1. METASTATIC
BREAST CANCER
PRESENTED BY
SHWETA KIRAN JOSHI ,TYBSc
Dr. Bmn College of Home Science
Incharge- Mrs. Anuradha Shekhar

2. BREAST CANCER
 What is Breast cancer?
 Metastasis
 Symptoms

3. STAGES OF BREAST CANCER
 Stage 0
 Ductal carcinoma in situ. In stage 0, there is no evidence of
cancer cells.
 Stage I
• The tumour measures up to 2 cm
• The cancer has not spread outside
the breast; no lymph nodes are
involved
IA Stage
• There is no tumour in the breast;
instead, small groups of cancer cells
• larger than 0.2 mm but not larger than
2 mm – are found in the lymph nodes.IB Stage

4. STAGE II
• No tumour can be
found in the breast, but
cancer cells are found
in the lymph nodes
under the arm.
IIA
• The tumour is larger
than 2 cm but no larger
than 5 cm and has
spread to the axillaries
lymph nodes
IIB

5. STAGE III
IIIA
• The cancer is any size and has spread to
axiliiary lymph nodes, which are clumped
together or sticking to other structures
IIIB
• The cancer may be any size and has
spread to the chest wall and/or skin of the
breast.
IIIC
• The cancer has spread to lymph nodes
above or below the collarbone and near to
breast bone.

6. STAGE IV
 Stage IV describes invasive breast cancer that has spread
beyond the breast and nearby lymph nodes to other organs of
the body, such as the lungs,skin, bones, liver, or brain.

7. CASE STUDY
 PERSONAL INFORMATION
 Name: ABC
 Age and sex: 32 years old Female
 Admit Date: 1-11-12
 Discharged Date: 13-11-12
 Blood group: A+
 Diagnosis: Metastatic Ca of right Breast.

8. PERSONAL INFORMATION
 Anthropometric measurements:
 Weight: - 65 kg.
 Height: 154cm
 BMI= wt/ht(mt)2
 BMI: 27
 IBW = Ht(in cm) -100
 154-100= 54
 IBW: 54 kg.
 Weight Status- 65-54=9 (Patient is 9 kg Overweight)

9. PERSONAL INFORMATION
 Personal information
 Marital status : Single
 Software engineer
 Eating Pattern: Veg and Non Veg.
 Family History:
 Family member : 4
 Income : 30,000
 Diabetes Mellitus : No History in Family
 Cancer: Mother had Cancer of left Breast. Operated 9 years
ago.
 Hypertension : Mother
 Allergy: None

10. VITALS
Date Pulse/min Blood Pressure Temp Respiration Rate
1/11/12 80 130/80 mm/Hg 100 F 20
7/11/12 90 120/70 mm/Hg 102 F 22
12/11/12 80 130/80 mm/Hg 100F 20
PARAMETERS
Haemoglobin 9.40 g/L
Sodium 127 MEq/L
Potassium 2.9 MEq/L
WBC 19.09 mcL

11. TESTS
 OTHER TESTS:-
 CT scan (Abdo+ Pelvis+ Chest): Multiple mass scattered in
both the lungs largest 3.3*2 evidence of 7*7.4 cm neurotic
mass in right anterior chest wall involving the pectorals
muscle and extending intrathorasically into the pleura.
 Blood culture: No any growth till now.
 HIV : Negative
 HCV: Negative
 HBS Ag : Negative

12. CASE INTERPRETATION
 Patient medical history show that she is known case of
Metastatic breast Cancer.
 Above mentioned biochemical parameters shows that
Haemoglobin, Sodium, potassium level were lower than
normal range except WBC was observed.
 Patient was undergoing chemotherapy; Due to Port infection
patient was in febrile condition.

13. HOME RECALL
Time Meal Menu
9:00am Breakfast Bread butter and Tea with sugar
11:00am Mid morning Milkshakes with sugar
12:15pm Mid morning ½ apple
1:00pm Mid morning Almond and Walnuts
2:00pm Lunch 1K dal, 1K Rice, Palak soup, fish
curry,1K bhaji, Salad
4:00pm Evening Snacks Tea and biscuits with sugar
7:00pm Mid evening Beet root juice and chikki, chakali
9:30pm Dinner 1Roti, 1k vegetable
11:00pm Bed time Milk with sugar

14. HOME RECALL
FOOD
EXCHANGE
No. Of
exchange
Energy
(Kcal)
CHO
(gm) Protein (gm)
Fat
(gm)
Cereal 4 400 88 10 2
Bread 1 100 21 3 0.5
Marie
Biscuits (2) 0.5 50 9 1 1
Pulses 2 200 34 14 1
Nuts &
oilseeds 2 200 6 6 16
Chicken / fish 1 100 0 21 1.5
Buffalo milk 3 300 15 13.5 21
Potato 0.5 50 12 0.9 0
Vegetable 2 70 14 4 0
Fruits 2 100 25 0 0
Sugar 4 80 20 0 0
Fats & oils 8 360 0 0 40
Total :- 2010 244 73.4 83
% 49.67 14.94 35.73

