Age : 67 y/o Mouth sores

Dysphagia
Ethnicity: Filipino

Generalized body weakness

erapy
moth
othe
rapy
Radi
Family History:

Che
1st degree family
history of cancer
(Father: colon) Nasopharyngeal
Carcinoma

Environmental: Chronic Cough

Secondhand smoke Difficulty in swallowing
Unintentional weight loss
(Husband - smoker)

Diet: Low in fruits;

High in red meats and
processed meats

Nasopharyngeal Carcinoma (NPC) is a type of head and neck cancer that originates from the epithelium of the nasopharynx.
The etiology of NPC is a complex combination between genetic and environmental factors. Based on the patient’s information,
personal attributes such as age, ethnicity, and family history of cancer are significant risk factors that play a role in the disease
development. First, the patient is 62 years old and it has been well determined that the incidence of NPC escalates dramatically with
age (ACS, 2018). Likewise, ethnicity is also a factor, since there is a high incidence of NPC in southern China and Southeast Asia.
According to a recent study by Lao & Le (2020), the Philippines has the third highest incidence (2913 cases) and mortality (1899
cases) of NPC among the Southeast Asian countries. Additionally, the patient’s father was diagnosed with colon cancer which also
contributes to her increased chance of developing the disease. People who have a close relative with cancer have a higher risk of NPC
due to genetic susceptibility as well as shared environmental and lifestyle factors (ACS, 2018). On the other hand, the patient’s
occupation may have influenced her dietary intake. Low consumption of fruits coupled with regular intake of fatty foods from
unsold meats and processed meats specifically longganisa contain nitrite preservatives which is associated with a substantially
increased risk of NPC (Li et al., 2016; Cancer Research UK, 2020). Lastly, exposure to secondhand smoke from the spouse which
contain benzopyrene, arsenic, formaldehyde and other carcinogenic substances, have also increased the patient’s risk of acquiring the
disease (ASCO, 2019).

NPC is difficult to detect in a silent and painless area, thus, it is usually diagnosed at advanced stages. Initially the patient
experienced notable symptoms such as persistent cough and difficulty in swallowing coupled with unintentional weight lost.
According to American Society of Clinical Oncology (2019), chronic cough can be caused by inhaling secondhand smoke and in this
case, the smoke originates from the spouse’s tobacco smoke. Persistent coughing greatly affects quality of life causing sleeping
problems, urinary incontinence, and even muscle tensions. Additionally, mild dysphagia or difficulty in swallowing is one of the
numerous symptoms frequently experienced by patients with worsening cough. Moreover, she also suffered unintentional weight
loss which may be incited by cytokines. These are immune and inflammation response substances produced by the body to fight off
cancer cells. However, cytokines also induces weight loss, muscle loss, and a decrease in appetite (Cancer Care, 2016).

As the symptoms progress and become unmanaged as well as dietary and environmental exposures to carcinogens became
repetitive, the patient was diagnosed with Nasopharyngeal Carcinoma, T2N1M1. The treatments of the disease require 35
radiotherapy cycles and 6 chemotherapy cycles. However, three weeks later the patient complained dysphagia, mucositis, and body
weakness. Radiotherapy and chemotherapy cycles induce mouth sores or mucositis and also affect the salivary gland and tissue
resulting to dry mouth leading painful or difficulty in chewing and swallowing or dysphagia (NCI, 2020). Generalized body
weakness is also a common side effect of both cancer and cancer treatments. Cancer produces toxic substances that change the normal
cellular process, whereas cancer treatments kill both normal and cancer cells and alter normal protein and hormone levels which
increases inflammation and worsen fatigue (ACS, 2020). Subsequently, the malignancy of cancer and ongoing treatments generated
other symptoms including severe dysphagia, dysgeusia, early satiety, as well as vomiting after chemotherapy sessions. These
factors significantly reduced the food intake and cause malabsorption of nutrients. In addition, the increased metabolic demand due to
the body’s adaptation to several changes in immune response and metabolic processes such as rapid glucose depletion and a shift
toward gluconeogenesis and lipolysis, promote malnutrition through anorexia (Irungu et al., 2015). As a result of hypercatabolic state,
symptoms influencing nutritional intake, and anorexia, the patient exhibited symptoms of cancer cachexia such as weak muscle
function, significant weight loss, paleness of skin and conjunctiva, and altered protein and blood parameters.

