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Lisa Marquand

Alexandra Perez
Delilah Bisase
DFM 484
Case Study 33 Esophageal Cancer treated with surgery and radiations
1) A malignant gland tumor. Aden=gland, oma=tumor, carcin=cancerous/malignant,
carcinoma=epithelial. Essentially a cancerous/malignant tumor originating from a
gland/glandular structures in epithelial tissue of the esophagus.
4) Surgical resection: The most effective and involves the removal of a tumor and/or
lymph node. Often chemotherapy or radiation is used prior to surgery to shrink the
tumor, making it smaller and easier to remove. Surgery can allow adjuvant therapy to be
more effective. Reconstructive and plastic surgery is also used to restore function and
appearance.
Radiation: Localized treatment using electromagnetic rays and charged particles. It can
control the growth of a tumor when it cannot be removed, or prophylactically to protect
the brain and spinal cord from leukemic infiltration. This process works by altering the
cancer cells cellular and nuclear material; mainly the DNA. Similar to chemotherapy,
radiation also targets rapidly dividing cells. Its commonly given in combination with
surgery and/or chemotherapy, and can also be a form of palliative care.
Chemotherapy: Systemic treatment with a relatively narrow therapeutic index; chemo
drugs circulate throughout the body via an IV. Four broad categories of what the drug
targets: DNA replication, small molecules/biologicals (ex: cytokines), hormonal therapy,
and macromolecules. It targets rapidly dividing cells, and in doing that unfortunately
healthy host cells may also fall victim to the drugs along with the cancer cells.
Biological Response Modifier Therapy: Aim is to reinforce or restore the immune
systems ability to fight off the cancer, without directly targeting cancer cells.
Immunotherapy- monoclonal antibodies (MAbs) stimulate immune response to
attack cancer cells
Cytokines- administered to help mediate and regulate immune response, the
types used are interferons (INF), interleukins (IL), and hematopoietic growth
factor.
Hematopoietic stem cell transplantation- stem cells are from donor, identical twin,
or the actual patient themselves. Most often for hematological cancers (ex:
lymphoma).
6) Common medical problems related to cancer include nausea/vomiting, early satiety,
dysgeusia, diarrhea, mucositis, xerostomia, constipation, weight loss/ cancer cachexia,
anemia, anorexia, and fatigue. These are a result of the disease itself and/or the side
effect of therapies. These affect nutrition status because they can cause a decrease in
oral energy intake, which is major because nutrition support (enteral or parenteral) is
generally only advised in some cases depending on the individual and type of treatment.
Inadequate energy intake can put the patient at risk for being malnourished. The main
goal for MNT in cancer is to prevent malnourishment, because it can be difficult to
reverse.
7) Radiation and surgery can affect the nutritional status of cancer patients. Radiation
can cause nausea and vomiting as well as impact the patients sense of taste and smell
making food less palatable. Other adverse effects of radiation therapy, particularly in the

head and neck, include xerostomia, dysphagia, odynophagia, and severe esophagitis, all
which would cause a decrease in both fluid and energy intake. Surgery can promote
swallowing disorders. All of these issues can lead to insufficient intake and negatively
impact treatment outcomes without nutritional intervention.
8) UBW% = 90 kg
103.6kg

x 100 = 86.9%

BMI= 90 kg
1.9 m2

= 24.9

9) Mr. Seyers BMI is 24.9, which indicates he is at the borderline of normal and
overweight. He reported that he has lost 30 lbs. in the last several months, a 13% weight
reduction, which indicates he is at severe nutritional risk.
11) Mr. Seyers protein needs were calculated as follows: 90 kg x 1.5 (for wasting)=169g
.8g/kg
His energy requirements are: 2777= 66.5 + (13.8x 90 Kg.) + (5 x 187.5 cm) - (6.8 X58
yrs.)(Including a 1.5 for wasting).
12) Fluid intake should be in the range of 30-35 mL/kg of body weight. Mr. Seyers
current weight is 90 kg. His fluid intake should be 90kg x 35 mL/kg = 3,150 mL= 3.15 L
13) Prior to admission Mr. Seyers intake had been declining. He was finding difficulty
and pain in swallowing. He was experiencing heartburn, regurgitation and fullness
regardless of intake. Mr. Seyers 24-hour recall when compared to his usual meals was
very telling. Adequate protein and a full varied diet were replaced with a sparse diet of
soft, easy to swallow foods.
17) Upon admission Mr. Seyers labs confirmed nutritional issues. His Hemoglobin and
Hematocrit lab values were both below the normal range. His protein, albumin and prealbumin were also below normal. These below normal lab values could be indicative of
microcytic anemia due to protein deficiency and his chronic disease state. The nutritional
concerns with microcytic anemia relate to the functions iron performs in the cell,
including the role of iron as a cofactor, transporter, and promoter. With anemia the
outcomes could be exhaustion and poor concentration. For Mr. Seyers, adequate
protein intake is critical to his postoperative healing.
20) Dehydration due to inadequate fluid intake, dysphagia, and odynophagia as
evidenced by xerostomia and dry mucous membranes.
Inadequate energy intake due to dysphagia and odynophagia, as evidenced by
significant weight loss (13%) in the past month and 24 hour recall.