15. DISTRIBUTION OF EACH MEAL
Meal Food
exchange
No. of
exchange
Energy
(Kcal)
CHO
(gm)
Protein
(gm)
Fats (gm)
BF Bread 1 100 21 3 0.5
Milk 1/2 50 2.5 2.25 3.5
Sugar 1 20 5 - -
Fat 1 45 - - 5
Total 215 28.5 5.25 9
MM Milk 1 100 5 4.5 7
Fruits 2 100 25 - -
Total 200 30 4.5 7

16. DISTRIBUTION OF EACH MEAL
Meal Food
exchange
No. of
exchange
Energy
(Kcal)
CHO
(gm)
Protein
(gm)
Fats (gm)
Lunch Cereal 2 200 44 5 1
Pulse 1 100 17 7 0.5
N&O 1 100 3 3 8
Fish 1 100 - 21 1.5
Veg. 1 35 7 2 -
Fat 3 135 - - 15
Total 670 71 38 25.5
E.S Milk 1/2 50 2.5 2.25 3.5
Sugar 1 20 5 - -
Biscuit 1/2 50 9 1 1
Total 120 16.5 3.25 4.5

17. Meal Food
exchange
No. of
exchange
Energy
(Kcal)
CHO
(gm)
Protein
(gm)
Fats (gm)
M.E Veg 1/2 17.5 3.5 1 -
N&O 1 100 3 3 8
Sugar 1 20 5 - -
Pulse 1 100 17 7 0.5
Fat 3 135 - - 15
Total 372.5 28.5 11 23
Dinner Cereal 2 200 44 5 1
Potato 1/2 50 12 1.4 -
Veg 1/2 17.5 3.5 1 -
Fat 1 45 - - 5
Total 312.5 59.5 6.9 6
B.T Milk 1 100 5 4.5 7
Sugar 1 20 5 - -
Total 120 10 4.5 7
Total 2010 244 73.4 83
% 49.67 14.94 37.16

18. HOSPITAL RECALL
Time Meals Food Pattern
6:00am Early morning Tea-1 cup (with sugar)
8:00am Breakfast
Potato Paratha & 1 cup of Milk
(with sugar)
10:00am Fruit 1K Watermelon
12:00pm Lunch
2 Roti + 1/2k Dal + 1k Rice + 1k
Sweet(with sugar) + 1k Vegetable
+ 1k Usal + 1k Salad + 1k Paneer
veg. + 1k curd.
4:00pm Evening snacks
Bread butter and cup of Tea (with
sugar)
6:00pm Mid evening Soup
8:00pm Dinner
2 Roti + ½ k Dal +1 k Rice + 1k
vegetable + 1 k Usal + Panner veg.
+ 1k Salad + 1k curd
10:00pm Bed Time
1 cup of Milk (with sugar) and
fruit

19. HOSPITAL RECALL
FOOD
EXCHANGE
No. Of
exchange Energy (Kcal) CHO (gm) Protein (gm) Fat (gm)
Cereal 6 600 132 15 3
Bread 1 100 21 3 0.5
Pulses 3 300 51 21 1.5
Milk & milk
products 7 700 49 35 42
Potato 1 100 24 1.8 0
Vegetable 2.5 87.5 17.5 5 0
Fruits 2 100 25 0 0
Sugar 5 100 25 0 0
Fats & oils 5 225 0 0 25
Total 2312 344.5 80.8 72
% 59.59 13.98 28.02

20. DISTRIBUTION OF MEALS
Exchange Total
Early
Morning
Morning
Mid
morning
Lunch Snack
Mid
evening
Dinner
Bed time
Cereal 6.5 1 2.5 1 2
Pulse 4 1 1.5 1.5
Milk 5 1/3 1 1 2/3 1/3 2/3
1
Vegetable 3 0.5 1
0.5
1
Potato 2 1 1
Fruit 1
1
Sugar 5 1 1 1 1
1
Oil 5 1 1.5 1 1.5
Interpretation: Patient’s Hospital diet intake was adequate.

21. HOSPITAL RECALL
DAY TOTAL
ENERGY
( Kcal)
CHO
( gm)
PROTEIN
(gm)
FAT
(gm)
Day 2 2230 352.5 78.85 60.25
Day 3 2297 350.5 83.55 66.25
Patient’s hospital diet intake was adequate.

