DE LA SALLE UNIVERSITY - DASMARIÑAS

COLLEGE OF INTERNATIONAL HOSPITALITY MANAGEMENT

HOTEL AND RESTAURANT MANAGEMENT DEPARTMENT
ACADEMIC YEAR 2010 -2011, 2nd SEMESTER

A Case Study Presented to

Ms. Marichou F. Señorin
In Partial Fulfillment of the Requirements in
Culinary Nutrition

Group Six

Silvestre, Jazmine D.
Tapawan, Faire Jessica
Serias, Neil
Umali, Erryl
Zalameda, Winzhel

HRM 16

March 10, 2011

 CASE STUDY

I. Introduction

A. Name: Paul C.

B. Age : 35 years old

C. Gender: Male

D. Height: 5’5

E. Weight:59 kg

F. Family Medical History:

 Aunts and uncles died from Colon Cancer at early age.

II. Pathophysiology

Colorectal cancer, also called colon cancer or large bowel cancer or "CRC", includes
cancerous growths in the colon, rectum and appendix. With 655,000 deaths worldwide per year,
it is the fourth most common form of cancer in the United States and the third leading cause of
cancer-related death in the Western world. Colorectal cancers arise from adenomatous polyps
in the colon. These mushroom-shaped growths are usually benign, but some develop into
cancer over time. Localized colon cancer is usually diagnosed through colonoscopy.

Invasive cancers that are confined within the wall of the colon (TNM stages I and II) are
curable with surgery. If untreated, they spread to regional lymph nodes (stage III), where up to
73% are curable by surgery and chemotherapy. Cancer that metastasizes to distant sites (stage
IV) is usually not curable, although chemotherapy can extend survival, and in rare cases,
surgery and chemotherapy together have seen patients through to a cure. Radiation is used
with rectal cancer.

On the cellular and molecular level, colorectal cancer starts with a mutation to the WNT
signaling pathway. When WNT binds to a receptor on the cell, that sets in motion a chain of
molecular events that ends with β-catenin moving into the nucleus and activating a gene on
DNA. In colorectal cancer, genes along this chain are damaged. Usually, a gene called APC,
which is a "brake" on the WNT pathway, is damaged. Without a working APC brake, the WNT
pathway is stuck in the "on" position.

From : http://en.wikipedia.org/wiki/Colorectal_cancer

Incidence And Mortality

Colon cancer ranks 6th overall, 5th among males and 7th among females. An estimated
2,963 new cases, 1,548 in males 1,415 in females, together with 1,567 deaths will be seen in
1998. Colon cancer increases markedly after age 50.

Risk factors & prevention

Personal or family history of colon cancer; personal or family history polyps in the colon;
inflammatory bowel disease. Evidence suggests that colon cancer may be linked to a diet high
in fat and deficient in whole grains, fruit and vegetables.

Warning signals

A change in bowel habits such as recurrent diarrhea and constipation, particularly with
the presence of abdominal discomfort, weight loss, unexplained anemia, and blood in the stool.

Early detection

Unfortunately, early colon cancer is asymptotic, and there is still no efficient screening
method for early detection. The aim should be earlier diagnosis of symptomatic patients who
complain of changes in bowel habits, vague abdominal pains, and unexplained weight loss and
anemia, particularly among patients 50 years old and above, by means of barium enema or
colonoscopy.
 The mistaken obsession of our physician with amoebiasis and other forms of
inflammatory bowel disease had for decades been a major factor that had delayed diagnosis of
colon cancer. The wider availability of antidiarrheal, antibiotics and amoebecides may have
worsened the situation. Too many physicians still insist in giving vitamin preparations and
hematinics for chronic unexplained weight loss and anemia without carefully looking for the
cause.

Treatment

Early colon cancer is curable, and surgery is the most effective method of treatment.

From : http://www.doh.gov.ph/healthadvisories/coloncancer/

What is Hereditary Non-polyposis Colorectal Cancer?

