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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

2. 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

3. 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

4. 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?

5. 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

6. 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?

7. 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

8. 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

9. TOTAL 260
*1040g
87
*348g
39
*351g
1739 kcal
V. Sample Meal Plan
Day Breakfast A.M. Snack Lunch P.M
Snack
Dinner Midnight
Monday Veggie –
Meaty
sandwich,
Low fat milk
Pineapple
slice
Fresh fruits with
sweet milk
Menudo
Rice
Mango
slices
Water
Papaya
slice
Nilagang
baka
Rice
Melon slice
water
Milk
Tuesday Mixed greens
with croutons
Orange juice
Oranges
Milk chocolate
latte
crackers
Macaroni
Lemon-
Chicken
Mango
slices
Mixed
green
salad
Beef steak Milk or
yoghurt
Wednesda
y
Chicken
Salad/ oats
with fruits
Honey dew
chills
Protein crackers
Bangus
friend
Yangchow
rice with
veggies
Vegetaria
n delight
Jasmine
tea
Oatmeal
bars
Milk
banana
Thursday Omelets
Wheat bread
Yellow tea
Lumpiang
sariwa
Buko juice with
milk
Naicha
Beef in
chinese
noodles
Tomatoe
delight
bread
Chopsuey in
chicken
Fresh
milk
Friday Caesar salad
with
thousand
island
dressing
Maruya
Choice of
greens and
fruits shake
Vegetarian
platter
Four
seasons
squeeze
Strawberr
y tea
Soft
crackers
Fish
crouquette
in sweet
sauce
Milk
youghurt
Saturday Pandesal
Ham, bacon
or eggs
Inihaw na
bangus
Rice
buko
Crab louie
delight
Lumpiang
ubod
Pancit bihon milk
Sunday Fish and
potatoes
Hot
Chocolate
Paella
Mano shake
Laing
Water rice
Green tea Embotido
Crab soup
Rice
water
cranberri
es
*** 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.

10. 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.

11. 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.
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