Cancer Overview and Management

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Questions and Answers

What is a key dietary recommendation for achieving or maintaining a healthy weight?

Limit energy dense food (correct)

Eat mostly animal products

Increase consumption of processed meats

Avoid physical activity

Which type of cancer is classified as affecting blood, bone marrow, and lymphatic tissue?

Hematopoietic (correct)

Sarcoma

Neoplasm

Carcinoma

How does chemotherapy primarily affect the body?

It enhances immune function

It can also affect normal high turnover cells (correct)

It selectively targets only cancerous cells

It requires no lab testing

What is a common nutritional impact of biotherapy or immunotherapy?

Anorexia and nausea Signup and view all the answers

Which of the following therapies is used to eliminate blood supply to tumors?

Antiangiogenic Therapy Signup and view all the answers

What does the 'TNM' in TNM staging stand for?

Tumor, Node, Metastasis Signup and view all the answers

Which of the following is not a treatment option mentioned for cancer management?

Exercise Therapy Signup and view all the answers

What lifestyle change is recommended to limit the risk of cancer according to dietary guidelines?

Limit alcohol consumption Signup and view all the answers

What percentage of cancer deaths is connected to factors related to nutrition, inactivity, and overweight?

30 % Signup and view all the answers

Which dietary component is considered an inhibitor of carcinogenesis?

Phytochemicals Signup and view all the answers

What effect does energy restriction have on cancer in animal studies?

Inhibits cancer and extends life span Signup and view all the answers

Which food preparation method is associated with increased cancer risk?

Grilling meat at high heat Signup and view all the answers

Which vitamin is linked to lower cancer incidence when consumed at adequate levels?

Vitamin D Signup and view all the answers

What is the recommended daily consumption of fruits and vegetables for cancer prevention?

3+ servings vegetables, 2+ servings fruit Signup and view all the answers

Which phytochemical found in red fruits and vegetables is known for its potential cancer-fighting properties?

Lycopene Signup and view all the answers

Which of the following is connected to an increased risk of various cancers, particularly in overweight individuals?

Excessive body weight Signup and view all the answers

What is the maximum recommended alcohol consumption for men as a cancer preventive measure?

2 drinks per day Signup and view all the answers

Which vegetable is rich in sulforaphanes, a recognized phytochemical with cancer-fighting properties?

Broccoli Signup and view all the answers

What is one of the primary goals of Medical Nutrition Therapy for cancer patients?

Minimize loss of lean body mass Signup and view all the answers

Which of the following symptoms is associated with oral mucositis due to radiation therapy?

Sore mouth/throat Signup and view all the answers

What is a common side effect of bone marrow transplant preparation that includes chemotherapy?

Depression of immune function Signup and view all the answers

Which hormone therapy is specifically used to treat hormone-sensitive breast cancer?

Tamoxifen Signup and view all the answers

What nutritional impact symptom is commonly seen in patients undergoing treatment for head and neck cancers?

Dysphagia Signup and view all the answers

Which of the following strategies is recommended for managing nausea in cancer patients?

Consume small, frequent meals Signup and view all the answers

In cancer cachexia, what plays a significant role in increasing energy expenditure?

Cytokine production Signup and view all the answers

What is the recommended protein intake for a severely stressed cancer patient?

1.5 g/kg or more Signup and view all the answers

What is the primary function of anti-angiogenic therapies in cancer treatment?

Reduce the growth of new blood vessels Signup and view all the answers

Which factor can lead to malabsorption and nutrient depletion in cancer patients?

Altered gastrointestinal function Signup and view all the answers

Study Notes

Cancer Overview

Cancer (CA) is the second leading cause of death in the US
Over 100 variations exist
1 in 2 men and 1 in 3 women will develop CA
30% of cancer deaths are linked to nutrition, inactivity, and excess weight; another 30% to tobacco use.
Cancer is preventable, supported by epidemiological studies
Survival rates are increasing, close to 67%

Cancer Causes

Multiple causes including:
- Chemicals
- Viruses
- Radiation
- Excess energy (especially unsaturated fats)
Limited antioxidants and other essential nutrients can also contribute

Cancer Pathophysiology

Proliferation of abnormal cells that don't differentiate normally
Increased mass of cells interfering with normal tissue function
Possible metastasis (spread)

Cancer Treatment

Medical Management:
- Surgery
- Radiation
- Chemotherapy
- Immunotherapy
- Bone marrow transplant
Nutritional Management:
- Prevent or correct nutritional deficiencies
- Minimize weight loss
- Support oral feeding, enteral tube feeds, or parenteral feeding

Nutrition and Cancer

Nutrition influences cancer development at any stage
Cancer treatments (radiation, chemo, surgery) and a patient's overall health and nutritional status may impact nutrition

Etiology of Cancer and Nutrition

Dietary carcinogens exist naturally and are added during food preparation and preservation
Inhibitors of cancer include antioxidants and phytochemicals
Enhancers of carcinogenesis include high fat and grilled foods

Nutrition and Cancer: Energy, Weight, and Activity

Energy restriction may inhibit cancer and extend lifespan in animals.
Overweight is linked to several cancers (GI tract, breast, endometrium, kidney, colon, rectum) and increases cancer recurrence and reduces survival rates.
Physical activity has an inverse association with cancer risk.

