Esophageal Cancer

cdunbar4's version from 2016-11-03 21:29


Question Answer
#1 and #2 risk factors Smoking and excessive alcohol use
Other predisposing factorsdiet low in fruits & vegetables (vitamins and minerals); asbestos & metal exposure; hx of GERD, Lye
Predisposing factor: achalasiadelayed emptying of lower esophagus (slow motility through system)
Survival rate5-year, 37%
Types of cancer (gland and mucosa)adenocarcinoma (of a gland) and the rest are squamous cell (mucosa)
Incidence increases withage (70-84); men 3x >women; Blacks and AK natives

Clinical Manifestations & Complications

Question Answer
symptoms early or late in disease?Late
Dysphagia worsens, pain is located...epigastric area, substernally or in the back; may radiate to neck and jaw
Weight loss is common, why?Due to dysphagia and pain
Complication r/t hemorrhagecancer can erode through esophagus and into the aorta (esp. ETOH varices)
Complication: esophageal perforationfistual formation into lung or trachea → really bad , you can die!
**Complication: Metastasiscan very easily metastasize via lymph system (lots of nodes nearby); liver and lung are common sties of metastasis; mucous membranes are very vulnerable tissues


Question Answer
Barium swallow with fluoroscopyreal-time images of the internal structures of a pt. via use of fluoroscope: x-ray and screen
endoscopic biopsydefinitive diagnosis
endoscopic ultrasonographystages disease
bronchoscopic examinationdetects malignant involvement of the lung
CT scan and MRIextent of disease
Best results with what combo of treatment?Surgery, chemo and radiation

Collaborative care

Question Answer
Poor prognosis r/tlate stage diagnosis, surgeries are usually very extensive can be thoracic, abdominal incision or laproscopic.
esophagectomyremoval of part of all of the esophagus with use of Dacron graft to replace resected part
esophagogastrostomyresection of a portion of the esophagus and anastomosis of remaining portion to the stomach
esophagoenterostomyresection of portion of esophagus and anastomosis of a segment of colon to remaining portion
Smaller surgeries are becoming more frequentlaproscopic and endoscopic to ablate Barrett's esophagus metaplasia

Collaborative Care post-op

Question Answer
What do you expect would be place for a post-op -ectomy patient?NG tube, do not reposition → call doc; there may be bloody drainage for 8-12hrs. gradually changes to greenish-yellow
Pt. is at greater risk for what, more than usual?respiratory aspiration
What else is more likely for post-op patient?cardiac dysrhythmias due to location and close proximity to heart
HOB positionFowler's or Semi-Fowlers to ↓ reflux
BOLO forleakage of fluids into mediastinum-pain, temp, dyspnea
Nutritional Therapyparenteral fluids; after BS, 30-60ml of water
Meal sizesprogression to small, frequent, bland meals

Assessment & Nursing Management

Question Answer
History of GERD, hiatel hernia, achalasia or Barrett's
SubstancesETOH and smoking use
Subjective reportspain, dysphagia, odynophagia
Objective flags?weight loss, regurgitation
Nursing Planopitimal nutritional intake; symptom relief, understand prognosis of disease; QOL appropriate to disease progression
Nursing Implementation (same as GERD, oral inflammations)stop smoking/ETOH; oral hygiene and diet; high calorie and proteins; explain surgical procedures

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