22. NUTRITIONAL ASSESSMENT
 HEIGHT: 154cms
 WEIGHT: 65 Kg
 BMI: 27
 In spite of being overweight this Patient was recommended
high calorie and high protein diet.
 as she was undergoing further cancer treatment.

23. DISCHARGE DIET
Time Meal Menu
9.00 am Breakfast- 1K Poha (upma/sewai upma/ rice
dosa/Cornflakes)+ Fruit+ a glass of
milk, with sugar
11.00 Mid morning Lime water/milkshakes
12:12pm ½ apple
1:00pm Almond, Walnuts, dry ruits
2.00pm Lunch 2 chapati(add spoonful of soya
flour) +1/2 rice+1/2k dal+1/2k
bhaji+1/2k salad + 1 Fish+ Any
Sweet(Milk based) with sugar
4.00pm Snacks 1k bhel(White Dhokla, Khakra, rice
flakes or Oats chiwda) with lemon
squeezed+ Marie biscuits+
TEA/Coffee with sugar
7:00pm Mid Evening Juices/ Milkshakes
8:00pm Dry fruit chikki, Chakali
9.30pm Dinner 2chapati+ ½ rice+1/2k
dal+1/2kbhaji+ 1k Panner+1/2k
salad
11.00pm Bed time 1 glass of milk (with Sugar)

24. DISCHARGE DIET
FOOD
EXCHANGE No. Of exchange Energy (Kcal) CHO (gm) Protein (gm) Fat (gm)
cereal 7 1/2 750 165 18.75 3.75
Marie Biscuits
(4) 0.5 50 9 1 1
Pulses 1 100 17 7 0.5
Nuts & oilseeds 1 100 3 3 8
Chicken / fish 1 100 0 21 1.5
Milk & milk
products 5 500 35 25 30
Vegetable 3 105 21 6 0
Fruits 2 100 25 0 0
Sugar 5 100 25 0 0
Fats & oils 5 225 0 0 25
Total 2130 300 81.75 69.75
% 56.34 15.35 29.47

25. DISTRIBUTION OF MEALS
Exchange Total Morning
Mid
morning
Lunch Snack
Mid
evening
Dinner
Bed time
Cereal 7.5 1 3 1 2.5
Pulse 1 0.5 0.5
Milk 5 1 1 1/ 2 ½ 1
1
Fish 1 1
Biscuits 0.5 0.5
Vegetable 3 0.5 1 0.5 1
Nuts 1
1/3
1/3
1/3
Fruit 2 1
1
Sugar 5 1 1 1
2
Oil 5 1 2 2

26. GENERAL INSTRUCTION
Troubled with Try
Nausea or vomiting Eat five or six smaller meals instead of three larger meals.
Eat dry or salty foods: toast, crackers, biscuits.
Eat frequent sips of fluids such as lemonades, gingerale or suck ice
candies.
Avoid spicy, strong odoured and thick gravy foods.
Avoid high-fat and oily foods.
Constipation Drink plenty of fluids (8-10 glasses per day).
Include foods high in fiber or bulk: whole fruits and vegetables, whole
grains, bran, oatmeal, whole pulses, flax seeds, papaya etc.
Avoid refined and processed food items.
Diarrhea Drink plenty of liquids such as coconut water, fruit juices, buttermilk,
rice kanji or a thin gruel of cereal and dals.
Eat yogurt instead of milk.
Eat only cooked vegetables.
Avoid foods high in bulk or fiber: raw vegetables, whole grains, bran.
Avoid foods that cause gas or cramping: beans, cabbage, broccoli,
spicy foods, and carbonated beverages.

27. COUNSELLING TIPS
 Patient is recommended high calorie and high protein diet.
 Intake of Vitamin C rich fruits and vegetables like Amla,
Guava, Orange, Pineapple, Lemon, Capsicum etc. This will
help to improve immunity.
 Include dry fruits like Dry dates, dates, fig, Jardalu etc. And
Nuts and oilseeds like Almond, Walnuts, Flax seeds, Garden
crass seeds etc.
 Include all milk and milk products like Khoa, Paneer, yogurt,
buttermilk, curd, Lassi etc. and Non-vegetarian food especially
fish, chiken,egg which will meet protein requirement.

28. COUNSELLING TIPS
 Wash Fruits and vegetables before using with warm water to
avoid infection.
 Drink 2-3 Lit of water/day.
 Restrict intake of Refined or processed food like Maida
products Pizza, burger, maggi, biscuits, Bread, bakery
products, pastries etc.
 Restrict the intake of outside food like Vada pav, Misal, pav
bhaji, pakoda etc.
 Include all food groups to have balanced diet.
 Include Oestrogen rich food like Soya and Products (Flour,
chungs, Tofu, soya milk etc.)

29. CONCLUSION

30. THANK YOU!!!!