Medical Nutrition Therapy A Case
Study Approach, 6th Edition by
Marcia Nelms
Complete Chapter Solutions Manual
are included (Ch 1 to 29)
** Immediate Download
** Swift Response
** All Chapters included
,Table of Contents are given below
1. Pediatric Weight Management.
2. Bariatric Surgery for Morbid Obesity with long-term nutritional
complications.
3. Malnutrition Associated with Chronic Disease.
4. Hypertension and Cardiovascular Disease.
5. Myocardial Infarction.
6. Heart Failure with Resulting Cardiac Cachexia.
7. Gastroesophageal Reflux Disease.
8. Gastroparesis.
9. Celiac Disease.
10. Irritable Bowel Syndrome (IBS).
11. Inflammatory Bowel Disease and Short Bowel Syndrome: Crohn’s
Disease with surgery.
12. Non-Alcoholic Fatty Liver Disease (NAFLD).
13. Acute Pancreatitis.
14. Pediatric Type 1 Diabetes Mellitus.
15. Type 2 Diabetes Mellitus in The Adult.
16. Adult Type 2 Diabetes Mellitus: Transition to Insulin.
17. Chronic Kidney Disease (CKD) Treated with Dialysis.
18. Chronic Kidney Disease: Treated with Transplant
19. Acute Kidney Injury (AKI).
20. Ischemic Stroke.
21. Progressive Neurological Disease: Alzheimer’s Disease
22. Pediatric Traumatic Brain Injury (TBI).
23. Pediatric Cerebral Palsy.
24. COPD With Respiratory Failure.
25. Metabolic Stress and Trauma: GSW.
26. Nutrition Support in Sepsis and Morbid Obesity.
27. Nutrition and Breast Cancer.
28. Tongue Cancer Treated with Surgery and Radiation.
29. Nutrition and Colorectal Cancer
,Solutions Manual organized in reverse order, with the last chapter displayed first, to ensure that all
chapters are included in this document. (Complete Chapters included Ch29-1)
Answer Guide for Medical Nutrition Therapy: A Case Study Approach 6th ed.
Case 29 – Colorectal Cancer with Preoperative Chemoradiotherapy
I. Understanding the Disease and Pathophysiology
1. The American Institute for Cancer Research outlines the impact of diet, nutrition, and physical activity for
colorectal cancers (CRC). Outline which factors are associated with an increased and decreased CRC risk.
Include the strength of the evidence for each factor. Which risk factors are likely associated with Mr.
Spence’s CRC?
Strong evidence of decreased risk:
• Being physically active
• Consuming whole grains
• Consuming foods containing dietary fiber
• Consuming dairy products
• Taking calcium supplements
Strong evidence of increased risk:
• Consuming red meat
• Consuming processed meats
• Consuming approximately two or more alcoholic drinks per day
• Being overweight or obese
• Being tall
Some evidence of decreased risk:
• Consuming foods containing vitamin C
• Consuming fish
• Vitamin D
• Consuming multivitamin supplements
Some evidence of increased risk:
• Low consumption of non-starchy vegetables
• Low consumption of fruit
• Consumption of foods containing heme iron
Risk factors likely associated with Mr. Spence’s CRC:
• Obesity
• Comorbidities (hypertriglyceridemia, T2DM)
• 1–2 alcoholic drinks per day
• Tall stature
• Eats “on the go”: likely red processed meats, McDonald’s sausage and biscuits or bacon/egg breakfast
sandwich.
• High charcoal-grilled meat intake
2. Multiple genes involved in various carcinogenesis pathways have been associated with CRC. Discuss two of
these genes and the role in CRC.
There are two major genes that are thought to influence the development of cancer:
• Oncogenes: oncogenes control cell division and therefore affect tumor growth. If these genes are
mutated, cancer cells can be allowed to grow significantly.
• Tumor suppressing genes: these genes cause cell death (apoptosis), but may lose this function in an
abnormal state. When cancer cells cannot be suppressed by these genes, they can grow significantly.
More specifically, mutations in the PMS2, MSH6, and MUTYH genes have been identified that place patients
at a higher predisposition for colorectal cancer.
• PMS2: this gene plays a role in helping to fix errors in DNA. Gene mutations in PMS2 lead to
abnormally short proteins that cannot efficiently repair DNA errors, increasing the risk of tumor
formation. This mutation has been reported in families with a history of Lynch syndrome, which places
one at a higher risk for many types of cancers.
, • MSH6: this gene also plays a role in repairing damaged DNA. It repairs errors by removing
mismatched DNA and replicating new segments. When this gene is mutated, it cannot repair errors in
DNA. These errors then compound and grow longer, increasing the risk of tumor formation. It is also
commonly found in those with Lynch syndrome.
• MUTYH: this gene provides instruction for how to produce MYH glycolase, which is also involved in
the repair of DNA (base excision repair). When base excision repair is impaired, mutations compound
and cell overgrowth takes place, possibly leading to tumor formation.
