Abdominal Cancers: Types, Treatment and Nursing Care

Table of Contents

ABDOMINAL CANCERS

Abdominal cancers are malignant tumours arising in organs or tissues within the abdomen, including the stomach, intestines, liver, pancreas, gallbladder, bile ducts and peritoneum. They may also involve abdominal lymph nodes, the retroperitoneum or abdominal organs through metastatic spread. This topic brings together their clinical features, investigation, treatment and nursing management for diploma surgical nursing revision.

The expression describes a group of diseases, rather than one cancer with one treatment. The site of origin, histological type, extent of spread, molecular characteristics, organ function and the person's general condition determine management. An abdominal swelling is not automatically malignant, and early cancer may cause no palpable mass.

Learning objectives

Define abdominal cancers and classify the important types.
Relate abdominal anatomy and tumour spread to the patient's symptoms.
Identify risk factors, warning features and emergency complications.
Explain diagnostic investigations, biopsy, grading and staging.
Outline medical, surgical, nutritional and palliative management.
Plan nursing care before, during and after treatment, with rationales.
Provide practical education on prevention, follow-up and symptoms requiring urgent review.

Relevant anatomy and physiology

Stomach: stores and mixes food, secretes acid and intrinsic factor, and controls delivery into the duodenum. Gastric disease can interfere with intake, emptying and vitamin B12 absorption after major resection.
Small intestine: performs most digestion and nutrient absorption. Tumour narrowing, extensive resection or treatment-related inflammation may impair nutrition.
Colon and rectum: absorb water, form and store stool. Lesions may cause bleeding, altered bowel habits or obstruction.
Liver: processes nutrients and drugs, produces bile and plasma proteins and helps maintain coagulation. A tumour may coexist with cirrhosis, making treatment dependent on the remaining liver's capacity.
Pancreas: produces digestive enzymes and hormones such as insulin. Disease or resection can cause maldigestion and disturbances of glucose control.
Gallbladder and bile ducts: store and carry bile to the intestine. Obstruction produces jaundice, pale stool, dark urine and itching.
Peritoneum: covers abdominal surfaces and contains a small amount of lubricating fluid. Cancer deposits can disturb drainage and cause ascites or bowel fixation.
Blood vessels and lymphatics: provide routes for tumour spread. Portal venous drainage helps explain why gastrointestinal cancers often metastasise to the liver.

Classification of abdominal cancers

Classification	Examples and meaning
By primary site	Gastric, colorectal, hepatocellular, pancreatic, gallbladder, bile duct and small-bowel cancers.
By tissue of origin	Adenocarcinoma from glandular epithelium; lymphoma from lymphoid tissue; sarcoma from connective tissue; neuroendocrine tumours from neuroendocrine cells; gastrointestinal stromal tumour (GIST) from specialised supporting cells of the gastrointestinal tract.
Primary malignancy	Begins in the affected organ, for example hepatocellular carcinoma originating in the liver.
Secondary malignancy	Spread from another primary site, for example colon cancer metastatic to the liver. It remains colon cancer and is treated accordingly.
Peritoneal involvement	Deposits from gastrointestinal or ovarian malignancy, or a less common primary peritoneal malignancy.
Retroperitoneal disease	Tumours behind the peritoneum, including some sarcomas, renal cancers and lymphomas.

Pelvic and urinary malignancies, such as ovarian, bladder and kidney cancers, can present with abdominal symptoms. They should be considered during assessment even when the lecture topic mainly concerns digestive organs. Cancer of the rectum also requires site-specific discussion because pelvic staging and treatment differ from those of colon cancer.

Benign tumour versus malignant tumour

Feature	Benign	Malignant
Growth	Often slow and localised.	May grow progressively and infiltrate surrounding structures.
Invasion and spread	Does not metastasise.	Can invade, spread through lymph or blood and seed body cavities.
Cell appearance	Often resembles the parent tissue.	May show abnormal differentiation and uncontrolled division.
Clinical effects	Can still cause compression, bleeding or obstruction.	Can cause local damage and systemic illness.

Clinical appearance alone does not establish the diagnosis. Some benign masses are large; some aggressive cancers are initially small. Imaging and appropriate pathological assessment are required.

Causes and risk factors

Cancer develops through accumulated changes affecting cell growth, repair and survival. A risk factor increases probability; it does not mean that every exposed person will develop cancer. Relevant factors vary by organ.

Increasing age and inherited susceptibility: a family history of related cancers, Lynch syndrome or familial adenomatous polyposis can indicate the need for genetic assessment and specialised surveillance.
Tobacco: contributes to several digestive malignancies, including pancreatic and stomach cancer.
Alcohol: heavy use can contribute to liver disease and is associated with cancer risk at several sites.
Obesity, inactivity and metabolic disease: may increase risk through metabolic disturbance and chronic inflammation.
Chronic inflammation: long-standing inflammatory bowel disease, chronic pancreatitis, cirrhosis and selected chronic biliary conditions can predispose to malignancy.
Infections: Helicobacter pylori is important in gastric malignancy; hepatitis B and C are important in liver malignancy.
Diet and exposures: frequently consuming processed meat is relevant to colorectal risk. Poorly preserved or heavily salted foods are relevant to gastric risk. Aflatoxin exposure from mould-contaminated food is relevant to liver cancer.
Previous precancerous lesions: some adenomatous bowel polyps and selected dysplastic lesions can progress to malignancy.

In Uganda, assessment should include hepatitis history, alcohol use, family history and food-storage practices without assuming that these explain every case. Risk assessment supports prevention and referral; it does not replace diagnostic testing.

Pathophysiology and routes of spread

Initiation: genetic and cellular changes alter normal regulation of growth.
Progression: abnormal cells multiply and acquire the ability to survive and form a tumour.
Local invasion: the tumour penetrates tissue planes, damages vessels or nerves and may narrow a hollow organ.
Regional spread: cancer cells enter lymphatic channels and regional lymph nodes.
Distant spread: cells travel through blood or seed the peritoneal cavity. Deposits may occur in the liver, lungs, bones or other sites depending on the primary cancer.
Systemic effects: reduced intake, inflammatory metabolism, bleeding and treatment toxicity can produce weight loss, anaemia, weakness and functional decline.

Mechanisms of common symptoms: mucosal ulceration causes visible or occult bleeding; luminal narrowing causes vomiting or obstruction; biliary blockage causes jaundice; nerve or tissue invasion causes pain; peritoneal deposits cause ascites; inflammation and impaired intake contribute to wasting. Cancer cachexia involves altered metabolism and muscle loss, so it may not be corrected simply by telling a patient to eat more.

Important types of abdominal cancer

1. Gastric cancer

Most stomach cancers are adenocarcinomas. Other tumours, including lymphoma and GIST, require different treatment. Persistent symptoms deserve assessment rather than repeated treatment for presumed uncomplicated dyspepsia.

Risk factors: H. pylori infection, gastric atrophy or intestinal metaplasia, smoking, family susceptibility and selected dietary exposures.
Features: persistent epigastric discomfort, early satiety, appetite loss, weight loss, nausea, vomiting or anaemia. Haematemesis, melaena and gastric outlet obstruction may occur.
Diagnosis: upper gastrointestinal endoscopy with biopsy. Staging uses imaging and, in selected patients, endoscopic ultrasound or laparoscopy.
Treatment direction: selected very early lesions may be treated endoscopically; operable disease may require partial or total gastrectomy with lymph-node assessment and systemic treatment. Advanced disease requires individualised anticancer and symptom management.
Nursing priorities: recognise bleeding and persistent vomiting, support nutrition, prepare for endoscopy or surgery and monitor eating difficulties after gastrectomy.

2. Colorectal cancer

Colorectal cancer includes malignancies of the colon and rectum, commonly adenocarcinoma. Some arise through an adenoma-to-carcinoma sequence; others develop through different molecular pathways.

Risk assessment: family history, inherited syndromes, previous high-risk polyps and long-standing colonic inflammatory disease are important.
Presentation: rectal bleeding, altered bowel habits, unexplained iron-deficiency anaemia, abdominal discomfort or weight loss. Right-sided lesions may present with occult bleeding and anaemia; left-sided lesions more often produce obstructive symptoms. These are tendencies, not diagnostic rules.
Diagnosis: colonoscopy and biopsy where appropriate. Imaging assesses disease extent; CEA is useful in selected monitoring situations but cannot establish or exclude cancer alone.
Management: resection of the involved bowel and appropriate lymph nodes for operable disease, with chemotherapy according to stage and risk. A stoma may be temporary or permanent. Rectal cancer may require radiotherapy as part of its treatment plan.

