N116BL

20 points

NAME:___Cindy Chen________
Due: Friday 2/26/2016

Mini Case-Study: Cancer

Mrs. S has been recently diagnosed with Stage III breast cancer. Her treatment course
includes a course of concurrent radiation treatment and chemotherapy, then surgical
resection with a mastectomy and lymph node dissection.
Mrs. S. is to begin a 10 day course of radiation treatment and is also to receive
chemotherapy treatment with 5-Fluorouracil (5-FU). The intent is to use 2 courses of
these treatments to decrease the size and growth of the tumor prior to surgical resection.
You are the outpatient dietitian consulted for advice on nutritional management of this
patient. You counseled the patient at the beginning of the treatment course and now you
are seeing her again on day 10, at the end of the first treatment course. She is
complaining of diarrhea that is painful, frequent (>6 episodes/day), and is also
experiencing some soreness in her mouth and throat on swallowing.
1. What is the drug 5-FU and how does it work? (2 pts)
5-FU is an antineoplastic and antimetabolite drug used for patients with
colorectal, breast, stomach or pancreatic cancer. It is usually given as either an
injection into the vein, as an infusion, or as a topical ointment. 5-FU interferes
with the biosynthesis of metabolites or nucleic acids necessary for DNA and RNA
synthesis. When 5-FU is incorporated into the cellular metabolism, cells are
unable to divide.
Food-Medications Interactions 18th edition p. 151
Nutrition Therapy and Pathophysiology 3rd Edition p. 695
2. Why might Mrs. S be experiencing GI problems? (2 pts)
Mrs. S might be experiencing GI problems because chemotherapy can kill rapid
turnover cells. These medications are targeting these rapid turnover cells but are
nonspecific to tumors. Therefore, normal cells can also be killed through
chemotherapy. Some of these rapid dividing cells are in the oral mucosa, GI tract,
and the intestinal area, which can cause diarrhea, mouth sores, nausea, and
vomiting.

NUT 116BL Cancer Part 2 Lecture Slide 7-8, February 24

3. List at least 4 nutrition recommendations you would give her. (4 pts)

1.
2.
3.
4.

Ensure adequate hydration

Small frequent meals
Eating energy dense foods
Soft, easy to tolerate foods and adjust to patients tolerance.

N116BL
20 points

NAME:___Cindy Chen________
Due: Friday 2/26/2016

NUT 116BL Cancer Part 2 Lecture Slide 35, February 24

Mrs. S begins her second chemotherapy course and on day 6 is admitted to the hospital
with severe neutropenia.
4. What is neutropenia and what health risk does it pose? (2 pts)
Neutropenia is an abnormal low number of white blood cells called neutrophils. These
cells are responsible for attacking bacteria and other organisms that invade the body. A
health risk that it might pose is that the patient will be immunocompromised, have
trouble fighting infections, and therefore have bacterial infections. These bacterial
infections can occur as ulcers, abscesses, rashes, fever, and wounds that take a long time
to heal.

Nutrition Therapy and Pathophysiology 3rd edition p. 687

Neutropenia:
http://www.webmd.com/a-to-z-guides/neutropenia-causes-symptoms-treatment
Neutropenia (low neutrophil count):
http://www.mayoclinic.org/symptoms/neutropenia/basics/definition/sym-20050854

5. What hospital diet would be most appropriate for her at this time? (2 pts)
A neutropenic diet would be most appropriate since she has neutropenia. This means no
fresh fruits or vegetables since they may contain some bacterial contamination. All
cooked and canned foods are recommended. Food safety is also important for the
neutropenic diet. Food should have good temperature control and good hygiene.
However, it is not very evident in the literature that a neutropenic diet works/is effective.
Our main goal is to make the patient comfortable. We can also try using a softer diet for
Mrs. S since she has some soreness on the mouth and throat.

