case study #33 esophageal cancer lynne roller and teresa schwendler

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