Oncology

Question 1

What is Cancer?

Answer 1

Cancer is a cellular disease which occurs when abnormal cells grow in an uncontrolled way.

These abnormal cells can build up as:
• a solid tumor (medical oncology), e.g. bowel, breast, melanoma and lung; or
• in the blood (heamatology), e.g. leukemia, lymphoma and myeloma.

A tumor can be benign (not cancerous) or malignant (cancerous).

Question 2

What is Cancer Staging?

Answer 2

Primary Tumour size: T1-4 (1 = smallest, 4 = largest)

Node involvement: (0= no nodal spread to 3, high degree)

Metastases:
M0 – no distant metastasis detected
M1 – metastatic disease present
MX – unknown

T1N1M0 : small disease, mild regional lymph node involvement, no distant metastatic disease present

T4N3M1 : large tumour, significant nodal spread and metastatic disease present

Question 3

What is the impact of cancer on nutrition?

Answer 3

• Reduced Appetite
• Early satiety
• Taste changes
• Nausea/vomiting
• Bowel changes (diarrhoea, constipation or both, obstruction)
• Chewing and swallowing difficulties
• Dysphagia (difficulty swallowing),
• Odynophagia (pain on swallow)
• Dry mouth

Question 4

What is Cancer Cachexia?

Answer 4

Cancer Cachexia describes the marked weight loss and muscle wasting in patients with cancer that cannot be reversed by normal nutrition support.

Question 5

What are the energy requirements of a Cancer Patient?

Answer 5

• Chemotherapy, Cancer Cachexia: >120 kJ/kg, >1.4 g protein/kg
• Radiation/chemorads – 125-145 kJ/kg, 1.2-1.5 g protein/kg

Question 6

Possible PESS Statment

Answer 6

Community Acquired Malnutrition related to very poor appetite, taste changes on background of recently diagnosed pancreatic Ca as evidenced by 9.6% (6kg) unintentional wt loss in 1/12, limited oral intake, however, meeting 80% of est requirements with nutrition support, physical evidence of moderate fat and muscle loss, PG-SGA C24, indicating severe protein-energy malnutrition (E43).

Question 7

What is a Intervention Plan for Patient with Cancer?

Answer 7

1. Continue nutrition supplement drinks: Resource 2.0 tds
2. Revised HPE diet education.
3. Encouraged pt to have regular nourishing snacks throughout
   the day (better tolerated than meals).
4. Encouraged to ensure adequate fluids.
5. Revised Creon use. Pt to take Creon with anything
   containing protein and fats – all snacks and nutrition
   supplement drinks.

Question 8

What is a Monitoring and Evaluation Plan for Patient with Cancer?

Answer 8

Review weight, NIS (appetite, N/V, taste etc)
• Bowels and signs of malabsorption (adequacy of PERT
dosage)
• Oral intake – diet and supplements
• Review HENS (Home ENS) as required for ongoing supply of nutrition supplement drinks.