NTD 414: Medical Nutrition Therapy II
Tongue Cancer Case Study
Be sure to include in-text citations and a reference list at the end in APA style
Student
Part 1: Research (10 points). Insert pages below.
Cancer occurs in the body when there is an abnormal proliferation of cells that multiply
into either benign or malignant tumors. The main groups of cancers include carcinomas,
sarcomas, leukemia, and lymphomas. Carcinomas are tumors of epithelial cells and are the most
common cancers in humans. Sarcomas arise from bone, cartilage, fat, muscle, and other
connective tissues in the body. Leukemias and lymphomas occur from malignancies in immune
cells or blood-forming cells. Since cancer can form from any cell, there are hundreds of types of
cancers, but only a few occur frequently, and each cancer is individually unique. The most
common cancers occur in the breasts, prostate, colon, and lungs. Of these four types, lung cancer
is the most fatal and accounts for more than 30% of all cancer-related deaths (Cooper, 2000).
Cancer is known as a genetic disease as it develops from abnormal changes in genes that
alter how cells function and divide. Two proteins that play a role in regulating the cell cycle are
cyclins and cyclin-regulating kinases (CDKs). If either of these proteins stops working properly,
certain genes that encode tumor-suppressing proteins also stop functioning properly. When this
occurs, tumor growth can lead to cancer in the cells. Proto-oncogenic genes, which later modify
to become oncogenic or tumor-promoting genes, can also result in the development of cancer. A
crucial mechanism in the cell cycle that can stop the progression of the cycle for base pairs to be
exchanged before cell division is mismatch repair, which occurs during DNA synthesis.
Mismatch repair proteins are important for correcting these mismatched sequences to stop
uncontrolled development. They are essential for the stabilization of DNA and frequently result
in genetic instability, which can result in cancer development (Mercadante & Kasi, 2022). If
cancer progresses or is left untreated, cancerous cells spread throughout the body by breaking
away from the original tumor, traveling through the bloodstream, and from there, forming new
tumors in other parts of the body (“How cancer cells spread”, 2017).
Genetic alterations can sometimes cause cancer when an error occurs in the nucleotide
sequence of DNA, or when segments of chromosomes are rearranged, removed, or copied.
Exposure to tobacco smoke, certain heavy metals, and viruses in the environment can cause
genetic changes that may lead to cancer (“The genetics of cancer”, 2015). Cancer-causing
genetic mutations can also be inherited from parents which can increase the offspring’s chance of
developing cancer. The National Cancer Institute mentioned, “up to 10% of all cancers may be
caused by inherited genetic changes,”. There are many other risk factors that can cause cancer,
some of which include aging, excessive alcohol consumption, immunosuppression, radiation,
chronic inflammation, poor diet, and as previously mentioned, exposure to tobacco smoke (“Risk
factors for cancer”, 2015).
Individuals with cancer are likely to experience nutrition-related issues that can cause
significant weight loss, cachexia, and malnutrition. Patients with cancer in the head and neck are
at high risk for malnutrition as cancer treatment can cause difficulty eating and swallowing. In
fact, approximately 60% of patients with head and neck cancers have malnutrition at the time of
their cancer diagnosis (Nelms, p. 693). Chemotherapy and other medications for treating cancer
are commonly associated with poor nutrition and digestion, as many patients experience a
suppressed appetite, early satiety, distaste for certain foods, constipation, diarrhea, and other
health factors that impact their daily eating.
The advantages of nutrition therapy in the treatment of cancer must also be considered
against the risks associated with its potential to promote tumor growth and metastasis. To
prevent muscle wasting and malnutrition, cancer patients are recommended to consume quality
protein sources and foods that help promote healthy bowel movements, eat smaller, frequent
meals, and get adequate fluids. Maintaining good nutrition is essential for faster recovery from
treatment and enhanced quality of life for these individuals.
