Esophageal cancer is a type of cancer that arises in the esophagus and is inclusive with the esophageal junction ( (Enzinger & Mayer, 2003) . Adenocarcinoma is the malignant tumor formed from glandular structures in epithelial tissue. Cancer is a terminal disease that is either treated with chemotherapy, radiotherapy or surgery. The survival rates are dependent on the stage it is diagnosed and the general health and history of the patient.
There are a number of esophageal cancers, but the two major types are Adenocarcinoma and squamous cell carcinoma . Adenocarcinoma originates in the mucus secreting glands of the esophagus, majorly in the lower portion of the esophagus. Squamous cell carcinoma is the type of the esophagus cancer that is found in the middle and upper parts of the esophagus that affects the thin flat cells that lines the esophagus surface.
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Cancer is diagnosed and categorized in 5 stages which are stage zero, 1, II, III and IV. Each stage defines the extent in which the cancer has spread in the body. The doctors use the TNM system where T is the representation of Tumor, N for Node while M for Metastasis. T illustrates how deeply the primary Tumor has spread in the walls of the esophagus, N illustrating if the tumor has spread to the lymph nodes while M is the explanation of whether the cancer has spread to other body parts. Mr. Seyer being diagnosed with Stage IIB (T1, N1, M0) of esophageal cancer can be interpreted to mean the tumor is in any part of the esophagus, and cancer cells have spread into the lining of the esophagus and underneath layers. Cancer has also spread to 1 or 2 lymph nodes near the tumor but the cancer has not spread to other body parts (Killinger et al., 1996).
A transhiatal esophagectomy is medical a procedure where a part or all the esophagus is removed, the stomach is mad into a cylinder and it is pulled into the neck to be attached to esophagus that remained after incision. The procedure removes the cancer affected esophagus together with the surrounding lymph nodes. The absorption of the food nutrients of Mr. Seyer is distorted after the surgery ( (Enzinger & Mayer, 2003) .
Cancer treatment influences the nutrition needs of the patient which arises from the change in the eating habits, altered digestion, absorption and usage of the nutrients. This leads to change in the nutritive needs that can culminate to malnutrition that is influenced by nausea or vomiting, painful swallowing and loss of appetite. Cancer patients are encouraged to have an adequate energy balance which is from the feeding on high energy foods to be able to counteract the weight loss associated with the cancer treatment.
Patients with cancer encounter high rates of weight loss and lack of energy that is contributed by the loss of appetite and the metabolism. This is a result of either the disease itself or the cancer treatment. This factor increases the likelihood of cancer patients to be malnourished and live a poor quality nutritive life.
After the reviewing of the patient’s history, there are clinical symptoms of malnutrition. This is evident from reported muscle wasting that has resulted to a loss of 30lb in a few months. This is an indication of acute malnutrition.
A terminal illness is a disease that cannot be cured which keeps progressing and eventually leads to death of the patient. Having diagnosed with a terminal illness, the negative impacts are manifested in both the patient and the family. This affects the nutrition intake of the patient arising from stress that further reduces the appetite. Being faced by such a situation, I will recommend the psychotherapy treatment for the family as well as the patient so that they stay positive and support the patient to the end.
The questions I will have for Mr. Seyer and family will include:
How is your attitude and emotions affecting the patient?
How is the situation affecting you, have you accepted and how are you coping?
How are preparing your family to cope when you leave?
References
Killinger, W. A, Rice, W. T., Adelstein, D. J., Medendorp, S., Zuccaro, J., Kirby, T., & Goldblum, J. R. (1996). Stage II esophageal carcinoma: The significance of T and N. The Journal of Thoracic and Cardiovascular Surgery, 111 (5), 935-940.
Enzinger, P. C., & Mayer, R. J. (2003). Esophageal Cancer. The New England Journal of Medicine (349), 2241-2252. doi:10.1056/NEJMra035010
