Question

Joan Monroy is a 58-year-old public relations consultant who was recently diagnosed with colon cancer after a routine colonoscopy, a procedure in which the colon is examined using a flexible tube attached to an optical device. Mrs. Monroy is scheduled to have surgery to remove the segment of colon that contains the tumor and to determine if the cancer has spread to the surrounding lymph nodes and, possibly, other organs. The nurse completing the nutrition assessment finds that Mrs. Monroy is 5 feet 5 inches tall and weighs 178 pounds. Mrs. Monroy usually spends most of the day sitting and has little time to engage in recreational exercise. Her diet typically includes red meat at both lunch and dinner, and she consumes one or two glasses of wine with both meals. She eats two or three servings of fruits and vegetables each day, although she does not like green leafy vegetables very much. She rarely drinks milk or consumes milk products.

1. Review Table 23-2 on p. 640, and describe the factors in Mrs. Monroy’s diet and lifestyle that may have contributed to the development of colon cancer.

2. What symptoms and complications may arise after colon surgery and impair nutrition status? If the cancer team decides that Mrs. Monroy needs follow-up chemotherapy, how might the chemotherapy affect her nutrition status?

3. If Mrs. Monroy is unresponsive to treatment and her cancer progresses, she may develop cancer cachexia. Describe this syndrome, its causes, and its consequences.

4. Provide suggestions that may help Mrs. Monroy handle the following problems should they develop: poor appetite, fatigue, taste alterations, nausea and vomiting, chewing and swallowing difficulties, mouth sores, dry mouth, diarrhea, constipation, and weight loss.

TABLE 23-2 Nutrition-Related Factors That Influence Cancer Risk Nutrition-Related Factors Cancer Sites Factors that may increase cancer risk Obesity Esophagus, colon, rectum, pancreas, liver, gallbladder, kidney, breast (postmenopausal), ovary, endometrium, prostate Red meat, processed meats Colon, rectum Salted and salt-preserved foods Stomach Beta-carotene supplements Lung Prostate High-calcium diets (over 1500 mg daily) Alcohol Low level of physical activity Factors that may decrease cancer risk Fruits and nonstarchy vegetables Mouth, pharynx, larynx, esophagus, colon, rectum, liver, breast Colon, rectum, breast (postmenopausal), endometrium Lung, mouth, pharynx, larynx, esophagus, stomach Lung, mouth, pharynx, larynx, esophagus Carotenoid-containing foods Tomato products Prostate Allium vegetables (onion, garlic) Stomach, colon, rectum Esophagus Vitamin C-containing foods Folate-containing foods Pancreas, colon, rectum Colon, rectum Fiber-containing foods Milk and calcium supplements High level of physical activity Colon, rectum Colon, rectum, breast (postmenopausal), endometrium

Answer 1

1. Factor in diet and lifestyle contribute colon cancer are the following :

• BMI is 29 so patient belongs ti over weight it increase the risk if colon cancer.
• Patient consumes red meet 2times in aday which trigger the development of colon cancer.
• Patient follows sedentary life style such as sitting most of time and do little recreational exercise. Lack of exercise leads to cancer colon.
• Calcium rich diet reduce the risk if colon cancer. Here patient rarely drink milk and its products.

2. Complications includes infection, hemorrhage, wound disruption, thrombophlebitis and abnormal stomal function.

Symptoms are the following

• abdominal cramping is occur due to distension of the bowel. Early ambulation relieve the discomfort.
• Pain can be relieved by side lying position, sitz bath and medication for pain.
• To prevent thrombophlebitis by administration of anticoagulant.
• Follow strict aseptic technique.
• Leakage is common problem.

The above mentioned problem reduces the nutritional requirement.  

Chemotherapy inhibit synthesis of viamins and also causes deficiencies and malnutrition. It leads anorexia, somatitis and alimentary tract disturbances which also impaired the nutrition.

3.Canver cachexia is condition in which wasting characterized by weight loss, anorexia, asthenia and anemia.

Causes are multifactorial.

Tumor host interaction causes poor appetite, increased level of cytokines, endocrine dysfunction and elevated resting energy expenditure result in cachexia.

4.Intervention

• Assess nutritional status of the patient
• Provide small and frequent diet
• Avoid gas forming foods
• Maintain adequate hydration by consuming large amount of water.
• Maintain well balanced diet to prevent fatigue.
• Insert nasigastric tube as prescribed by the doctor.