3. Liver cancer

Hepatocellular carcinoma (HCC) arises from liver cells and often occurs with chronic liver disease. Cancer in the liver may instead be metastatic, or may originate in intrahepatic bile ducts.

Risk factors: chronic hepatitis B or C, cirrhosis, alcohol-related liver damage, metabolic liver disease and aflatoxin exposure.
Features: right upper abdominal discomfort, loss of weight or appetite, hepatomegaly, worsening ascites or new deterioration in a patient with liver disease. Early HCC may be detected during surveillance before symptoms develop.
Assessment: ultrasound, multiphasic CT or MRI, liver-function assessment and selected AFP testing. In an appropriate high-risk patient, characteristic imaging may establish HCC without biopsy; this decision belongs to the specialist team.
Treatment: options include resection, transplantation in selected patients, ablation, arterial treatments, systemic treatment and radiotherapy. Liver reserve and tumour extent both influence suitability.
Nursing priorities: monitor bleeding, ascites, jaundice, confusion, nutrition and response to the chosen procedure.

4. Pancreatic cancer

The common exocrine cancer is pancreatic ductal adenocarcinoma. Pancreatic neuroendocrine tumours have different biology and may produce hormone-related syndromes.

Risk factors: smoking, chronic pancreatitis, obesity and inherited susceptibility. New or changing diabetes can sometimes be an associated warning feature.
Features: upper abdominal pain radiating to the back, progressive weight loss, jaundice, dark urine, pale stool, itching or steatorrhoea. A tumour in the pancreatic head can obstruct the bile duct.
Assessment: pancreatic-protocol imaging and selected endoscopic ultrasound with tissue sampling; laboratory studies assess biliary obstruction, nutrition and glucose.
Management: surgery for suitably resectable disease, often with chemotherapy. A Whipple operation treats selected head lesions; distal pancreatectomy treats selected body or tail lesions. Biliary or duodenal stents can relieve obstruction in appropriate cases.
Nursing priorities: pain relief, glucose monitoring, nutrition, prescribed enzyme replacement and early recognition of infection or postoperative leaks.

5. Gallbladder and bile-duct cancers

Gallbladder carcinoma and cholangiocarcinoma may present with jaundice, pruritus, weight loss or abdominal pain. Some gallbladder cancers are discovered after cholecystectomy. Persistent biliary obstruction needs investigation; fever and jaundice with systemic illness raise concern for cholangitis and require urgent review.

Ultrasound, CT, MRI/MRCP and selected endoscopic or drainage procedures help locate the lesion and obtain material where appropriate. Treatment may involve resection, systemic therapy or drainage to relieve obstruction. Nurses monitor fever, drainage, skin irritation, hydration, coagulation concerns and the effects of impaired bile flow.

6. Small-bowel, peritoneal and other abdominal malignancies

Small-bowel cancers, lymphoma, GIST, neuroendocrine tumours and retroperitoneal sarcomas can cause pain, anaemia, bleeding, a mass or obstruction. Their treatment cannot be inferred from location alone. Peritoneal disease may present with ascites and bowel symptoms. Persistent bloating, early satiety or a pelvic mass also require assessment for ovarian disease. Specialist pathological classification is essential before an organ-specific treatment plan is adopted.

General clinical manifestations

Manifestation	Clinical interpretation and nursing response
Unintentional weight loss and anorexia	Record baseline weight, recent change, intake and functional ability; assess access to food and refer for nutritional support.
Persistent or progressive abdominal pain	Assess location, radiation, severity, duration and associated symptoms; escalate a sudden change.
Bleeding or iron-deficiency anaemia	Observe stool and vomit, assess circulation and fatigue; arrange ordered investigation rather than assuming haemorrhoids.
Altered bowel habit	Document onset, stool pattern, blood, incomplete evacuation and medicines; identify obstruction symptoms.
Jaundice and itching	Assess urine and stool changes, fever, skin integrity and evidence of liver dysfunction.
Abdominal mass or distension	Assess gently, document the location and associated symptoms; distinguish suspected fluid, organ enlargement and obstruction through medical assessment.
Fatigue and weakness	Consider anaemia, poor intake, pain, sleep disturbance and treatment toxicity; support safe activity.