Part 2: Patient (15 points)
Questions:
Height: 6’3”; Weight: 198#
UBW: 230# 6 months ago
1. What is NS’s DBW, %DBW, % weight change, and BMI (Show your work for all calculations)?
Discuss your findings regarding his weight status. Classify the severity of his weight loss.
What factors may have contributed? (2 pts.)
DBW: 75 inches (15 inches above 5 ft) 15x6=90+106= 196 lbs
%DBW: = (198/196)x100 = 101%
% wt change: 230/198/198x100 = 13.9%, severe weight loss
BMI: 198/75/75x704= 24.8, normal weight
NS’s weight decreased by 32 pounds in six months. He underwent significant weight loss due to
his early satiety, tongue pain, and odynophagia which causes him to eat smaller portions and
sometimes skip lunch.
2.
Estimate NS’s energy, protein, and fluid requirements using cancer guidelines. Show
your work. (2 pts.)
Energy: 89.8 kg x (30-35 kcal) = 2,694-3,143 kcals/d
Protein: 89.8 kg x (1.5-2.5 g)= 91-225 g PRO/d
Fluid: 89.8 kg x (30-35 mL)= 2,964-3,143 mL/d
3.
What risk factors does NS have for tongue cancer? (1 pt.)
NS’s frequent alcohol consumption, smoking, and regular consumption of processed meats are
risk factors for his tongue cancer.
4.
Refer to NS’s biochemical data. List each abnormal lab and provide an explanation as to
why each value is not within normal limits. Provide explanations specific to this patient. (Add or
remove rows if needed). (2 pts.)
Lab
Albumin
Prealbumin
RBC
Hematocrit
C-reactive
protein
Explanation of abnormal lab
Low; inadequate protein intake, Family history of liver problems.
Low; inadequate protein intake
Low; inadequate oral intake, decreased RBC production caused from
tongue cancer
Low; inadequate oral intake, decreased RBC production caused from
tongue cancer
High; hypertension, progression of tongue cancer
5.
Adjust NS’s diet recall to comply with the diet requirements and guidelines described in
question two. Remember to keep dietary adjustments as close to the patient’s preferences as
possible. This includes preferences listed in the usual diet/24-hour recall and appropriate
options for the patient’s demographics (gender, age, race/ethnicity, socio-economic status,
etc.) Be sure to include serving sizes in your revised menu. Using a nutrient analysis software,
analyze your revised menu (include a copy of your analysis report). (2 pts.)
BREAKFAST
1 packet plain instant oatmeal
made with water
Sips of coffee
LUNCH
¾ cup chicken noodle soup
2 saltine crackers
1 Ensure High Protein
8 oz. spring water, at least 30 minutes before eating
2 eggs
1 packet instant oatmeal prepared with 3 tbs of hemp
seeds and ¼ cup low-fat milk
6 oz coffee
1.5 cups low-sodium chicken noodle soup
4 whole wheat saltine crackers
1 can tuna with 3 tbs light mayo
1 Ensure high protein
8 oz water at least 30 minutes before dinner
SNACK
2 tbs Peanut butter on 1 slice whole wheat bread and 1
tbs dark chocolate chips
1 light beer or 8 oz water at least 30 minutes before
eating
DINNER
½ cup macaroni and cheese
1 Ensure High Protein
SNACK
1 cup chocolate ice cream
1 cup mashed potatoes with 3 tbs low sodium gravy
1 cup peas and 1 cup green beans with 1 tbs butter
4 oz ground turkey
1 Ensure high protein
Fruit smoothie with 1/2 cup Greek yogurt, 1/3 cup
frozen fruit and ½ cup spinach
1 soft boiled egg with salt and pepper or condiment of
choice
8 oz water at least 30 minutes after eating
The adjusted diet falls slightly under NS’s recommended energy intake by 240 kcals. However, it
satisfies his protein requirement range with 211 grams of protein. NS could increase his calories
by adding another Ensure drink before lunch or by slightly increasing his portion sizes to meet
his energy intake goal. NS may find it helpful to find softer protein sources, such as eggs, tofu,
and beans as he reports that he avoids tough foods like meat. NS should consider avoiding
drinking fluids with meals to prevent early satiety. He should also be mindful of his potassium
intake as high-potassium foods can lower the effectiveness of his medication. Limiting sodium
and saturated fat will help lower his high blood pressure.