3. The pathology report reveals that Mr. Spence has locally advanced rectal cancer that is currently staged as
T3N0. Explain this terminology for staging malignancies. Define the TNM staging system in your answer.
• The Tumor Node Metastases (TNM) Staging System uses T, N, and M to further categorize the tumor.
o The T category describes the original tumor:
▪ TX means the tumor can’t be measured or found.
▪ T0 means there is no evidence of a primary tumor.
▪ Tis means the tumor has not started growing into surrounding tissues.
▪ The numbers T1–T4 describe size and/or level of invasion into nearby structures.
o The N category describes whether or not the cancer has reached nearby lymph nodes:
▪ NX means nearby lymph nodes can’t be measured or found.
▪ N0 means nearby lymph nodes do not contain cancer.
▪ N1–N3 describe size, location, and/or the number of lymph nodes involved.
o The M category tells whether there are distant metastases:
▪ MX means metastasis can’t be measured or found.
▪ M0 means there are no known distant metastases.
▪ M1 means distant metastases are present.
o In stage T3 N0, it means that cancerous cells have significantly invaded into nearby tissues and no
nearby lymph nodes contain cancer.
4. After reviewing all imaging, the surgical oncologist determined that Mr. Spence will require preoperative,
neoadjuvant chemoradiotherapy for his locally advanced rectal cancer. Describe these therapies and the
nutritional implications that Mr. Spence might encounter throughout his treatment.
Neoadjuvant chemoradiotherapy is a treatment that aims to reduce tumor size prior to a surgical procedure.
Chemoradiotherapy combines both chemotherapy and radiation in order to provide additional treatments to
those with advanced tumors.
Chemotherapy:
• Interrupts cell DNA, RNA, or protein synthesis of the cell cycle.
• Different types of drugs interrupt cell proliferation at different stages.
• It is common therapy to use a combination of drugs, which will enhance the effectiveness of treatment
and minimize overall toxicity.
Radiation therapy:
• Therapeutic radiation is the use of electromagnetic energy, which can destroy rapidly proliferating
cells.
• It alters DNA enough to “break” the cell cycle.
• It reduces tumor size and is often used in conjunction with other therapies.
There are many nutritional implications that occur with cancer and cancer treatment, including:
• Presence of a malignancy may cause systemic effects such as:
o Increased metabolism
o Altered metabolism
o Anorexia: exercise as tolerated, appetite stimulants
o Dysgeusia
o MNT intervention: high-protein, high-calorie diet with use of supplementation and nutrition
support as indicated
Study Approach, 6th Edition by
Marcia Nelms
Complete Chapter Solutions Manual
are included (Ch 1 to 29)
** Immediate Download
** Swift Response
** All Chapters included
,Table of Contents are given below
1. Pediatric Weight Management.
2. Bariatric Surgery for Morbid Obesity with long-term nutritional
complications.
3. Malnutrition Associated with Chronic Disease.
4. Hypertension and Cardiovascular Disease.
5. Myocardial Infarction.
6. Heart Failure with Resulting Cardiac Cachexia.
7. Gastroesophageal Reflux Disease.
8. Gastroparesis.
9. Celiac Disease.
10. Irritable Bowel Syndrome (IBS).
11. Inflammatory Bowel Disease and Short Bowel Syndrome: Crohn’s
Disease with surgery.
12. Non-Alcoholic Fatty Liver Disease (NAFLD).
13. Acute Pancreatitis.
14. Pediatric Type 1 Diabetes Mellitus.
15. Type 2 Diabetes Mellitus in The Adult.
16. Adult Type 2 Diabetes Mellitus: Transition to Insulin.
17. Chronic Kidney Disease (CKD) Treated with Dialysis.
18. Chronic Kidney Disease: Treated with Transplant
19. Acute Kidney Injury (AKI).
20. Ischemic Stroke.
21. Progressive Neurological Disease: Alzheimer’s Disease
22. Pediatric Traumatic Brain Injury (TBI).
23. Pediatric Cerebral Palsy.
24. COPD With Respiratory Failure.
25. Metabolic Stress and Trauma: GSW.
26. Nutrition Support in Sepsis and Morbid Obesity.
27. Nutrition and Breast Cancer.
28. Tongue Cancer Treated with Surgery and Radiation.
29. Nutrition and Colorectal Cancer
,Solutions Manual organized in reverse order, with the last chapter displayed first, to ensure that all
chapters are included in this document. (Complete Chapters included Ch29-1)
Answer Guide for Medical Nutrition Therapy: A Case Study Approach 6th ed.
Case 29 – Colorectal Cancer with Preoperative Chemoradiotherapy
I. Understanding the Disease and Pathophysiology
1. The American Institute for Cancer Research outlines the impact of diet, nutrition, and physical activity for
colorectal cancers (CRC). Outline which factors are associated with an increased and decreased CRC risk.
Include the strength of the evidence for each factor. Which risk factors are likely associated with Mr.
Spence’s CRC?