Warning: these symptoms can also occur in non-cancerous conditions. Their persistence, progression or combination warrants investigation. A normal early examination or one normal blood test does not reliably exclude malignancy.

Assessment and diagnostic investigations

History taking

Clarify the main complaint, duration and progression.
Assess pain, vomiting, swallowing difficulty, early satiety and food tolerance.
Ask about stool frequency, colour, blood, constipation, diarrhoea and passage of flatus.
Explore jaundice, itching, urine changes and abdominal enlargement.
Record weight change, appetite, fatigue, fever and daily functioning.
Ask about previous ulcers, polyps, hepatitis, pancreatitis, liver disease, inflammatory bowel disease and earlier operations.
Review prescribed medicines, anticoagulants, allergies, supplements and herbal preparations.
Obtain relevant family cancer history and previous test or screening results.
Assess smoking, alcohol, diet and relevant occupational exposures.
Explore the person's understanding, emotional state, support, transport and financial barriers.

Physical examination

Assess airway, breathing and circulation first if the patient is acutely unwell. Record temperature, pulse, blood pressure, respiratory rate, oxygen saturation and hydration. Look for pallor, jaundice, wasting, oedema and impaired mobility. Examine the abdomen systematically for scars, distension, tenderness, masses, enlarged organs and evidence of fluid. An intimate examination requires explanation, consent, privacy, a chaperone where appropriate and a trained practitioner. Document findings precisely rather than labelling a mass as cancer before confirmation.

Investigation	Purpose and nursing considerations
Full blood count	Detect anaemia and establish white-cell and platelet baselines before treatment.
Renal function and electrolytes	Identify dehydration, electrolyte disturbance and treatment-related renal concerns.
Liver tests, albumin and coagulation	Assess cholestasis, liver reserve, nutrition-related concerns and procedural bleeding risk.
Stool testing	FIT or occult-blood tests support appropriate pathways; a negative result must not dismiss persistent alarm symptoms.
Ultrasound	Assess masses, liver, biliary dilation and ascites; may guide selected procedures.
CT or MRI	Characterise the lesion and spread. Check pregnancy possibility, relevant implants, contrast history and renal assessment according to protocol.
Endoscopy	Visualise the lumen and obtain biopsies. Follow procedure-specific fasting, preparation and sedation instructions.
Histopathology	Determine tumour type and grade from appropriately obtained tissue; ensure correct specimen identification and transport.
Molecular or biomarker tests	Guide selected therapies or identify inherited risk. Blood markers such as CEA, AFP and CA19-9 are not universal screening or stand-alone diagnostic tests.
Selected fluid or other sampling	Ascitic-fluid cytology or other targeted sampling may clarify spread. A negative sample does not exclude every malignancy.

Nursing preparation for endoscopy or biopsy

Confirm identity, procedure, consent and the person's understanding.
Review allergies, anticoagulants, diabetes treatment and previous sedation problems; alterations require authorised instructions.
Follow the exact fasting or bowel-preparation regimen and assess its effect on hydration.
Explain positioning, likely sensations, specimen collection and recovery.
After sedation, monitor airway, consciousness and vital signs and follow safe discharge arrangements.
Report severe new pain, persistent vomiting, fever, marked bleeding or instability after an invasive procedure.

Grading, staging and prognosis

Grade describes how abnormal the tumour cells appear and relates to biological behaviour. Stage describes the extent of disease. They answer different questions.

T: size or local extent of the primary tumour.
N: regional lymph-node involvement.
M: distant metastasis.

TNM categories are grouped into organ-specific stages. A T category has different definitions for different cancers, so stage should be read from the relevant report rather than guessed from tumour size. Liver cancer assessment also needs to account for liver function and performance status. Resectability asks whether safe, useful surgical removal is possible; it is related to, but not identical to, stage.

Prognosis depends on cancer type, disease extent, tumour biology, response to treatment, organ function, nutritional and functional status and access to care. Avoid giving a fixed survival prediction from the label “abdominal cancer”. Nurses can explain the documented treatment goal and direct individual prognostic questions to the treating team.

Management of abdominal cancers

Principles and treatment goals

Management is planned by an appropriate multidisciplinary team. The goals may be cure, long-term disease control, symptom relief or a combination. Neoadjuvant therapy is given before the main treatment; adjuvant therapy follows it. Palliative treatment aims to improve comfort or control illness and may include active anticancer treatment.

