. If total gastrectomy, may have minimal secretions. Manage chest tubes if chest cavity entered during surgery Antibiotic and anti ulcer meds Vitamin replacement – vitamins C, D, K and B Observe for complications such as ruptured sutures, leakage of juices, hemorrhage, abscess Assess for return of bowel function Monitor for manifestations of dumping syndrome, postprandial hypoglycemia and bile reflux gastritis
Colon	Hemicolectomy (right or left) Rectal surgery: Local excision, low anterior resection (LAR), or abdominal perineal resection (APR) Colostomy if APR used Colonic J-pouch or coloplasty if spincters preserved Chemotherapy, biologic and targeted therapy Palliative radiation	Pre-op - bowel prep with antibiotics ,osmotic lavage Post-op - monitor stoma for color, drainage, position and size, monitor drainage. Sterile dressing changes Pain management Sexual function - assess Skin care- pouching Stoma care- perform and teach Nutrition - intervene for constipation, gas, or diarrhea Psychosocial support for body image disturbance
Pancreas	Whipple procedure Radiation Chemotherapy	Pain management Monitor for complications: hemorrhage, peritonitis, pneumonia, shock Pneumonia prevention Psychosocial support for poor prognosis Nutrition - appetite stimulation, supplemental feeding

Drug therapy: Review chemotherapy

Diet therapy:

a) Goals:

i) maximize nutrition
ii) Management of ostomy
- Gas
- Constipation
- Diarrhea

b) Methods of delivery of alternative feedings:

i) Oral supplements if possible - enteral route preserves mucosa
ii) TPN - increased risk for sepsis

3) Other interventions:

a) Teach

i) enterstomal therapist
ii) ostomy mnagement
iii) nutrition

b) Psychological support

i) body image
ii) social isolation
iii) cancer support groups
iv) ostomates
v) grieving - real and anticipatory

c) Prognosis

i) poor for GI cancers due to late detection
ii) surgical treatment usually radical
iii) chemo and radiation usually palliative