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