Early satiety

. As per recent guidelines, the TNM staging stands for: Tumor with parapharygeal extension, unilateral metastasis in cervical lymph
nodes of 6cm or less in greatest dimension, and distant metastasis (Shah et al., 2020).
Moreover, the late effects of cancer treatment include fatigue, severe dysphagia, mucositis, dysgeusia, early satiety,
anorexia

Besides direct effects of cancer and its treatment, people with cancer often also experience other
things that can add together to increase fatigue. These are things like surgery, stress and worry,
changes in activity level, and changes in blood counts, electrolytes, and hormone levels.

National Cancer Institute. (2020, January 21). Mouth and throat problems during cancer treatment.
https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat
American Cancer Society. (2020, February 1). What is fatigue or weakness? https://www.cancer.org/treatment/treatments-
and-side-effects/physical-side-effects/fatigue/what-is-cancer-related-fatigue

Irungu, C. W., Oburra, H. O., & Ochola, B. (2015). Prevalence and predictors of malnutrition in Nasopharyngeal
Carcinoma. Clinical medicine insights: Ear, nose and throat, 8, 19–22. https://doi.org/10.4137/CMENT.S12119

Shah, A. B., Zulfiqar, H., & Nagali, S. (2020, September 8). Nasopharyngeal carcinoma. In StatPearls (Internet).
https://www.ncbi.nlm.nih.gov/books/NBK554588/
American Society of Clinical Oncology. (2020, November). Nasopharyngeal cancer: Risk factors and prevention.
https://www.cancer.net/cancer-types/nasopharyngeal-cancer/risk-factors-and-prevention
American Society of Clinical Oncology. (2019, January). Health risks of secondhand smoke.
https://www.cancer.net/navigating-cancer-care/prevention-and-healthy-living/stopping-tobacco-use-after-cancer-
diagnosis/health-risks-secondhand-smoke
American Society of Clinical Oncology. (2019, January). Cough. https://www.cancer.net/coping-with-cancer/physical-
emotional-and-social-effects-cancer/managing-physical-side-effects/cough
Cancer Care. (2016, November 21). Coping with Cancer-related weight changes and muscle loss.
https://www.cancercare.org/publications/140-coping_with_cancer-related_weight_changes_and_muscle_loss
American Cancer Society. (2020, June 9). Does body weight affect cancer risk? https://www.cancer.org/cancer/cancer-
causes/diet-physical-activity/body-weight-and-cancer-risk/effects.html
American Cancer Society. (2018, September 24). Risk factors for nasopharyngeal cancer.
https://www.cancer.org/cancer/nasopharyngeal-cancer/causes-risks-prevention/risk-factors.html

Li, F., Duan, F., Zhao, X., Song, C., Cui, S., & Liping, D. (2016).  Red meat and processed meat consumption and
Nasopharyngeal Carcinoma risk: A dose-response meta-analysis of observational studies. Nutrition and Cancer, 68(6),
1034-1043. DOI: 10.1080/01635581.2016.1192200
Lao, T. D. & Le, T. A. H. (2020). Epidemiology, incidence and mortality of Nasopharynx Cancer in Southeast Asia: an
update report. Advancements in Life Sciences, 7(2): 86-90. http://www.als-journal.com/articles/vol7issue2/725.20/897.pdf
Cancer Research UK. (2020, October 23). Does eating processed and red meat cause cancer.
https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/diet-and-cancer/does-eating-processed-and-red-meat-
cause-cancer

Nasopharyngeal Carcinoma (NPC) is a type of head and neck cancer that originates from the epithelium of the
nasopharynx. American Society of Clinical Oncology (2020) asserts that as age increases, the risk of NPC increases as
well.
Nasopharyngeal Carcinoma (NPC) is a type of head and neck cancer that originates from the epithelium of the
nasopharynx. With its distinct geographical and ethnic distribution, this disease is native to Asia. According to a recent
study by Lao & Le (2020), the Philippines has the top 3 highest incidences (2913 cases) and mortality (1899 cases) of
nasopharyngeal cancer among the Southeast Asian countries, followed by Vietnam and Indonesia.

nicotine, hydrogen cyanide, formaldehyde, lead, arsenic, ammonia, benzene, carbon

monoxide, tobacco-specific nitrosamines (TSNAs), polycyclic aromatic hydrocarbons

high incidence and mortality of NPC were recorded in medium HDI countries, which include the Philippines (Lao & Le,
2020).

Based on the patient’s information, dietary intake, age, family history of cancer, lifestyle, exposure to tobacco smoke, and
ethnicity are the notable risk factors that contributed to the development of the disease.

