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Case Study # 33
Esophageal Cancer
Adrienne Grogan
Mariah Guthrie
Esophageal Cancer
● 20% 5 year survival
● Two types
Cancer found in the secretory cells of the body.
These type of cells secrete mucus, digestive
juices, or other fluids into the body. Common
adenocarcinoma cancers are found in the
breast, prostate, esophagus, pancreas, lungs,
and colon.
Etiology of Esophageal Cancer
Heavy Drinking
Poor diet
Barrett’s Esophagus
Poor Diet
Patient Description
● Mr. Seyer, 58 y.o. male
● After undergoing chest x-ray, endoscopy
with brushings and biopsy, and CT scan,
diagnosed with Stage IIB (T1, N1, M0)
adenocarcinoma of esophagus
● Dysphagia and Odynophagia
● Smokes 2ppd/ drinks 1-2 drinks/1-2 x week
Staging of Cancer
Mr. Seyer’s Diagnosis= Stage IIB (T1, N1, M0)
● T- how far the tumor has grown
● N- nearby lymph nodes
● M- metastasized to other organs
Patient History
Height: 6’3”
Weight: 198lbs.
Current BMI: 24.7
Normal Weight: 228lbs.
%UBW: 86.8%
14% weight loss= severe
Nutritional Effects of Cancer
● Nausea and Vomiting
● Cachexia
● Metabolic Changes
protein (increased protein metabolism, decreased
protein synthesis, depletion of lean body mass)
fat (increase of lipid metabolism, depletion of total
body fat)
carbohydrate (increased gluconeogenesis, glycose
synthesis, increased cori cycle activity)
Usual Dietary Intake
24 Hour Recall
AM: Eggs, bacon, toast
Am: 1 packet oatmeal, coffee
Lunch: cold lunch, with sandwich,
deli meat, leftovers, fruit, cookies, tea
Lunch: 6oz. tomato soup, 2-4
PM: All meats, rice or pasta, 2-3
vegetables, 1-2 beers
Dinner: Macaroni and Cheese (½
Bedtime: 1 scoop chocolate ice cream
Abnormal Lab Results
Transhiatal Esophagectomy
● Removes
diseased part
of esophagus
● Stomach is
attached to
Radiation Therapy
● Kill cancer cells by sending
high doses of radiation to the
cancer cells of the tumor
● Targeted to affect just the
tumor whereas chemo treats
the whole body
● Administered from a machine
outside of the body or from
objects put inside of the body
Side Effects:
● Dysgeusia
● Delayed wound healing
● mucositis
● dysphagia
● xerostomia
Potential Nutritional Complications of Radiation
Nutrition Assessment
(10 x 90kg) + (6.25 x 190.5cm) – (5 x 58yrs) + 5= 1,805 kcal
Energy Requirements (30-35 kcal/kg)
30 kcal x 90kg= 2,700 kcal
35 kcal x 90kg=3,150 kcal
Protein Requirements (extreme wasting 1.5-2.5 g/kg)
1.5g x 90kg=135g
2.5g x 90kg=225g
Fluid Requirements (30-35 mL/kg)
30mL x 90kg=2,700 mL
35mL x 90kg=3,150mL
Isosource HN Formula
Isosource HN: 1.2
18% Protein
53% Fat
29% Carbohydrate
*high in omega fatty acids &
Isosource HN Formula
Current Nutrient Breakdown of Enteral Formula:
Kcals= 75 mL/hr x 24 hr=1,800 mL x 1.2kcal/mL= 2,160 kcal
Protein=2,160 kcal x .18 protein= 388.8kcal from protein / 4 kcal/g
protein= 97.2g protein
*Recommended 2,700-3,150kcal and 135-2,25g protein
PES Statements
PES 1:
Malnutrition related to decreased appetite and pain while eating as
evidenced by weight loss of 30# over past several months.
PES 2:
Inadequate protein intake related to changes in metabolism due to
cancer state as evidenced by weight loss and low total protein,
prealbumin, and albumin levels.
Change formula to Isosource HN 1.2kcal at 105 mL/hr x 24
Kcals= 105 mL/hr x 24 hr=2,520 mL x 1.2kcal/mL= 3,024 kcal
Protein=3,024 kcal x .18 protein= 544 kcal from protein / 4 kcal/g protein=
136 g protein
Once off enteral nutrition formula…
● Clear liquids (no caffeine)
● High calorie/high protein beverage (ex:
Ensure or Boost)
● small meals 6-8 times a day
● Multivitamin and mineral supplement
1. Clear liquid diet
2. Thickened or thick liquid diet
3. Soft and pureed foods
4. Foods softened with gravy or water
Weight (3x week)
Signs of edema (daily)
Signs of dehydration (daily)
fluid intake and output (daily)
nitrogen balance (weekly)
stool output and consistency (daily)
urine glucose (weekly)
serum electrolytes, BUN, creatinine, and blood count (weekly)
chemistry profile such as proteins, calcium, magnesium, phosphorus, LFT’s (weekly)
American Cancer Society. Treatment Types. (n.d.). Retrieved October 2, 2014, from
Definition of adenocarcinoma - NCI Dictionary of Cancer Terms. (n.d.). Retrieved September
22, 2014, from
Esophageal cancer treatment. (2014). National Cancer Institute. Retrieved from
National Cancer Institute, (NCI). What You Need To Know About" Cancer of the Esophagus.
(2013, April 4). Retrieved September 22, 2014, from
Nelms, M. (2011). Nutrition therapy and pathophysiology (2nd ed., p. 48. Belmont, CA:
Wadsworth, Cengage Learning.
Nutrition in Cancer Care (PDQ®). (2014, September 3). Retrieved October 1, 2014, from
Transhiatal Esophagectomy (THE). (2012, May 8). Retrieved October 2, 2014, from
Types of Esophageal Cancer. (2013, April 4). Retrieved September 22, 2014, from
Witte, S., & Mahan, L. (1996). Krause's food, nutrition and diet therapy(9th ed.). Philadelphia: