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Mrs. S is a postmenopausal woman who has been recently diagnosed with Stage III breast
cancer. Her treatment course includes a course of concurrent radiation treatment and
chemotherapy, then surgical resection with a mastectomy and lymph node dissection.
Mrs. S. is to begin a 10 day course of radiation treatment and is also to receive chemotherapy
treatment with 5-Fluorouracil (5-FU). The intent is to use 2 courses of these treatments to
decrease the size and growth of the tumor prior to surgical resection.
You are the outpatient dietitian consulted for advice on nutritional management of this patient.
You counseled the patient at the beginning of the treatment course and now you are seeing her
again on day 10, at the end of the first treatment course. She is complaining of diarrhea that is
painful, frequent (>6 episodes/day) and is also experiencing some soreness in her mouth and
throat on swallowing.
1. Regarding the drug 5-FU: what is the drug class and how does it work? (2 pts)
a. Drug class:
Antineoplastic, Antimetabolite
Brand name: Adrucil
Chemotherapy
Citation: FMI p. 51
b. Mechanism of action
As a thymidylate synthase inhibitor, 5-FU interferes with the synthesis of pyrimidine
thymidine furthermore, inhibiting the process of DNA replication. Typically, thymidylate
synthase allows for the methylation of deoxyuridine monophosphate (abbreviated dUMP
for short), to convert into thymidine monophosphate (abbreviated dTMP). In terms of 5-
FU administration, there will be interruption of this conversion of dUMP to dTMP,
conclusively interfering with cancerous cell proliferation.
Citation: http://www.nature.com/nrc/journal/v3/n5/full/nrc1074.html
Citation: Width & Reinhard: The Clinical Dietitians Essential Pocket Guide p. 147
FMI p.151
Citation: Width & Reinhard: The Clinical Dietitians Essential Pocket Guide p. 147
NUT 116BL: Cancer Intro: Slide 22
Mrs. S begins her second chemotherapy course and on day 6 the lab tests indicate severe
neutropenia.
c. Are there any risks related to foods or are there key messages that you should
give to Mrs. S?:
- Risks related to foods for patients with neutropenia include undercooked fresh
fruits and vegetables, some animal products including unpasteurized milk, soft
cheeses made with raw milk, luncheon meats and deli-type salads, raw/
undercooked eggs, meat, poultry, fish, shellfish and the juices of all of the
above. All of these make the body more susceptible to infections.
N116BL NAME: Karina Almanza ID: 999730656
20 points Due: Sunday 3/5/2017 by 11:59 pm Online submission only
- Key messages to give to Mrs. S would include support of food intake that she
finds tolerable while eliminating foods that would make Mrs. S more
susceptible to food borne illnesses.
Two years later, Mrs. S. is diagnosed with recurrence of her cancer and with metastatic lesions.
She and the MD have agreed to continued aggressive treatment of her cancer using a variety of
therapies. She is currently in a six month break from therapies, waiting for the next cycle. She
recently presented at her doctors office with c/o weight loss, feeling tired, and no appetite. She
reports taking a few bites and getting full. She states that meats & coffee no longer taste good to
her. Her fatigue is beginning to limit her usual daily activities. These symptoms have increased
over the past 3 months. She feels like she may have lost a little weight over the past year, but it
has been really evident to her the past 3-4 months.
5. Calculate IBW, %UBW and % change in BW over the past 3 months. Indicate the level of
nutritional risk this change in BW represents. (show calculations) (3 pts)
MNT PG p. 2
6. Interpret the biochemical data, and comment on the overall status of the patient,
considering her symptoms and weight changes. (3 pts)
a. Biochemical data interpretation:
Hgb: 11.0 g/dl (Normal: 12-16 g/dL)
- Slightly below normal range
Hct: 31% (Normal: 34-45%)
- Below normal range
MCV:115fL (Normal: 80-100 fL)
- Above normal range
Ferritin: 90 ng/ml (Normal: 12-150 ng/mL)
- Within normal limits
TIBC: 255 g/dl (Normal: 240-450 ug/dL)
- Within normal limits
Alb: 3.1 g/dl (Normal: 3.5-5.0 g/dL)
- Below normal range
N116BL NAME: Karina Almanza ID: 999730656
20 points Due: Sunday 3/5/2017 by 11:59 pm Online submission only
Hemoglobin and hematocrit mare possibly low due to the chemotherapy
medication, while targeting quick turn-over cells and interfere with
erythropoiesis. The hematological and albumin data indicate that Mrs. S might
be anemic as a result of cancer acting as a chronic disease due to the
hypermetabolic and catabolic nature of the chemotherapy and radiation
therapy on the human body and general malnutrition of energy and protein.
MNT PG p 10- 17
7. What is your priority nutritional goal for this patient? How would you determine the
appropriate energy and protein needs for Mrs. S? (Indicate why you would use either
her UBW, IBW or CBW; and show your calculations with the equations you would use
for energy and protein) (3 pts)