-2011, 2nd SEMESTER

A Case Study Presented to Ms. Marichou F. Señorin In Partial Fulfillment of the Requirements in Culinary Nutrition

Group Six Silvestre, Jazmine D. Tapawan, Faire Jessica Serias, Neil Umali, Erryl Zalameda, Winzhel HRM 16

March 10, 2011

CASE STUDY I. Introduction A. Name: Paul C. B. Age : 35 years old C. Gender: Male D. Height: 5’5 E. Weight:59 kg F. Family Medical History:  Aunts and uncles died from Colon Cancer at early age.



Colorectal cancer, also called colon cancer or large bowel cancer or "CRC", includes cancerous growths in the colon, rectum and appendix. With 655,000 deaths worldwide per year, it is the fourth most common form of cancer in the United States and the third leading cause of cancer-related death in the Western world. Colorectal cancers arise from adenomatous polyps in the colon. These mushroom-shaped growths are usually benign, but some develop into cancer over time. Localized colon cancer is usually diagnosed through colonoscopy. Invasive cancers that are confined within the wall of the colon (TNM stages I and II) are curable with surgery. If untreated, they spread to regional lymph nodes (stage III), where up to 73% are curable by surgery and chemotherapy. Cancer that metastasizes to distant sites (stage IV) is usually not curable, although chemotherapy can extend survival, and in rare cases, surgery and chemotherapy together have seen patients through to a cure. Radiation is used with rectal cancer. On the cellular and molecular level, colorectal cancer starts with a mutation to the WNT signaling pathway. When WNT binds to a receptor on the cell, that sets in motion a chain of molecular events that ends with β-catenin moving into the nucleus and activating a gene on

DNA. In colorectal cancer, genes along this chain are damaged. Usually, a gene called APC, which is a "brake" on the WNT pathway, is damaged. Without a working APC brake, the WNT pathway is stuck in the "on" position.

From :

Incidence And Mortality Colon cancer ranks 6th overall, 5th among males and 7th among females. An estimated 2,963 new cases, 1,548 in males 1,415 in females, together with 1,567 deaths will be seen in 1998. Colon cancer increases markedly after age 50.

Risk factors & prevention Personal or family history of colon cancer; personal or family history polyps in the colon; inflammatory bowel disease. Evidence suggests that colon cancer may be linked to a diet high in fat and deficient in whole grains, fruit and vegetables.

Warning signals A change in bowel habits such as recurrent diarrhea and constipation, particularly with the presence of abdominal discomfort, weight loss, unexplained anemia, and blood in the stool.

Early detection Unfortunately, early colon cancer is asymptotic, and there is still no efficient screening method for early detection. The aim should be earlier diagnosis of symptomatic patients who complain of changes in bowel habits, vague abdominal pains, and unexplained weight loss and anemia, particularly among patients 50 years old and above, by means of barium enema or colonoscopy.

The mistaken obsession of our physician with amoebiasis and other forms of inflammatory bowel disease had for decades been a major factor that had delayed diagnosis of colon cancer. The wider availability of antidiarrheal, antibiotics and amoebecides may have worsened the situation. Too many physicians still insist in giving vitamin preparations and hematinics for chronic unexplained weight loss and anemia without carefully looking for the cause.

Treatment Early colon cancer is curable, and surgery is the most effective method of treatment.

From :

What is Hereditary Non-polyposis Colorectal Cancer? HNPCC is an inherited colorectal cancer syndrome and accounts for 5 percent of all cases of colorectal cancer. The “H” stands for hereditary, meaning it is inherited or can be passed from parent to child; “N” stands for non-polyposis, contrasting it to the inherited condition FAP where hundreds to thousands of polyps develop in the colon; “CC” stands for colorectal cancer, the most frequent cancer that develops in these families. Patients with HNPCC have an 80 percent chance of developing colorectal cancer.

The cause for HNPCC is due to an inherited mutation (abnormality) in a gene that normally repairs our body’s DNA. There are at least 5 genes that have been found to cause HNPCC. They are called Mismatch Repair Genes. If part of the DNA is not matched properly cancer can occur. Because the HNPCC gene mutation is present in every cell in the body’s other organs can develop cancers too. Cancer of the uterus (womb or endometrium) is very common and may be the main cancer in some HNPCC families. Other cancers can occur in the rest of gastrointestinal tract (stomach, small intestine, and pancreas), urinary system (kidney, ureter) and female reproductive organs (ovary). Although the risk to develop cancer in HNPCC

is high, knowing about the risk of cancer and getting appropriate check-ups and treatment by experts in this disorder can save lives and prevent cancer.

How is HNPCC diagnosed?

Family History

The first step in suspecting someone belongs to an HNPCC family is by reviewing the family history. The strictest definition of an HNPCC family is called the Amsterdam criteria. It includes:

• 3 relatives with colorectal cancer (one first degree relative to the other two) • 2 successive generations • 1 colorectal cancer occurring in someone 50 years old or less

The colon cancers are often found in the right colon and usually occur before the age of 50. Other clues to an HNPCC family include multiple relatives with colon cancers, including relatives who have had more than one colorectal cancer, or a colon and endometrial cancer, and clusters of colorectal and other cancers of the gastrointestinal, urinary or female reproductive system.

