Dietary management: Carcinoma in left buccal mucosa

Rajeswari P*

Assistant Manager, Clinical Nutrition and Dietetics, Kauvery Hospital, Salem, India

*Correspondence: M: +91 8838413328; Email: [email protected]

Case Presentation

A 40 years old male presented with complaints of ulcero- proliferative growth in the left buccal mucosa. History of swelling over the cheek, old ischemic stroke, tobacco chewing.

Anthropometric Data

Height – 170cm

Weight – 68kg

BMI – 23.5kg/m2

IBW – [Height (m2) × 24] to [Height (m2) × 27] = 67 kg to72 kg

Findings and Plan

CT report

4 × 4 cm ulcerative proliferative growth involving left buccal mucosa involving lower GBS (Gingivobuccal sulcus). Skin corresponding to the lesion is thickened and oedematous. Few enlarged neck nodes level II.

Plan

Full thickness WLE (Wide local excision) + Post segmental mandibulectomy + MRND (Modified radical neck dissection) + free fibula reconstruction.

Buccal mucosa cancer

Buccal mucosa cancer is a rare cancer that develops in the inner cheek of the mouth. It’s a type of head and neck cancer. The buccal mucosa extends from the inside of lips and cheeks to just behind the last teeth. It’s a soft, wet mucous membrane that’s made up of several layers of tissue. Its main function is to support the mouth when eating and chewing. It also provides a barrier against infections and chemicals in the diet.

Causes

In this patient the main cause was tobacco chewing.

Symptoms

In this patient symptom was Swelling in cheek.

Clinical Data and Diet History

ComplaintHematemesis
DiagnosisLeft buccal mucosa carcinoma
Past historyCVA
TreatmentFull thickness WLE + Post segmental mandibulectomy + MRND + free fibula reconstruction.
Personal historyTobacco chewer
Diet Habit/AllergicVegetarian/Nil
Subjective Global AssessmentHealthy Weight

Biochemical Data

Vitals16/5/2428/5/2431/5/241/6/242/6/243/6/244/6/245/6/24
Hb16.118.010.05.76.47.98.78.8
PCV58.155.130.417.41924.426.727.3
TC94107250------
Platelet2.603.11------
Urea16---10---
Creatinine0.7---0.5---
Sodium140-133133133-131131
Potassium4.9-5.03.63.4-3.23.5
Total Bilirubin-0.9------
Direct-0.5------
Indirect-0.4------
SGOT-60------
SGPT-94------
GGTP-87------
Total Protein-7.9------
Albumin-4.4------
Globulin-3.5------
BT--------
CT--------
PT/INR11.9/1.10-------
Calcium10.4-------

Medical Nutritional therapy

  • Energy: To provide adequate calories
  • Carbohydrates: To provide moderate carbohydrates to prevent protein catabolism
  • Protein: Provide for high protein for tissue repair and growth
  • Fat: To provide moderate fat
  • Fibre: Limit intake of fibre.
  • Fluids: To provide adequate fluid to maintain the hydration.
  • Micro nutrient as per WHO

Post-operative nutrition target

  • Energy – 2500Kcal
  • Protein – 2 gm/Kg of IBW(140gm)
  • CHO – 60% of total Calories
  • Fat – 20% of total calories
  • Salt – Based on Sodium level

Diet Follow-up

DayDateType of DietEnergyProteinRemarks
Day 125.05.2024Oral soft solid diet + ONS 200ml 4 times per day2200 Kcal110 gm-
Day 226.05.2024Oral soft solid diet + ONS 200ml 4 times per day2200 Kcal110 gm-
Day 327.05.2024Oral soft solid diet + ONS 200ml 4 times per day2200 Kcal110 gm-
Day 428.05.2024Oral soft solid diet + ONS 200ml 4 times per day2200 Kcal110 gm-
Day 529.05.2024Oral soft solid diet + ONS 200ml 4 times per day2200 Kcal110 gm-
Day 630.05.2024NPO---
Day 731.05.2024NPO---
Day 801.06.2024RT feed 30ml 2nd hourly675 Kcal40.5 gmNo complaint
Day 902.06.2024RT feed 60ml 2nd hourly1350 Kcal81gmNo complaint
Day 1003.06.2024RT feed 100ml 2nd hourly1674 Kcal135 gmNo complaint
Day 1104.06.2024RT feed 250ml 2nd hourly2366 Kcal169 gmNo complaint
Day 1205.06.2024RT feed 250ml 2nd hourly2366 Kcal169 gmNo complaint
Day 1306.06.2024RT feed 250ml 2nd hourly2366 Kcal169 gmNo complaint
Day 1407.06.2024RT feed 250ml 2nd hourly2366 Kcal169 gmNo complaint
Day 1508.06.2024RT feed 250ml 2nd hourly2366 Kcal169 gmNo complaint
Day 1609.06.2024RT feed 250ml 2nd hourly2366 Kcal169 gmNo complaint
Day 1710.06.2024RT feed 250ml 2nd hourly2366 Kcal169 gmNo complaint

Discharge Advice

  • Target Nutrition achieved.
  • RT high protein feed advice.
  • Regular follow-up, Started high protein soft diet.

Now patient on chemotherapy.

Outcomes

Target nutrition was achieved and patient health conditions improved. Now the patient is on regular follow-up.

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