Modality	Purpose and nursing focus
Surgery	Remove an operable tumour, obtain staging information or relieve a complication. Prepare the patient and monitor recovery.
Chemotherapy	Treat cancer systemically. Check protocol, blood results, access, adverse effects and infection risk.
Radiotherapy	Provide local control or symptom relief in selected cancers. Monitor fatigue, skin effects and site-dependent bowel symptoms.
Targeted therapy	Act on selected tumour pathways. Eligibility and monitoring depend on the drug and tumour biomarkers.
Immunotherapy	Support an immune response against selected cancers. Recognise possible immune-related inflammation affecting bowel, liver, lungs or endocrine organs.
Ablation and arterial procedures	Destroy or treat selected liver lesions locally. Monitor procedural complications and liver function.
Stents, bypass and drainage	Relieve selected bowel or biliary obstruction and support comfort or further treatment.
Supportive and palliative care	Address pain, nausea, nutrition, psychological distress, family needs and practical difficulties throughout illness.

Drug regimens and availability vary by cancer, biomarkers, local protocols and patient fitness. Chemotherapy should be administered only by trained staff using the prescribed regimen and handling precautions. A general nursing lecture should not be used to select or calculate an oncology regimen independently.

Preoperative nursing care

Assessment: establish vital signs, pain, nutrition, hydration, elimination, mobility and comorbidities.
Optimisation: implement ordered correction of dehydration, electrolyte disturbance and anaemia; involve the team in nutritional support and glucose control.
Preparation: verify consent, investigations, blood availability where required and medication plans. Follow prescribed fasting, bowel preparation, antibiotics and thromboprophylaxis.
Teaching: explain postoperative pain relief, supported coughing, breathing exercises, mobilisation, wound care and possible tubes or drains.
Stoma planning: arrange preoperative counselling and site assessment when a stoma is anticipated.
Psychological support: allow questions about cancer, body changes and recovery; use an interpreter when needed.
Safety: complete the surgical checklist and hand over important risks and baseline findings.

Postoperative care with rationales

Care area	Nursing action	Rationale
Airway and breathing	Assess breathing, saturation and sedation; provide prescribed support and encourage breathing exercises when stable.	Anaesthesia, pain and immobility increase respiratory-complication risk.
Circulation	Monitor vital signs, perfusion, wound and drain losses; escalate instability.	Early recognition of haemorrhage or sepsis permits prompt treatment.
Fluid balance	Record intake, urine, vomit, stoma and drain output; review weight and ordered laboratory results.	Losses and inadequate intake can cause dehydration and electrolyte disturbance.
Pain	Assess pain at rest and on movement, administer prescribed analgesia and reassess effect and sedation.	Comfort supports breathing, mobilisation and participation in care.
Abdominal recovery	Assess distension, nausea, pain pattern and bowel/stoma function. Report new tachycardia, fever, increasing pain or abnormal drainage.	These may indicate ileus, obstruction, anastomotic leak or another complication.
Wounds and drains	Use aseptic technique; record drainage amount and character; secure devices and follow the removal plan.	Maintains safety and helps identify bleeding, infection or leakage.
Nutrition	Follow the procedure-specific feeding plan; assess tolerance and involve the dietitian.	Supports healing while accounting for the operation and clinical condition.
Activity and thrombosis prevention	Assist early mobilisation when safe and implement prescribed mechanical or medication measures.	Cancer and surgery increase venous-thromboembolism risk.
Skin and pressure areas	Inspect skin, reposition according to need and support hygiene.	Weakness and poor nutrition increase pressure-injury risk.
Discharge readiness	Assess self-care, caregiver support, supplies and understanding through demonstration and teach-back.	Reduces avoidable complications after discharge.

Procedure-specific considerations

After gastrectomy: assess meal tolerance, weight and possible dumping symptoms. Teach smaller frequent meals according to dietetic advice and arrange required micronutrient monitoring or replacement, especially B12 after total gastrectomy.
After bowel resection: monitor recovery of intestinal function, wound healing and evidence of leak. Follow the prescribed feeding and bowel-management plan.
After pancreatic surgery: monitor glucose, nutrition and drain findings; administer prescribed pancreatic enzymes with food and report suspected pancreatic leak.
After liver surgery: assess bleeding, liver dysfunction, glucose disturbance and mental state; escalate deterioration promptly.
With biliary drainage: secure the tube, record output, maintain the prescribed drainage arrangement and report fever, leakage, dislodgement or cessation of expected flow.