Based on the patient’s information, the usual consumption of fatty foods, red meats, and cured meats such as
longganisa is a signif icant risk factor for the development of the disease. According to Cancer Research UK (2020), red
and processed meats contain chemicals that can be natural, added, or produced while cooking. These chemicals include
haem, nitrates and nitrites, heterocyclic amines (HCAs) and polycyclic amines (PCAs) which are known to damage the
cells and increase the risk of cancer.

https://www.cancer.org/cancer/nasopharyngeal-cancer/causes-risks-prevention/risk-factors.html
https://www.cancer.gov/types/head-and-neck
https://www.nhs.uk/conditions/nasopharyngeal-cancer/
https://www.hopkinsmedicine.org/health/conditions-and-diseases/nasopharyngeal-carcinoma
https://www.cancercouncil.com.au/cancer-prevention/diet-exercise/nutrition-and-diet/meat-and-cancer/
https://www.wcrf.org/dietandcancer/exposures/meat-fish-dairy
https://www.nutritionletter.tufts.edu/healthy-eating/processed-meats-and-cancer-its-not-just-nitrates/
https://pubmed.ncbi.nlm.nih.gov/27367552/
https://www.hindawi.com/journals/ijcb/2012/594681/
the upper nasopharynx, the upper part of the throat behind the nose

Cough and difficulty in swallowing

Unintentional weight loss
NPCA T2N1M1

3 months PTA
Dysphagia, mucositis, and weakness

1 week PTA
Severe weight loss
Weakness
Sever dysphagia
Mucositis
Dysgeusia
Early satiety
Anorexia
Inability to perform usual daily taska
Weigh 39 kls
Usual dietary intake <800-1000kcal

Review of DM
Discuss how the disease develop and progressed
Contextualize the discussion based on the case
Additionally the age is a risk factor
Moreover, the patient’s sedentary lifestyle and dietary intake play a role in disease development
Back up the factors with a study/ reference for more comprehensive discussion

The patients mother was diabetic as well which significantly increases her chance of developing Diabetes Mellitus

A. Ano ang cancer?

Ang cancer ay nailalarawan sa pamamagitan ng abnormal at walang pigil na paglaki ng mga cell. Ang mga cancer cell
ay hindi namamatay at maaaring bumuo ng isang mass ng tisyu na tinatawag na tumor (NCI, 2015). Ang nagresultang
masa o tumor ay maaaring atakiihin at sirain ang mga nakapalibot na normal na tisyu. Ang mga cells sa cancer mula
sa tumor ay maaaring kumalat sa daloy ng dugo o lymph system at magsisimula ng mga bagong cancer sa ibang mga
bahagi ng katawan. Ang proseso na ito ay tinatawag na metastasis (SNHD, 2018).

B. Ano ang anorexia?

Ang anorexia ay isa sa mga epekto ng cancer. Ito ay kawalan ng gana sa pagkain o kawalan ng kakayahang kumain
(Allarakha, S., 2020). Marami sa mga may cancer ay anorexic dahil sa pagtaas ng pamamaga na dulot ng
chemotherapy, isang pangunahing paggamot sa cancer (Ezeoke, C.C., & Morley J.E., 2015). 

C. Estratehiya
Upang maiwasan ang pagkakaroon ng kanser, ang mga sumusunod ay ilan sa mga estratehiya base sa Cleveland Clinic
(2010), at Rock et al. (2020)

 Panatilihin ang tamang timbang

 Kumain ng iba’t ibang gulay at prutas
 Bawasan ang pagkain na matataas sa taba
 Iwasan ang paninigarilyo
 Bawasan ang pag inom ng alak
 Bawasan ang pagkain na maalat
 Dagdagan ang Vitamin D sa katawan
  Dagdagan kumain ng pagkain na mataas sa Fiber
 Siguraduhin na nakakapag-ehersisyo ng 150-300 minuto kada linggo para sa mga matatanda, isang oras naman
para sa bata at kabataan

