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Esophageal Cancer
7th leading cause of death
On the rise
Nutritional Challenges:
Oral intake due to obstructions (tumors)
Dysphagia
Malnutrition
Weight loss, cancer cachexia
Stages
Patient
Age: 56 years old male
History:
GERD
Barretts esophagus
Drinks 3-4 martinis on weekends
Smoking
30 packs/yr
2.5 packs/month (50 cigs/month or about 2 cigs/day)
Nutritional-Focused Physical
Findings
Appears weak and uncomfortable
Coughing
Sore throat
Nausea
Early satiety
Progressive difficulty swallowing
Odynophagia (painful swallowing)
First, solid foods
Now liquids
Food/Nutrition-Related
History
Current Diet:
Scrambled eggs, oatmeal, apple juice, canned
peaches, soup
Small amounts of food
Medications
Intravenous fluids
Ondanestron
Used to prevent nausea and vomiting
Hydromorphone
Opioid pain med
Lansoprazole
Stomach and intestinal ulcers
PPI (proton-pump inhibitor)
Chemotherapy
5-fluorouracil
Cisplatin
Anthropometrics
Height:
58, 68
Weight:
165 lbs, 75 kg
BMI: 25.1
Overweight (25-29.9)
Usual weight:
185 lbs (4 months ago)
IBW:
154 lbs +/- 10% (139-169 lbs)
Biochemical Data
Parameters
Results
Normal Ranges
Sodium
140 mEq
135-147 mEq/L
Potassium
4.3 mEq/L
3.5-5.0 mEq/L
Chloride
100 mEq/L
98-106 mEq/L
CO2
25 mEq/L
21-30 mEq/L
BUN
15 mg/dL
8-23 mg/dL
Creatinine
0.9 mg/dL
0.7-1.5 mg/dL
Glucose
89 mg/dL
70-110 mg/dL
Phosphorous
3.2 mg/dL
3.0-4.5 mg/dL
Albumin
3.5-5.5 mg/dL
Prealbumin
8 mg/dL (L)
16-40 mg/dL
Hemoglobin
14-18 g/dL
Hematocrit
37% (L)
38-54%
Tests
Modified barium swallow
Results:
Functional oropharyngeal swallow
Moderate-to-severe esophageal dysphagia
Delayed movement of liquids in upper esophagus
Reflux in pharynx
Biopsy
Results:
Adenocarcinoma of the distal esophagus
Gastroesophageal junction
Micrograph of an esophageal adenocarcinoma (dark blue upperleft of image) and normal squamous epithelium (upper-right of image).
H&E stain (wikipedia).
Treatment
Esophagectomy
J-tube placement
Radiation
Chemotherapy
5-fluorouracil
Cisplatin
Question 1
What risk factors does this client have for
esophageal cancer?
Smoking
Drinking
GERD
Barretts esophagus
Sex (male)
Age: between 45-70
Question 2
What is his:
IBW:
BMI: 25.1
Overweight (25-29.9)
Usual weight:
%IBW
%UBW
165/185 = 89%
Lost 11% in 4 months
Question 2 (cont.)
Comment on his recent weight change and
nutritional status
Question 3
List the nutritional-related side effects of
radiation treatment?
Fatigue, mucositis, fistulas, dysgeusia, xerostomia, dysphagia,
Question 4
Do you think he will be able to take sufficient
Question 5
What specific dietary interventions could be
Question 6
Assuming gastric access can be obtained preoperatively,
Question 10
Write a note that summarizes your assessment in ADIME format.
A: Assessment
56 y/o male
Labs: Albumin 2.9, prealbumin 8, Hemoglobin 13.8, Hematocrit 37%
BMI: 25.1
Wt: 165#, Ht: 68
D: Diagnosis
Involunatry weight loss (NC-3.2) related to nausea, vomiting, difficulty
swallowing as evidence by weight loss of 20# in 4 months
I: Intervention
Nutritional-Related Modification Therapy (C-1) using goal setting
methods to maintain weight and increase albumin levels
M: Monitor and E: Evaluate
Follow up in 7 days
Monitor weight changes and re-evaluate diet recommendations if
needed
Assess compliance with goals
Monitor lab values and request another script in 7 days
References
1. Emery, Elizabeth Zorzanello. Clinical Case