NUT 116BL Cancer Part 2 Lecture Slide 37, February 24

Mrs. S. subsequently completes her radiation and chemotherapy, has successful surgery
and does well for nearly two years.
6. She asks you whether it is OK for her to eat soy foods (tofu, soy milk, edamame).
What do you recommend? (2 pts)

N116BL
20 points

NAME:___Cindy Chen________
Due: Friday 2/26/2016

Soy has certain phytochemicals called isoflavones with similar structure as estrogen.
Isoflavones can also bind to estrogen receptors in the body like estrogen. If breast cancer
is estrogen receptor positive, the patient will more likely have a cancer by stimulation of
estrogen. Even so, the amount of soy you get in (1-2 servings) is relatively modest and
thought to be fine. However, it can be problematic if someone is taking 100mg of
estrogen isoflavone supplements while having ER positive breast cancer. Dietary soy
intake doesnt show increase risk of breast cancer, especially since western diet is limited
in soy from diet. There is no demonstration of reoccurrence of cancer even if patients
have modest amounts of soy. Therefore, it is okay to eat soy. Since I do not know if Mrs.
S has ER positive breast cancer or not, I will not recommend her to eat soy foods. I would
also recommend Mrs. S to not take soy supplements, just in case she has ER positive
breast cancer. I would recommend another type of plant protein without isoflavones in it.

NUT 116BL Cancer Part 2 Lecture slide 39, February 24

Mrs. S. recently presented at her doctors office with c/o weight loss, feeling tired, and no
appetite. She reports taking a few bites and getting full. She states that meats & coffee no
longer taste good to her. Her fatigue is beginning to limit her usual daily activities. These
symptoms have increased over the past 3 months. She feels like she may have lost a little
weight over the past year, but it has been really evident to her the past 3-4 months.
The following information is available:
Age: 60 Ht: 54 Wt: 126 lb. UBW: 145 lb. Wt 3 months ago: 140 lb
Hgb: 11.0 g/dl Hct: 31% MCV:115fL Ferritin 90 ng/ml TIBC 255 g/dl Alb: 3.1 g/dl

7. Calculate IBW, %UBW and % change in BW over the past 3 months. Indicate the
level of nutritional risk this change in BW represents. (show calculations) (2 pts)
Ht: 54/162.56cm

Wt: 126lb/57.15kg

IBW: 100lbs + (5x4) = 120lbs/54.5kg

%UBW: (126lbs/145lbs) x 100 = 87%
%change in BW over past 3 months = (140-126)/140lbs = 10% weight loss
This is severe nutritional risk because Mrs. S has 10% weight loss over the past 3 months.
Also, a severe weight loss is categorized as >7.5% UBW and Mrs. S is currently only
86.9% of her usual body weight.

MNT Pocket Guide page 2.

N116BL
20 points

NAME:___Cindy Chen________
Due: Friday 2/26/2016

8. Interpret the biochemical data, and comment on the overall status of the patient,
considering her symptoms and weight changes. (2 pts)
Both hemoglobin and hematocrit values are low. MCV is high. Both ferritin and TIBC
are within normal limits. This shows that Mrs. S has anemia, but not an iron deficiency.
She probably has an anemia of chronic disease, especially since she has severe weight
loss. She is showing signs of loss of appetite, loss of taste, early satiety, and fatigue. Mrs.
S has a severe weight loss of 10% over the past 3 months. These signs are indicative of
cachexia. Cachexia can be caused by the cancer itself. Albumin is a little low, but this is
not an intake problem.

MNT Pocket Guide page 17

NUT 116BL Cancer Part 2 Lecture slides 20-22, 25

9. How would you determine the appropriate energy and protein needs for Mrs. S?
(Indicate why you would use either her UBW, IBW or CBW; and show your
calculations with the equations you would use for energy and protein) (2 pts)
I would determine the appropriate energy and protein needs for Mrs. S using Mifflin St.
Jeor equation with her current body weight and protein needs of 1.2-1.4g protein/kg
weight because it is already hard for her to not lose weight. We want to maintain and
prevent further weight loss for Mrs. S. We want to encourage nutrient intake in a form
that is practical. If she doesnt have an appetite, we do not want to force her to eat more
than she can tolerate. We want to support or improve the patients quality of life.
Energy Needs:
Activity Factor: 1.2-1.3
Injury Factor: 1.1
[(10*57.15kg) + (6.25*162.56cm) (5*60) -161] * 1.2-1.3 * 1.1 = 1486.98-1610.90 ~
1490-1610kcals
Protein Needs:
1.2-1.5g protein/kg/d * 57.15kg = 68.58g-85.73protein/day ~70-85g protein/day

MNT Pocket Guide

NUT 116BL Neoplastic Diseases aka Cancer Lecture, February 22