Mga estratehiya naman upang mapabuti ang anorexia base sa pag aaral nBC Cancer Agency (2005). 
 Himukin kumain ng pagkain na mataas sa protina at enerhiya
 Sa panahong ginaganahan kumain ang pasyente, himukin na mas marami ang kanyang kainin
 Siguraduhin na ang nakakarelaks ang paligid habang kumakain
 Isaalang-alang ang pamamaraan nang paghain ng pagkain sa pasyente, kung ito ba ay ayon sa gusto niya
 Kung humahaba ang panahon na ang pagkain ay hindi bumubuti kahit na may nutrition counselling. Maaring
subukang magpahangin muna o kaya mag rekomenda ng appetite stimulant .
D. Rekomendasyon
 Pagdaragdag ng mga pampalasa sa pagkain tulad ng mga herbs o spices. Pero, kapag ang pasyente ay may singaw
o hirap sa paglunok ay mainam na huwag na itong lagyan pa.
 Gumamit ng mga kubyertos na gawa sa plastik upang di lumala ang panlasang kalawang.
 Ang small frequent feeding o ang paunti unting pagbigay ng pagkain sa isang araw ay mas mabuti kaysa sa
tatlong malalaking pagkain sa isang araw dahil ang mga pasyente na may cnacer ay kadalasang walang gana.  
  Regular na pagkonsulta sa Nutritionist-Dietitian upang masubaybayan ang progreso ng kanyang nutritional
status.
 Paggamit ng isang Standard na Polymeric Feed
 i-Gastrostomy ang pasyente kapag di na ito tumutugon sa oral polymeric feed at pagkain hatid ng  Nutritionist-
Dietitian.

Nasopharyngeal Carcinoma (NPC) is a type of head and neck cancer that originates from the epithelium of the nasopharynx.
The etiology of NPC is a combination between genetic and environmental factors. Based on the case, personal attributes such as age,
ethnicity, and family history are significant risk factors that contributed to the disease development. First, the patient is 62 years old
and it has been well determined that the incidence of NPC escalates dramatically with age (ACS, 2018). Likewise, ethnicity is also a
factor since there is a high incidence of NPC in southern China and Southeast Asia.  A study by Lao & Le (2020),  the Philippines has
the third highest incidence (2913 cases) and mortality (1899 cases) of NPC in Southeast Asia. Additionally, the patient’s father was
diagnosed with colon cancer which also contributes to her increased chance of acquiring the disease. People who have a close relative
with cancer have a higher risk of NPC due to genetic susceptibility and shared environmental and lifestyle factors (ACS, 2018). On
the other hand, the patient’s occupation may have influenced her dietary intake. Low consumption of fruits coupled with regular
intake of fatty foods from unsold meats and processed meats specifically longganisa contain nitrite preservatives which is
associated with a substantially increased risk of NPC (Li et al., 2016; Cancer Research UK, 2020). Lastly, exposure to secondhand
smoke from the spouse which contain benzopyrene, arsenic, formaldehyde and other carcinogenic substances, have also increased
the patient’s risk of acquiring the disease (ASCO, 2019).

         NPC is difficult to detect in a silent and painless area, thus, it is usually diagnosed at advanced stages. Initially, the patient
experienced notable symptoms such as persistent cough and difficulty in swallowing coupled with unintentional weight loss.
According to American Society of Clinical Oncology (2019), chronic cough can be caused by inhaling secondhand smoke. As stated
in this case, the smoke originates from the spouse’s tobacco smoke. Additionally, mild dysphagia or difficulty in swallowing is one of
the numerous symptoms frequently experienced by patients with worsening cough. Moreover, unintentional weight loss is incited by
cytokines which are immune and inflammation response substances produced by the body to fight off cancer cells. (Cancer Care,
2016).

         As the symptoms progressed and became unmanaged the patient was prompted to seek medical attention. Therefore, she was
diagnosed with Nasopharyngeal Carcinoma (T2N1M1). The treatments of the disease require 35 radiotherapy cycles and 6
chemotherapy cycles. However, three weeks later the patient complained of dysphagia, mucositis, and body weakness. Radiotherapy
and chemotherapy cycles induce mouth sores or mucositis and also affect the salivary gland and tissue resulting in dry mouth leading
to difficulty in chewing and swallowing or dysphagia (NCI, 2020). Generalized body weakness is also a common side effect of both
cancer and cancer treatments. Cancer produces toxic substances that change the normal cellular process, whereas cancer treatments
kill normal and cancer cells and alter normal protein and hormone levels which increases inflammation and worsen fatigue (ACS,
2020).  Subsequently, the malignancy of cancer and ongoing treatments generated other symptoms, besides body weakness and
mucositis, such as severe dysphagia, dysgeusia, early satiety, and anorexia. These factors significantly contribute to a decrease in
appetite and reduced nutrient intake. Additionally, the increased metabolic demands due to the body’s adaptation to changes in
immune response and metabolic processes such as rapid glucose depletion and a shift toward gluconeogenesis and lipolysis, promote
malnutrition through anorexia (Irungu et al., 2015). Hence, the patient was admitted. Furthermore, the cancer treatments were
suspended and will resume once her overall condition improves.