6.
Describe the clinical signs of malnutrition noted in the patient’s admission history,
dietary history, and physical exam. (2 pts.)
NS has reported of several risk factors for malnutrition, including a decreased appetite, early
satiety, and pain with eating and swallowing. His physical signs indicate cachexia due to the
progression of his tongue cancer and eating less frequently. Smoking tobacco can also
contribute to his decreased appetite.
7.
Finish the Nutrition Care Process (NCP) by writing 2 high-priority PES statements,
determine an appropriate nutrition prescription, list appropriate interventions and goals, and
factors to monitor and evaluate. (4 pts.)
E. NUTRITION DIAGNOSIS:
Problem
PES Statement 1:
Etiology (related to)
Signs and Symptoms (as evidenced by)
Inadequate fluid intake
related to early satiety and pain with swallowing
as evidenced by patient diagnosis of odynophagia and insufficient fluid intake in 24-h recall.
PES Statement 2:
Inadequate oral intake
related to decreased appetite, pain while eating and swallowing and early satiety
as evidenced by intake of <1,100 kcals in 24-h recall and abnormal lab values of low albumin, prealbumin, and
hematocrit indicating inadequate protein intake.
MEASURABLE GOALS
Goal 1 (must relate to PES 1):
Drink 8 oz of water between meals,
or 1,100 mL water daily for three
weeks.
Goal 2 (must relate to PES 2):
Normalize albumin levels to 3.5 g/dl,
prealbumin to 18 g/dl, and
hematocrit to 41% in 3 months
INTERVENTION (should include nutrition Rx and education)
Plans for Goal 1:
Advise pt. to avoid alcohol to prevent dehydration and prevent cancer
progression. Recommend pt. to drink fluids at least 30 minutes before
meals to prevent fullness and provide education on hydration for faster
cancer recovery.
Plans for Goal 2: Educate pt. on increasing kcals to 2,000 each day by
adding quality protein-rich foods and increasing portion sizes.
H. MONITORING and EVALUATION
Identify what will be used to monitor and evaluate the effectiveness of the intervention:
_____Weight Waist Circumference __X__Food intake __X__Fluid intake
__X__Labs
_____Other
Labs: Albumin, prealbumin, RBC, hematocrit
Identify patient’s stage of change:
___Precontemplation __X_Contemplation
__X_Preparation
References
___Action
_ __Maintenance
Mercadante, A., & Kasi, A. (2022, August). Genetics, cancer cell cycle phases - statpearls - NCBI
bookshelf. National Library of Medicine. Retrieved February 19, 2023, from
https://www.ncbi.nlm.nih.gov/books/NBK563158/
Nelms, M. N. (2016). Nutrition therapy and pathopysiology. Cengage Learning.
Risk factors for cancer. National Cancer Institute. (2015, December 23). Retrieved February 18, 2023,
from https://www.cancer.gov/about-cancer/causes-prevention/risk
The genetics of cancer. National Cancer Institute. (2015, December 23). Retrieved February 18, 2023,
from https://www.cancer.gov/about-cancer/causesprevention/genetics#:~:text=Genetic%20changes%20can%20lead%20to,specialized%20RNA%2
0such%20as%20microRNA.
U.S. Department of Health and Human Services. (2017, September 8). How cancer cells spread in the
body. National Institutes of Health. Retrieved February 18, 2023, from
https://newsinhealth.nih.gov/2017/04/how-cancer-cells-spread-body