Colon Cancer Case StudyAmy Good, Dietetic Intern

What is Colon Cancer?

Medical Nutrition Therapy for Colon Cancer

Contents

Patient Overview

Nutrition Care Process

• 57 year old male• Past medical hx:

• 18” resection of colon two months ago• 20# weight loss over the past year

• Has since gained the weight back• Port placement in right chest for chemotherapy

• Current medical hx:• Stage III colon cancer

Patient Overview

• Cancer of the large intestine• Typically begins as benign colon polyps that become cancerous overtime

• Often called colo-rectal cancer which combines cancer of the rectum

What is colon cancer?

•Can be found in men or women•Typically affects those 50+ years of age.•In 2013, 50,830 people died from colon cancer•Dietary risks include:

•Diet high in red meat•Diet high in fat•Diet low in calcium, folate, and fiber.

•Inactivity and obesity has been linked to higher risk of colon cancer as well.

Prevalence of colon cancer

Most Common Cancers in the U.S.

Men Women

1. Prostate 1. Breast

2. Lung 2. Lung

3. Colon 3. Colon

Stages of Colon CancerStage Description

Stage 0 Abnormal cells are found in the lining of the colon. These cells may become cancerous.

Stage I Cancerous cells have formed and spread into the colon wall

Stage II Divided into three stages

-Stage IIA Cancer has spread to the outermost layer of the colon wall

-Stage IIB Cancer has spread through the outermost layer of the colon wall but has not spread to nearby organs

-Stage IIC Cancer has spread through the outermost layer of the colon wall to nearby organs

Stage III Divided into three stages

-Stage IIIA Cancer has spread to as many as 3 lymph nodes

-Stage IIIB Cancer has spread to as many as 3 lymph nodes and has spread: beyond the middle tissue layers of the colon wall; or to nearby tissues around the colon or rectum; or beyond the colon wall into nearby organs and/or through the peritoneum.

-Stage IIIC Cancer has spread to 4 or more lymph nodes and has spread: to or beyond the middle tissue layers of the colon wall; or to nearby tissues around the colon or rectum; or to nearby organs and/or through the peritoneum.

Stage IV Cancer may have spread to nearby lymph nodes and has spread to other parts of the body, such as the liver or lungs

Medical Treatment of Colon Cancer

Chemotherapy• Use of chemicals

to kill cells that divide rapidly, like

cancer cells.

Surgery• Tumor removal• Colon resection

Radiation • A needle at the

source of the cancer directs

imaging technology

Biological Therapy

• Uses medicines made from living sources, rather

than chemicals, to kill cancer cells

Goals of MNT for cancer patients

Medical Nutrition Therapy

Prevent or reverse nutrient deficiencies

Preserve lean body mass

Minimize nutrition-related side effects

Maximize the quality of life

• MNT will depend on the individual patient’s clinical status.

• RD will evaluate the following information:• Diagnosis• Medical hx• Treatment method• Laboratory data• Anthropometric measurements

• RD will determine if the following is present• Malnutrition• Fever• Edema• Ascites• Vomiting• Diarrhea• Diuretics

• The Registered Dietitian will use this information to determine calorie, protein, and fluid needs, as well as a potential need for supplementation.

Medical Nutrition Therapy for Colon Cancer

Nutritional Assessment

Pertinent InformationHeight 70”Weight 220 #

Ideal Body Weight 166 #% Ideal Body Weight 132%

Adjusted Ideal Body Weight 179.5 #Calcium 8.0 (low)Albumin 3.8 (normal)

•No pertinent medications

•Patient’s son lives with him every other

week

•Patient experiences decreased

appetite, nausea on chemotherapy

weeks (every other week)

•Patient takes phenergan for nausea

•Patient cannot eat/drink anything cold

due to a chemotherapy side effect

• 25-30 kcal/kg of body weight

• 2,500-3,000 kcal/d.

• 30 ml of fluid/kg of body weight

• 3,000 ml/d = 101 fl oz/d

Nutrition Assessment

• 1.2 g of protein/kg of body weight

• 120g/d

Due to inadequate intake every other week secondary to chemotherapy treatments, I

recommend Ensure Clear for chemotherapy weeks

• Ensure Clear can be consumed at room temperature

• Must be refrigerated upon 4 hours after opening

ENSURE CLEAR

Nutrition Facts

Serving Size 10 fl oz

Calories 180 kcal

Protein 9 g

Carbohydrate 35 g

Total Fat 0 g

Essential Vitamins & Minerals

21

Assessment

Diagnosis

InterventionMonitoring

Evaluation

Diagnosis

•Increased nutrient needs related

to compromised function of

intestine as evidenced by dx of

Stage III colon cancer,18” colon

resection, low calcium, and diet

history of poor intake during

weeks of treatment.

Intervention

•High calorie/high protein diet

education

•Ensure Clear nutritional

supplement

Monitoring & Evaluation

•Monitor weight, labs, PO intake

•Follow up in 3 months

Nutrition Care Process

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•Mahan, L. Kathleen. "Medical Nutrition Therapy for Renal Disorders." Krause's food &

nutrition therapy. 12th ed. St. Louis, Mo.: Saunders/Elsevier, 2008. Print.

•Mayo Clinic Staff. "Colon cancer." Definition. N.p., n.d. Web. 22 Apr. 2014.

<http://www.mayoclinic.org/diseases-conditions/colon-cancer/basics/definition/con-

20031877>.

•"NAACCR | North American Association of Central Cancer Registries." Top 5 Cancers

in the U.S.. N.p., n.d. Web. 22 Apr. 2014.

<http://www.naaccr.org/DataandPublications/Top5USCancers.aspx>.

•Rock, C. L.. "Dietary Counseling Is Beneficial for the Patient With Cancer." Journal of

clinical oncology 23 (): 1348-1349. Print.