Strong evidence of decreased risk:
• Being physically active
• Consuming whole grains
• Consuming foods containing dietary fiber
• Consuming dairy products
• Taking calcium supplements
Strong evidence of increased risk:
• Consuming red meat
• Consuming processed meats
• Consuming approximately two or more alcoholic drinks per day
• Being overweight or obese
• Being tall
Some evidence of decreased risk:
• Consuming foods containing vitamin C
• Consuming fish
• Vitamin D
• Consuming multivitamin supplements
Some evidence of increased risk:
• Low consumption of non-starchy vegetables
• Low consumption of fruit
• Consumption of foods containing heme iron
Risk factors likely associated with Mr. Spence’s CRC:
• Obesity
• Comorbidities (hypertriglyceridemia, T2DM)
• 1–2 alcoholic drinks per day
• Tall stature
• Eats “on the go”: likely red processed meats, McDonald’s sausage and biscuits or bacon/egg breakfast
sandwich.
• High charcoal-grilled meat intake
2. Multiple genes involved in various carcinogenesis pathways have been associated with CRC. Discuss two of
these genes and the role in CRC.
There are two major genes that are thought to influence the development of cancer:
• Oncogenes: oncogenes control cell division and therefore affect tumor growth. If these genes are
mutated, cancer cells can be allowed to grow significantly.
• Tumor suppressing genes: these genes cause cell death (apoptosis), but may lose this function in an
abnormal state. When cancer cells cannot be suppressed by these genes, they can grow significantly.
More specifically, mutations in the PMS2, MSH6, and MUTYH genes have been identified that place patients
at a higher predisposition for colorectal cancer.
• PMS2: this gene plays a role in helping to fix errors in DNA. Gene mutations in PMS2 lead to
abnormally short proteins that cannot efficiently repair DNA errors, increasing the risk of tumor
formation. This mutation has been reported in families with a history of Lynch syndrome, which places
one at a higher risk for many types of cancers.
, • MSH6: this gene also plays a role in repairing damaged DNA. It repairs errors by removing
mismatched DNA and replicating new segments. When this gene is mutated, it cannot repair errors in
DNA. These errors then compound and grow longer, increasing the risk of tumor formation. It is also
commonly found in those with Lynch syndrome.
• MUTYH: this gene provides instruction for how to produce MYH glycolase, which is also involved in
the repair of DNA (base excision repair). When base excision repair is impaired, mutations compound
and cell overgrowth takes place, possibly leading to tumor formation.
3. The pathology report reveals that Mr. Spence has locally advanced rectal cancer that is currently staged as
T3N0. Explain this terminology for staging malignancies. Define the TNM staging system in your answer.
• The Tumor Node Metastases (TNM) Staging System uses T, N, and M to further categorize the tumor.
o The T category describes the original tumor:
▪ TX means the tumor can’t be measured or found.
▪ T0 means there is no evidence of a primary tumor.
▪ Tis means the tumor has not started growing into surrounding tissues.
▪ The numbers T1–T4 describe size and/or level of invasion into nearby structures.
o The N category describes whether or not the cancer has reached nearby lymph nodes:
▪ NX means nearby lymph nodes can’t be measured or found.
▪ N0 means nearby lymph nodes do not contain cancer.
▪ N1–N3 describe size, location, and/or the number of lymph nodes involved.
o The M category tells whether there are distant metastases:
▪ MX means metastasis can’t be measured or found.
▪ M0 means there are no known distant metastases.
▪ M1 means distant metastases are present.
o In stage T3 N0, it means that cancerous cells have significantly invaded into nearby tissues and no
nearby lymph nodes contain cancer.
4. After reviewing all imaging, the surgical oncologist determined that Mr. Spence will require preoperative,
neoadjuvant chemoradiotherapy for his locally advanced rectal cancer. Describe these therapies and the
nutritional implications that Mr. Spence might encounter throughout his treatment.
Neoadjuvant chemoradiotherapy is a treatment that aims to reduce tumor size prior to a surgical procedure.
Chemoradiotherapy combines both chemotherapy and radiation in order to provide additional treatments to
those with advanced tumors.
Chemotherapy:
• Interrupts cell DNA, RNA, or protein synthesis of the cell cycle.
• Different types of drugs interrupt cell proliferation at different stages.
• It is common therapy to use a combination of drugs, which will enhance the effectiveness of treatment
and minimize overall toxicity.
Radiation therapy:
• Therapeutic radiation is the use of electromagnetic energy, which can destroy rapidly proliferating
cells.
• It alters DNA enough to “break” the cell cycle.
• It reduces tumor size and is often used in conjunction with other therapies.
There are many nutritional implications that occur with cancer and cancer treatment, including:
• Presence of a malignancy may cause systemic effects such as:
o Increased metabolism
o Altered metabolism
o Anorexia: exercise as tolerated, appetite stimulants
o Dysgeusia
o MNT intervention: high-protein, high-calorie diet with use of supplementation and nutrition
support as indicated