HNPCC is an inherited colorectal cancer syndrome and accounts for 5 percent of all
cases of colorectal cancer. The “H” stands for hereditary, meaning it is inherited or can be
passed from parent to child; “N” stands for non-polyposis, contrasting it to the inherited condition
FAP where hundreds to thousands of polyps develop in the colon; “CC” stands for colorectal
cancer, the most frequent cancer that develops in these families. Patients with HNPCC have an
80 percent chance of developing colorectal cancer.

The cause for HNPCC is due to an inherited mutation (abnormality) in a gene that
normally repairs our body’s DNA. There are at least 5 genes that have been found to cause
HNPCC. They are called Mismatch Repair Genes. If part of the DNA is not matched properly
cancer can occur. Because the HNPCC gene mutation is present in every cell in the body’s
other organs can develop cancers too. Cancer of the uterus (womb or endometrium) is very
common and may be the main cancer in some HNPCC families. Other cancers can occur in the
rest of gastrointestinal tract (stomach, small intestine, and pancreas), urinary system (kidney,
ureter) and female reproductive organs (ovary). Although the risk to develop cancer in HNPCC
is high, knowing about the risk of cancer and getting appropriate check-ups and treatment by
experts in this disorder can save lives and prevent cancer.

How is HNPCC diagnosed?

 Family History

The first step in suspecting someone belongs to an HNPCC family is by reviewing the
family history. The strictest definition of an HNPCC family is called the Amsterdam criteria. It
includes:

• 3 relatives with colorectal cancer (one first degree relative to the other two)

• 2 successive generations

• 1 colorectal cancer occurring in someone 50 years old or less

The colon cancers are often found in the right colon and usually occur before the age of
50.

Other clues to an HNPCC family include multiple relatives with colon cancers, including
relatives who have had more than one colorectal cancer, or a colon and endometrial cancer,
and clusters of colorectal and other cancers of the gastrointestinal, urinary or female
reproductive system.

 Genetic testing

 Colon examinations

What lifestyle changes can be expected?

Most patients are able to eat normal diets and lead normal lives following surgery. Some people
notice more frequent bowel movements. Otherwise, their lives will be perfectly normal. Their
sexual and social activities are unaffected. None of the procedures affects a man’s ability to
father children or a woman’s ability to have a normal pregnancy. However, the way in which a
baby is delivered may be affected by the type of surgery and should be discussed with the
surgeon.

What testing is needed to keep patients with HNPCC or at risk of HNPCC healthy?

III. Nutritional Assessments

Desirable Body Weight =

Height - 5”5

5x12 = 60 + 5

65 x 2.54 = 165.1 – 100

65.1 x .90 = 58.59 kg

DBW = 58.59 kg

Nutritional Status =

(59kgs / 58.59kgs) x 100

NS = 100.70Normal

IV. Dietary Requirement

Diet for Colon cancer patients: Moving away from red meat, fatty foods, foods high in sugar,
and refined grains to more fruits, vegetables and dietary fiber.

A colon cancer diet many patients tolerate well includes:

 Whole grains

 Fresh, raw vegetables and fruits

 Legumes such as beans and lentils

 Non fatty fish, chicken and meats, free of hormones and additives

These foods supply your body with:

 Complex carbohydrates

 Vitamins, minerals and enzymes

 Easily digestible protein

Vegetables with cancer preventive compounds include:

