In patients with cnutritional assessment and nutritional management plays a vital role. Nutritional assessment would mean recording the history, physical examination, doing laboratory tests. Several problems associated with the nutrition including symptoms that make feeding a problem, problems with digestion, malnutrition, etc. At time oral intake may be difficult due to the performance of certain procedures including surgery, radiotherapy, etc. In such instances other forms of feeding may have to be instituted.

However, all evidence does not point out that total parenteral nutrition is required in managing GI cancer patients (D’Agnelo, 2000). Review of Literature In GI cancer nutritional assessment and management plays a very important role. The nutritional assessment of a patient suffering from GI cancer is not very different from other out-patients. The nutritional management of the patient includes taking a detailed general and diet history, physical examination, diagnostic tests and a nutritional management program.

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There needs to exist certain signs of weight loss, malnutrition, etc. The body weight loss should suggest significant changes in the body weight greater than 10 % and occurring within the last 6 months. However, positive prognosis factors for the patient suffering from GI cancer should also exist. Some of the important tests for nutritional assessment include serum pre-albumin and retinol-binding proteins as these have the shortest half, and with albumin and transferrin levels. Serum proteins are not exactly a test for nutritional status but can help to probe further.

A patient may choose a fad diet during their cancer condition in order to cope with the disease. However, a fad diet may have an adverse effect on the patient’s condition and at the same time deter the nutritional status of the patient. The patient may also find it very difficult to chew and swallow during GI cancer which creates a further problem. A patient suffering from GI cancer would suffer from various problems including Dysphagia, nausea, vomiting, indigestion, malnutrition, weight loss, cachexia, etc.

Cachexia is a major problem for all cancer patients and can occur in about half the number of patient’s suffering from serious cancers. The causative factor for cachexia is cytokines and studies have shown that antibodies against cytokines can help reduce the symptoms of cachexia. The patient would have an improved intake of food and better management of weight loss. Thus nutritional management in cancer patient not only figures around diagnosing and treating the nutritional problems, but also the problems that can result in poor food intake and significant weight loss (D’Agnelo, 2000).

Many conditions in which the risk for cancer is high would ensure that the patient develops self-surveillance skills in order to monitor the diet and the condition. In a study conducted by Giarelli et al (2006), the various self-surveillance activities and the emotional responses in genetic conditions in which the risk for gastrointestinal cancers was high (namely MEN 2a and famililial adenomatous polyposis) is defined. The study found that individuals were driven to several self-monitoring activities such as medication appraisal, phenotype tracking, intervention tracking, input and output monitoring, tracking visits, etc.

Irrespective of age, gender or type of syndrome, the self-monitoring activities tend to occur. These self-surveillance activities may be attained through the anticipation (risks for cancer) and the urge to control and understand the condition. The patient would closely monitor the dietary intake of food and the fluids, and also elimination by the body. Some of the aspects of diet which are closely self-monitored include:- • Type of diet consumed • Amount of food consumed

• Quality of the diet • Types of food consumed • Changes to body weight • Determining changes to body weight • Tolerating various fluids and food intake • Impact of food on the functional impact • Patterns of elimination • Any effect of digestive disturbance on the normal activities • Effect of digestive problems over sleep and rest These self-monitoring capabilities which are seen in several genetic conditions would help the patient to adhere to the treatment recommendation.

Even f the patient is at the risk of cancer and develops GI cancer, the patient would have an improved understanding of self-monitoring and the healthcare professional would just have to recommend treatment and guidelines. When these self-monitoring skills are present, there are greater chances of collaboration between the health professional and the patient. In oncology, there is greater implication of these lifelong surveillance tendencies of the patients. Self-surveillance can be utilized as a positive instrument in a patient suffering from a prolonged condition.