Stoma care

Explain whether the patient has a colostomy or ileostomy and whether reversal is planned. Assess stoma colour, moisture, swelling, output and surrounding skin. A healthy stoma is usually moist and pink to red. A newly dusky, black or markedly pale stoma needs prompt surgical assessment.

Measure the stoma and fit the appliance to protect the skin without constriction.
Clean gently, dry the surrounding skin and avoid unnecessary irritating products.
Teach emptying, changing the appliance and managing leakage through supervised practice.
Record output and hydration, especially with an ileostomy; unusually high output can cause major fluid and salt losses.
Discuss clothing, body image, intimacy, work and reliable access to supplies.
Teach urgent review for severe pain, persistent vomiting, absent output with obstructive symptoms, major bleeding or dehydration.

Care during systemic anticancer treatment

Problem	Nursing management
Infection or neutropenia	Monitor temperature and symptoms, use hand hygiene and safe line care, review blood counts and escalate suspected infection immediately.
Nausea and vomiting	Give prescribed antiemetics at the planned times; monitor intake and losses and investigate persistent vomiting rather than assuming treatment toxicity.
Mouth soreness	Assess the mouth, provide gentle oral care and suitable food textures; report painful ulceration or suspected infection.
Diarrhoea	Record frequency, blood and associated fever; monitor hydration and electrolytes. Severe diarrhoea may require urgent assessment, particularly during immunotherapy.
Constipation	Assess medicines, intake and bowel pattern; use the prescribed bowel regimen after obstruction has been excluded.
Bleeding tendency	Observe bruising, gum bleeding and stool or urine changes; reduce trauma and follow platelet-related precautions.
Neuropathy or fatigue	Assess sensation and function, prevent falls and support pacing of activity; report changes that may affect treatment.
Infusion reaction or extravasation	Observe during administration. If suspected, stop administration and follow the drug-specific emergency protocol; do not blindly flush a suspected extravasation.

Oncology and surgical emergencies

Suspected bowel obstruction: colicky pain, vomiting, distension and failure to pass stool or flatus require prompt assessment. Follow orders for fasting, intravenous fluids and decompression; do not give routine laxatives when obstruction is suspected.
Perforation or peritonitis: sudden severe pain, rigidity, marked tenderness or shock requires emergency surgical review.
Major gastrointestinal bleeding: assess circulation, call for urgent help, monitor losses and prepare ordered resuscitation, investigations and blood products.
Cholangitis or sepsis: fever with jaundice, pain, hypotension or confusion demands urgent assessment and treatment.
Fever during chemotherapy: a temperature of 38°C or above, or other signs of infection, should be reported urgently according to the oncology plan. Do not mask fever with self-medication and delay assessment.
Venous thromboembolism: sudden breathlessness, chest pain or unilateral leg swelling requires urgent medical review.
Severe treatment toxicity: new breathlessness, marked diarrhoea, confusion, jaundice or reduced urine during therapy must be assessed promptly.

The nursing priority in an emergency is early recognition, rapid escalation, ABC assessment, monitoring and implementation of authorised emergency care. Routine appointments should not delay urgent treatment.