 

Genetic testing Colon examinations

What lifestyle changes can be expected?

Most patients are able to eat normal diets and lead normal lives following surgery. Some people notice more frequent bowel movements. Otherwise, their lives will be perfectly normal. Their sexual and social activities are unaffected. None of the procedures affects a man’s ability to father children or a woman’s ability to have a normal pregnancy. However, the way in which a baby is delivered may be affected by the type of surgery and should be discussed with the surgeon.

What testing is needed to keep patients with HNPCC or at risk of HNPCC healthy?


Nutritional Assessments

Desirable Body Weight = Height - 5”5 5x12 = 60 + 5 65 x 2.54 = 165.1 – 100 65.1 x .90 = 58.59 kg DBW = 58.59 kg Nutritional Status = (59kgs / 58.59kgs) x 100

NS = 100.70Normal IV. Dietary Requirement

Diet for Colon cancer patients: Moving away from red meat, fatty foods, foods high in sugar, and refined grains to more fruits, vegetables and dietary fiber. A colon cancer diet many patients tolerate well includes:  Whole grains  Fresh, raw vegetables and fruits  Legumes such as beans and lentils  Non fatty fish, chicken and meats, free of hormones and additives These foods supply your body with:  Complex carbohydrates  Vitamins, minerals and enzymes  Easily digestible protein Vegetables with cancer preventive compounds include:  Broccoli  Cabbage  Cauliflower  Kale  Winter squash TOTAL ENERGY REQUIREMENT TER =DBW x PA TER =58.59 x 30 *sedentary

= 1757.7 kcal TER =58.59 x 27.5 *bed rest =1611.23 kcal
CHO CHON FAT 60% 20% 20% 1758 X .60 1758 X .20 1758 X .20 1054.8 /4 351.6 /4 351.6 /9 263.7g 87.9g 39.1g

Food Items Veg A Veg B Fruits Milk Whole Low Fat Skimmed Rice Meat Low Medium High Fat Sugar TOTAL Exchange 7 6 5 1 2 5 3 1 1 2 2 CHO 21 18 50 12 24 115 20 260 *1040g 24 8 8 87 *348g 39 *351g 16 10 CHON 7 6 8 Tr 3 6 10 10 Fat 10 Total Energy Calories 112 96 200 170 160 500 123 86 122 90 80 1739 kcal


Sample Meal Plan
Day Breakfast Veggie – Meaty sandwich, Low fat milk Pineapple slice Mixed greens with croutons Orange juice Oranges Chicken Salad/ oats with fruits A.M. Snack Fresh fruits with sweet milk Lunch Menudo Rice Mango slices Macaroni LemonChicken Mango slices Bangus friend Yangchow P.M Snack Water Papaya slice Dinner Nilagang baka Rice Melon slice water Beef steak Midnight Milk



Milk chocolate latte crackers Honey dew chills Protein crackers

Mixed green salad Vegetaria n delight Jasmine

Milk or yoghurt

Wednesda y

Oatmeal bars

Milk banana

rice with veggies Thursday Omelets Wheat bread Yellow tea Caesar salad with thousand island dressing Pandesal Ham, bacon or eggs Fish and potatoes Hot Chocolate Lumpiang sariwa Buko juice with milk Maruya Choice of greens and fruits shake Inihaw na bangus Rice buko Paella Mano shake Naicha Beef in chinese noodles Vegetarian platter Four seasons squeeze Crab louie delight Laing Water rice

tea Tomatoe delight bread Strawberr y tea Soft crackers Lumpiang ubod Green tea Chopsuey in chicken Fish crouquette in sweet sauce Pancit bihon Fresh milk Milk youghurt





Embotido Crab soup Rice water

cranberri es

*** All meals should have glass of water. *** More vegetable dishes than red meat dishes. ***eat more white meat than red meat. *** Juices should be in form of fresh rather than can.


Diagnosis & Goal  Since the colon cancer is patented from the family genes. The family members should be conscious of their health lifestyle not only Paul.  Dietary Plan should be taken care of to avoid aggravating the colon cancer cells.  To extent patients longevity existence.  To make and enable the person do simple tasks in daily intake.  To ensure short term recovery goals be achieve and long term recovery goals be observe and imply the measures to the patient’s lifestyle. 



Undergo these procedures to confirm the level of the colon cancer rather than considering it as advance stage. There may be more than the illness stated or provided, if there are there will be more test to undergo before the surgery will be conducted. Digital rectal exam (DRE): The doctor inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. It only detects tumors large enough to be felt in the distal part of the rectum but is useful as an initial screening test. Fecal occult blood test (FOBT): a test for blood in the stool. Two types of tests can be used for detecting occult blood in stools i.e. guaiac based (chemical test) and immunochemical. The sensitivity of immunochemical testing is superior to that of chemical testing without an unacceptable reduction in specify. Endoscopy: Sigmoidoscopy: A lighted probe (sigmoid scope) is inserted into the rectum and lower colon to check for polyps and other abnormalities. Colonoscopy: A lighted probe called a colonoscope is inserted into the rectum and the entire colon to look for polyps and other abnormalities that may be caused by cancer. A colonoscopy has the advantage that if polyps are found during the procedure they can be removed immediately. Tissue can also be taken for biopsy.