 Broccoli

 Cabbage

 Cauliflower

 Kale

 Winter squash

TOTAL ENERGY REQUIREMENT

TER =DBW x PA

TER =58.59 x 30 *sedentary

= 1757.7 kcal

TER =58.59 x 27.5 *bed rest

=1611.23 kcal

CHO 60% 1758 X .60 1054.8 /4 263.7g

CHON 20% 1758 X .20 351.6 /4 87.9g
FAT 20% 1758 X .20 351.6 /9 39.1g

FOOD EXCHANGE

Food Items Exchange CHO CHON Fat Total Energy Calories

Veg A 7 21 7 - 112
Veg B 6 18 6 - 96
Fruits 5 50 - - 200
Milk - - - - -
Whole 1 12 8 10 170
Low Fat - - - - -
Skimmed 2 24 16 Tr 160
Rice 5 115 10 - 500
Meat - - - - -
Low 3 - 24 3 123
Medium 1 - 8 6 86
High 1 - 8 10 122
Fat 2 - - 10 90
Sugar 2 20 - - 80
TOTAL 260 87 39 1739 kcal
*1040g *348g *351g

V. Sample Meal Plan

Day Breakfast A.M. Snack Lunch P.M Dinner Midnight

Snack
Monday Veggie – Fresh fruits with Menudo Water Nilagang Milk
Meaty sweet milk Rice Papaya baka
sandwich, Mango slice Rice
Low fat milk slices Melon slice
Pineapple water
slice
Tuesday Mixed greens Milk chocolate Macaroni Mixed Beef steak Milk or
with croutons latte Lemon- green yoghurt
Orange juice crackers Chicken salad
Oranges Mango
slices
Wednesda Chicken Honey dew Bangus Vegetaria Oatmeal Milk
Salad/ oats chills friend n delight bars banana
y
with fruits Protein crackers Yangchow Jasmine
 rice with tea
veggies
Thursday Omelets Lumpiang Naicha Tomatoe Chopsuey in Fresh
Wheat bread sariwa Beef in delight chicken milk
Yellow tea Buko juice with chinese bread
milk noodles
Friday Caesar salad Maruya Vegetarian Strawberr Fish Milk
with Choice of platter y tea crouquette youghurt
thousand greens and Four Soft in sweet
island fruits shake seasons crackers sauce
dressing squeeze
Saturday Pandesal Inihaw na Crab louie Lumpiang Pancit bihon milk
Ham, bacon bangus delight ubod
or eggs Rice
buko
Sunday Fish and Paella Laing Green tea Embotido cranberri
potatoes Mano shake Water rice Crab soup es
Hot Rice
Chocolate water

*** All meals should have glass of water.

*** More vegetable dishes than red meat dishes.

***eat more white meat than red meat.

*** Juices should be in form of fresh rather than can.

VI. Diagnosis & Goal

 Since the colon cancer is patented from the family genes. The family members
should be conscious of their health lifestyle not only Paul.

 Dietary Plan should be taken care of to avoid aggravating the colon cancer cells.

 To extent patients longevity existence.

 To make and enable the person do simple tasks in daily intake.

 To ensure short term recovery goals be achieve and long term recovery goals be
observe and imply the measures to the patient’s lifestyle.


VII. Recommendations

Undergo these procedures to confirm the level of the colon cancer rather than considering it as
advance stage. There may be more than the illness stated or provided, if there are there will be
more test to undergo before the surgery will be conducted.

Digital rectal exam (DRE): The doctor inserts a lubricated, gloved finger into the rectum to feel
for abnormal areas. It only detects tumors large enough to be felt in the distal part of the rectum
but is useful as an initial screening test.

Fecal occult blood test (FOBT): a test for blood in the stool. Two types of tests can be used for
detecting occult blood in stools i.e. guaiac based (chemical test) and immunochemical. The
sensitivity of immunochemical testing is superior to that of chemical testing without an
unacceptable reduction in specify.

Endoscopy:

Sigmoidoscopy: A lighted probe (sigmoid scope) is inserted into the rectum and lower colon
to check for polyps and other abnormalities.

Colonoscopy: A lighted probe called a colonoscope is inserted into the rectum and the entire
colon to look for polyps and other abnormalities that may be caused by cancer. A
colonoscopy has the advantage that if polyps are found during the procedure they can be
removed immediately. Tissue can also be taken for biopsy.