case study #33 esophageal cancer lynne roller and teresa schwendler
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Case Study #33Esophageal Cancer
Lynne Roller and Teresa Schwendler
What is cancer?
Cancer is a class of diseases characterized by uncontrolled cell division and the ability of these cells to invade other tissues-either by direct growth to adjacent tissue(invasion) or by migration of cells to distant sites(metastasis)
Esophageal Cancer
Esophageal Cancer
Form 1: Adenocarcinoma (AC)
Form 2: Squamous cell carcinoma(SCC)
Etiology For Esophageal Cancer
SmokingAlcohol abuseObesity Having bile refluxEating few fruits and vegetables Having gastro-esophageal reflux diseaseBeing male and between the ages of 45-70
Cancer Identification Procedures
Cytologic testPhysical testBiochemical test
Description of Patient
● Nick Seyer, 58 y.o. male contractor● Diagnosed with Stage IIB adenocarcinoma
of the esophagus. ● Experiencing Dysphagia and Odynophagia● Smokes 2ppd; wife also smokes● Alcohol use: 1-2 drinks 1-2 x/week
Mr. Sayer’s History
• Height: 6’3”• Weight: 198lbs.• BMI: 24.9• %UBW: 87%• Recent weight loss of 30lbs over the past few
months• 14% weight loss = severe weight loss• Energy Requirements to maintain weight:
1796kcal/day• Energy Requirements to gain weight: 2700kcal/day• Protein Requirements: 135g/day• Fluid Requirements to maintain weight:
1796mL/day• Fluid Requirements to gain weight: 2700mL/day
Mr. Seyer’s Disease measures
Chemistry Normal Value Mr. Seyer’s Value
Reason for Abnormality
Nutritional Implications
Total Protein 6-8 5.7 Inadequate Protein intake
Increase protein intake
Albumin 3.5-5 3.1/3.0 Inadequate protein intake, dehydration
Increase protein intake, rehydrate
Prealbumin 16-35 15/12 Inadequate protein intake
Increase protein intake
RBC 4.5-6.2 4.2/4.3 Malabsorption/side effect of cancer
Increase iron, B12, folate
Hemoglobin 14-17 13.5/13.9 Low RBC due to cancer
Increase iron, B12, folate
Hematocrit 40-54 38 Decreased RBC Increase iron, B12, folate
Mean cell Hgb 26-32 32.4/32.3 Low RBC Increase iron, B12
Mr. Sayer’s Diagnosis
Inadequate Protein intake
Inadequate energy intake
Difficulty swallowing
Severe weight loss- Cachexia
Current Treatment
MedicalExternal Beam Radiation Therapy
Surgery- surgical resection of tumor- transhiatal esophagectomy
NutritionEnteral Nutrition-Isosource HN
Increased calories and protein intake
EsophogectomyMedical Treatment
kcal/mL: 1.2Caloric Distribution (% of kcal) Protein: 18% Carbohydrate: 53% Fat: 29% Protein Source: soy protein isolateNPC:N Ratio: 115:1MCT:LCT Ratio: 20:80 n6:n3 Ratio: 2.7:1Osmolality (mOsm/kg water): 490Water 82%
Isosource HNEnteral Formula
Enteral Nutrition
Comparison to Mr. Seyer’s Estimated Nutrition Requirements
Value
from I/O chart
Currently
Receiving
To maintain weight(REE
with PAL factor of
1.3)
To gain weight (using
30kcals/kg)
Protein needed for
Cancer Patient
(1.5g/ kg)
Rate of mL/hr.
60.24mL/hr 75mL/hr 81 mL/hr 94 mL/hr
Total of Enteral Formula for day
1.7 L 1.8 L 2 L 2.25 L
Total Calories for day
2,082 kcal
2,160 kcals
2,335kcals 2,700 kcals
Total Protein 90.1g 95.4g 103 g 119g 135g
PES
Malnutrition (NI-5.2) related to insufficient enteral nutrition recommendations as evidence
by weight loss of over 30 pounds in a two month period and signs of cachexia
Inadequate protein energy intake (NI-5.7.3) related to metabolic abnormality due to
cancerous state as evidence by Estimated protein intake higher than recommended
prescribed enteral nutrition therapy.
Goals
Talk with other members of the nutrition care team about the current amount of
enteral nutrition that Mr. Seyer is receiving . Increase Mr. Seyer’s daily
protein intake, via enteral nutrition, to 135g and increasing calories to 2,700kcals
Intervention
Increase enteral protein intake to 135g per day.
Increase total energy intake to 2700kcal/day in order to gain weight.
Monitoring and Evaluation
Monitor anthropometrics to track weight gain.
Monitor biochemical data- track proteinSubjective Global Assessment- gauges the
patient’s perception of their ability to accomplish self-care.
True or False?
When people have surgery to remove their cancer they often also have chemotherapy before to reduce the size of the tumor and after to treat local areas of reoccurrence?
When people who have cancer start eating again sometimes they have aversions to eating certain foods?
Enteral nutrition is always suggested for terminally ill cancer patients?
True or False?
When people have surgery to remove their cancer they often also have chemotherapy before to reduce the size of the tumor and after to treat local areas of reoccurrence?(T)
When people who have cancer start eating again sometimes they have aversions to eating certain foods? (T)
Resources
Jager-Wittenaar, H;Dijkstra PU; Vissink A. “Changes in nutritional status and dietary intake
during and after head and neck cancer treatment.” http://www.ncbi.nlm.nih.gov/pubmed/20737491 Mayo Clinic (n.d.). Chemotherapy - MayoClinic.com. Retrieved May 5, 2011,
from http://www.mayoclinic.com/health/chemotherapy/MY00536 Mayo Clinic (2011, May). Esophageal cancer: Treatments and drugs -
MayoClinic.com, from http://www.mayoclinic.com/health/esophageal-cancer/DS00500/DSECTION=treatments-and-drugs
National Cancer Institute (2012, November 1). When Someone You Love Has Advanced Cancer - National Cancer Institute. Retrieved from http://www.cancer.gov/cancertopics/coping/when-someone-you-love-has-advanced-cancer/page4
National Institutes of Health (2013). Esophageal cancer - National Library of Medicine - PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001328/
Nelms, Marcia; Sucher, Kathryn; Lacey, Karen; Roth, Sara Long. Nutrition Therapy and Pathophysiology.2/e