Nursing care plan

Problem and goal	Interventions	Rationale and evaluation
Pain: tolerable pain with improved function.	Assess pattern and severity, provide prescribed analgesia and comfortable positioning, and reassess.	Individualised relief supports activity; evaluate the patient's reported relief and ability to rest.
Inadequate nutrition: intake meets the agreed plan.	Record intake and weight trend; address nausea, mouth problems and food access; offer suitable small meals and dietetic referral.	Targets reversible barriers; evaluate intake, tolerance, strength and nutritional goals.
Fluid deficit: adequate perfusion and balanced losses.	Monitor vital signs, urine and all losses; provide prescribed replacement and review electrolytes.	Vomiting, diarrhoea and stoma losses can be substantial; evaluate hydration and clinical response.
Infection risk: prompt detection and reduced exposure.	Monitor temperature, wounds and lines; use aseptic technique and teach urgent reporting.	Immunosuppression and devices increase vulnerability; evaluate findings and timely escalation.
Altered elimination: safe, manageable bowel function.	Record stool/stoma output, assess distension and pain, implement the prescribed plan and teach appliance care.	Distinguishes expected change from complications; evaluate comfort and safe self-care.
Anxiety or disturbed body image: informed participation.	Listen, explain in understandable language, involve chosen support and refer for counselling or stoma support.	Information and practical support improve coping; evaluate concerns and participation.
Knowledge needs: safe home management.	Use teach-back for medicines, wound/stoma care, danger signs and appointments.	Demonstration identifies gaps; evaluate what the patient can explain and perform.
Fatigue and reduced activity: appropriate daily function.	Assess contributing causes, plan rest and supported activity and provide fall prevention.	Addresses reversible contributors without exhausting the patient; evaluate function and safety.

Nutrition, pain relief and palliative support

Assess food intake, swallowing, bowel function, nausea, pain and social barriers. Encourage acceptable nutrient-dense foods and fluids when appropriate. Supplements, tube feeding or parenteral nutrition require individual assessment; the route depends on gastrointestinal function, treatment goals and anticipated benefit. Avoid restrictive “cancer diets” that worsen intake, and review supplements or herbal preparations for possible interactions.

Pain assessment should include physical, emotional and functional effects. Use prescribed medicines, bowel support where appropriate and non-drug comfort measures, with reassessment for benefit and adverse effects. Palliative care can accompany treatment from an early stage. It supports symptoms, communication, family needs, spiritual concerns and advance-care discussions according to the person's wishes.

Complications

Obstruction, perforation, bleeding and anaemia.
Biliary obstruction, infection and liver dysfunction.
Ascites and progressive abdominal discomfort.
Malnutrition, cachexia, dehydration and electrolyte disturbance.
Venous thrombosis and pulmonary embolism.
Metastatic disease and organ-specific complications.
Postoperative infection, anastomotic leak, fistula, ileus and wound problems.
Treatment-related marrow suppression, mucositis, neuropathy and organ toxicity.
Psychological distress, caregiver strain and loss of livelihood.

Prevention, discharge teaching and follow-up

Support tobacco cessation, healthy activity, weight management and reduced alcohol exposure.
Promote hepatitis B vaccination and assessment/treatment of chronic hepatitis according to local services.
Encourage safe food storage; avoid consuming visibly mould-contaminated food.
Complete prescribed H. pylori treatment and attend follow-up when indicated.
Explain colorectal screening and surveillance for high-risk conditions using the applicable local pathway; screening applies to people without symptoms, whereas alarm symptoms require diagnostic assessment.
Provide a clear medication plan and explain possible adverse effects.
Demonstrate wound, drain or stoma care and confirm access to necessary supplies.
Give practical nutrition and hydration advice relevant to the operation and treatment.
Provide contacts and teach urgent reporting of fever, bleeding, severe pain, persistent vomiting, breathlessness, worsening jaundice or reduced urine.
Explain appointments for pathology results, further therapy, surveillance and supportive care. Address transport and referral barriers before discharge.

Revision questions and clinical application

Define abdominal cancers and give six examples by primary site.
Differentiate primary liver cancer from colorectal cancer metastatic to the liver.
Explain why grade, stage and resectability are different concepts.
Outline assessment of a patient with weight loss and a new change in bowel habits.
List nursing preparations for endoscopy with biopsy.
Describe postoperative care after major abdominal cancer surgery, giving rationales.
Explain stoma assessment and education for an ileostomy patient.
Identify five emergency symptoms during anticancer treatment.

Clinical case: A patient reports fatigue, weight loss and a persistent change in bowel habit. Haemoglobin is low. The nursing response is to document symptoms, assess stability and nutrition, support the diagnostic referral and avoid assuming a benign cause. If the same patient develops distension, vomiting and inability to pass flatus, priorities change to urgent assessment for obstruction.

References and further reading

These notes combine general surgical nursing principles with organ-specific guidance. Consult the following original sources alongside the patient's documented treatment plan and local clinical protocols.

Return to the Diploma in Nursing Direct Curriculum. Related notes: Ascites and Cholecystitis.

Abdominal Cancers: Types, Symptoms, Treatment and Nursing Care