Chapter 18: MNT for Esophageal and Gastric Cancers Flashcards
T/F: Esophageal ca is the 8th most common cancer in the world
True
5-year survival rate in the USA is ____ and in Europe is ____.
20% in the USA
10% in Europe
2 most common forms of EC are:
Esophageal squamous cell carcinoma (ESCC) - found in upper third portion
Esophageal adenocarcinoma (EAC) - found in lower third portion
Risk Factors for ESCC
Smoking
Alcohol use
HPV infection
Yerba mate consumption
Gender (male)
Race (more common in black men in the USA)
Genetics
Intake of red or processed meats
Risk Factors for EACs
Obesity
Body fatness
GERD
Barrett’s esophagus
Smoking
Gender
Race (more common in white people)
Genetics
T/F: adenocarcinoma at the GE junction is treated like esophageal cancer
TRUE
Symptoms of EC include:
Dysphagia
Odynophagia
Reflux like pain
Throat pain
Back pain
Weight loss
Diagnostic tests that may be used to stage EC include
Barium swallow
Chest or abdominal CT
MRI
PET scans
Endoscopy
Biopsies
Lab tests
Physical Exam
Treatment (curative intent)
Chemo, RT, ChemoRT, targeted therapy, surgery (partial or total esophagectomy), endoscopic mucosal resection
Treatment (palliative)
Chemo, RT (including brachytherapy), targeted therapy, endoscopic treatment.
Diet modification, stent, dilation, feeding tube, medications for symptom management
NIS of EC
- More common during weeks 3-6 of chemoRT
- Nausea, vomiting, anorexia
- Dysphagia
- Odynophagia
- Reflux
- Fatigue
- Constipation or diarrhea
- Dry mouth
- Altered taste
Esophageal Stents
- Improved swallowing function and QoL with esophageal stents
- Stent migration is a possible complication
Esophageal Stent Diet
Adequate chewing
Small bites
Sitting upright during and after meals (30-60 minutes)
Fluids with oral intake (save for after meals if pt has early satiety)
Sips of carbonated beverages to help food pass through stent if it gets stuck
Typical post-op diet: liquids - > soft/moist/easy to chew foods for 24 hrs
_____% of patients with EC experience malnutrition
75%
_____ is the most common symptom of EC
Dysphagia
Preferred feeding route for EC?
Jejunostomy
Gastric cancer is the _____th most common cancer in the world
5th
5-year survival rate of gastric cnacer
32%
T/F: Gastric cancer is more common in women
FALSE
Types of Gastric Cancers
Adenocarcinoma: 90-95%
Lymphomas, sarcomas, carcinoid tumors: 5-10%
_____ and _____ are the 2 types of gastric cancer.
Intestinal, diffuse
What is the leading cause of gastric cancer?
Inflammatory changes related to H. pylori.
What is onitis plastica?
Infiltration of the gastric wall by diffuse adenocarcinoma
Risk factors for GI cancer
Advanced Age
Male gender
Family hx of gastric cancer
Family hx of familial adenomatous polyposis
Cigarette smoking
PMH: h pylori infection, Epstein-Barr virus, Menetrier disease, gastric andemoatous polyps, intestinal metaplasia, chronic atrophic gastritis
Diet low in fruits and vegetables
Diet high in salted, smoked, or preserved foods.
Early symptoms of gastric cancer
Indigestion
Post-prandial bloating
Nausea
Decreased appetite
Reflux
Later symptoms of gastric cancer
Heme positive stools
Vomiting
Jaundice
Stomach pain
Ascites
Dysphagia
Gastric cancers most frequently metastasize to the ____, ____, and ____?
Liver, lung, bone
Malnutrition and weight loss occur in ____% of gastric cancers?
70%
What are the common treatments for gastric cancer?
Chemotherapy, biotherapy, radiation therapy and surgery
What are types of partial gastrectomies?
Billroth I (gastroduodenostomy), Billroth II (gastrojejunostomy), partial hastric resections, and Rouex-en -Y
Management of Dumping Syndrome
Limit foods high in concentrated sugar
Test tolerance to lactose containing foods
Avoid fried and greasy foods, but test tolerances to small amounts of fat.
Eat protein rich foods
Eat complex rather than simple carbohydrates
Drink liquids 30 minutes before or after meals, but not during.
Eat 5-6 small meals daily.
Avoid large potritons
Eat slowly and chew well
Post-Vagotomy diarrhea
Episodic, explosive diarrhea unrelated to oral intake. Can happen with any gastrectomy but more commonly with vagotomy.
Nutrient Deficiencies & Conditions After Partial or Total Gastrectomy
Vitamin B12 - rec 1000 mcg IM once monthly or 1000-2000 mcg daily orally
Folate - replete deficiency with 5 mg folate daily
Iron - IDA occurs in 50% of patients. Supplement with 200 mg ferrous sulfate TID (67 mg elemental iron per 200 mg tablet)
Bone disease - vitamin D, calcium
Fat malabsorption
