MED/SURG CASE STUDY

Esophageal Cancer
The client is a 56 year old man with a history of gastroesophageal reflux, Barrett’s
esophagus, and a 30 pack per year history of smoking. He presents with a 2 month
history of coughing, sore throat and progressive difficulty swallowing, first of solid foods
and more recently of liquids.He is currently experiencing nausea and early satiety. A
biopsy revealed adenocarcinoma of the distal esophagus and gastroesophageal
junction.Following chemotherapy with 5-fluorouracil and cisplatin,along with radiation.
Modified barium swallow revealed functional oropharyngeal swallow, but
moderate-to-severe esophageal dysphagia with delayed movement of liquids in upper
esophagus and reflux into the pharynx.An esophagectomy and J-tube placement are
planned.

1. Anthropometric measurements
Ht: 5’8”
Wt: 165 lbs
Usual weight: 185 lbs (4 months ago)

2. Biochemical Data

Parameter Value

Sodium 140 mEq/L

Potassium 4.3 mEq/L

Chloride 100 mEq/L

Carbon Dioxide 25 mEq/L

BUN 15 mg/dL

Creatinine 0.9 mg/dL

Glucose 89 mg/dL

Prealbumin 2.9 mg/dL

Hemoglobin 13.8 mg/dL

Hematocrit 37%
 3. Nutrition-Focused Physical Findings
Appears weak and uncomfortable.Reports sore throat,cough,odynophagia,and dysphagia.

4. Client History
Social History: 30 pack per year history of smoking,and drinks 3-4 martinis on weekends.

5. Food/Nutrition-Related history
Recently has been eating only small amounts of scrambled egg,oatmeal,apple juice,canned
peaches,and soup.

Medications
Ondanestron, hydromorphone,and lansoprazole

QUESTIONS

1. What risk factors does this client have for esophageal cancer?
a. age (between 40-70 y/o)
b. gender (male)
c. tobacco
d. alcohol
e. Baretts esophogus

2. What is his IBW, BMI,%IBW and usual body weight? Comment on his recent weight
change and nutritional status.Calculate his energy(Mifflin St Jeor),protein,and fluid
needs.Show your work.

a. IBW = 154 lb (70 kg)

b. BMI = 25 (overweight)
c. %IBW = 107 %
d. UBW = 84 kg (Comment: 10.8% weight loss in 4 months. He has a nutrition risk
score of 2 for nutrition. This weight loss could be related to his recent reduced
dietary intake related to his swallowing difficulty. This patient is at risk for
continued weight loss.
e. Estimated energy needs
i. REE = 1554 x 1.25 (AF) = 1950 kcals
ii. Protein requirement: 1.2-1.5 g/kg = 90g-115g (used actual body weight
75kg)
iii. Fluid requirements: RDA 30ml/kg = 2250 ml (used actual body weight
75kg)

3. List the nutrition-related side effects of the chemotherapeutic agents that he will be
receiving.What are the possible side effects of radiation treatment?

a. Chemo: Diarrhea, constipation, nausea, vomiting, loss of appetite. Difficulty

swallowing. Sores in mouth. Heartburn. Jaw pain.
b. Radiation: xerostomia, mucositis, dysphagia, odynophagia, heartburn, fatigue.

4. Identify an appropriate nutrition diagnosis and write a PES statement based on his initial
presentation.

a. Inadequate oral intake​ related to swallowing difficulty as evidenced by patient

stated sore throat,cough,odynophagia, barium swallow with moderate-to-severe
esophageal dysphagia and recent weight loss of 10.8 % in 4 months.
5. Do you think he will be able to take adequate nutrition by mouth after a partial
esophagectomy with reanastamosis?
a. No, the patient will need nutrition support until the area of the esophagus that
was operated on is healed. Once the area is healed the patient will be able to
resume oral nutrition.
6. What type of diet should be recommended? During chemotherapy and radiation? Why or
why not?
a. The neutropenic diet should be recommended during chemo a radiation. This
diet will be useful for a patient with a weakened immune system.
b. Clear liquid, full liquid, soft and/or low fiber.

7. What would be your overall goals for this client, and how would you monitor the results or
outcomes of your interventions?
a. Consume adequate nutrition to support increased protein needs and prevent
further weight loss.
b. Goals​:
i. Provide a liquid supplement such as Boost Plus 3x day.
ii. Consume 6 small frequent meals throughout the day to help with early
satiety.
iii. May need to use J-tube to increase caloric intake.
c. M & E​:
i. weight loss/gain/maintenance

8. What is the current research on diet and cancer prevention?

a. There is no concrete evidence/studies proving that certain foods or nutrients can
prevent cancer. Part of the problem with doing research on certain nutrients are
there are too many outside variables contributing to the prevention or further
development of cancer. A healthy diet is important for overall general health and
may impact cancer, but there is no causative reliable evidence.