Nutrition and Cancer: Specific Nutrients

Alcohol: 1/day for women; 2/day for men
High fat, specifically red meat and dairy
High carbohydrates, including high fiber, sugars, and glycemic index
Sugars, artificial sweeteners (GRAS)
High protein, especially plant-based, diet
Methods of food preparation and preservation, such as high heat, and the use of nitrates/nitrites.
Other food toxins

Nutrition and Cancer Prevention

Coffee and tea may have cancer-preventing properties
Adequate calcium and vitamin D levels are linked to lower cancer rates
Phytoestrogens (like soy) may protect against breast and prostate cancers
Higher folate intake may be linked to reduced pancreatic cancer risk
Eating 3+ servings of vegetables and 2+ of fruits daily is beneficial

Specific Phytochemicals in Vegetables and Fruits

Red: Lycopene (tomatoes, etc.)
Red/Purple: Anthocyanins and polyphenols (berries, grapes)
Orange: Beta carotene, beta cryptoxanthin, and flavonoids (carrots, mangoes)
Orange/Yellow: Lutein and zeaxanthin (cantaloupe, peaches)
Yellow/Green: Sulforaphane and indole (spinach, avocado)
Green: Sulforaphane, indoles (cabbage, broccoli)
White/Green: Allicin (leeks, onions)

ACS and AICR Guidelines for Cancer Prevention

ACS: Adopt physical activity, maintain healthy weight, eat varied colorful plant-based foods, limit alcohol intake.
AICR: Maintain normal weight, be physically active, limit energy-dense foods, consume mostly plants, limit meat, limit alcohol and salt, ensure adequate nutrients

Cancer Definitions, Diagnosis, and Staging

Neoplasm: (tumor) abnormal growth
Benign: noncancerous
Malignant: cancerous tumor
Metastasis: spread of cancer
Cancer classification: Carcinoma, sarcoma, hematopoietic, infections
Diagnosis: Symptoms, lab tests (blood, tissue), imaging
Stages: I, II, III, IV, TNM staging

Medical Treatments

Chemotherapy: Use of drugs/chemicals to kill cancer cells
Immunotherapy or Biotherapy: Stimulates natural defenses
Hormone Therapy: Reduce growth of hormone sensitive cancer
Antiangiogenic Therapy: Stops the growth of blood vessels to tumors
Radiation Therapy: Disrupts chemical bonds in cancer cells
Surgery: Removal of cancerous tissues
Hematopoietic Cell Transplant (HCT): Replacement of bone marrow with healthy cells from donor.

Chemotherapy Details

Use of drugs/chemicals to induce a toxic effect on tumors
Includes antibiotics, alkaloids, alkylating agents, and antimetabolites
Often multiple agents used in cycles
Affects normal cells with high turnover
Can depress immune function

Biotherapy/Immunotherapy Details

Stimulates natural defenses (indirect)
Includes cytokines, antibodies, and vaccines
Hematopoietic therapies stimulate marrow to produce red blood cells or neutrophils

Anti-angiogenic and Hormonal Therapies Details

Anti-angiogenic: Reduces growth of new blood vessels to prevent cancer invasion
- Example drug: Avastatin
Hormonal: Reduces growth of hormone-sensitive breast or prostate cancers
- Example drugs: Tamoxifen, Lupron

Radiation Therapy Details

Disrupts chemical bonds to prevent tumor growth
Effects are specific to the irradiated region
Affects normal cells
Can depress immune function

Oral Mucositis

A side effect of some cancer treatments
Inflammation of the oral mucosa

Radiation Therapy Nutrition Impact (Table 35-9)

CNS: Nausea, vomiting, fatigue, decreased appetite
Head/Neck: Xerostomia, sore mouth/throat, mucositis, dysphagia, odynophagia, decreased appetite
Thorax: Dysphagia, odynophagia, heartburn, fatigue, decreased appetite
Abdomen: Bowel and urinary changes (malabsorption, lactose intolerance), nausea, vomiting, fatigue, decreased appetite

Surgery Nutrition Impact (Table 35-10)

Head/Neck: Nausea, vomiting, difficulty chewing/swallowing, sore/dry mouth, change in taste/smell
Esophageal: Dysphagia, reflux
Stomach: dumping syndrome
Pancreatic: Malabsorption, hyperglycemia
Intestinal: Malabsorption syndromes

Bone Marrow Transplant (HCT)

For leukemia, lymphoma, aplastic anemia
Replacement of bone marrow from a donor or self with stem cells (bone marrow) to establish a graft and produce normal cellular components
Preparation may include chemotherapy or total body irradiation to lower immune response and malignant cells.
Precautions for neutropenia (low white blood cell count)

Medical Nutrition Therapy (MNT) for Cancer

Goals include preventing/correcting nutritional deficits, minimizing loss of lean body mass (LBM), minimizing side effects of cancer treatment, and increasing quality of life.
Optimal nutritional status can help reduce infections and better tolerate treatment.

Nutritional Care Process (ADIME)

Screen: Identify risk of nutrition issues
Assessment: Evaluate nutritional status (SGA, MST, medical history, social history, diet, appetite, intake, vitamins, supplements, nutrition impact symptoms, CIM)
Anthropometrics: maintain LBM, BMI
Labs: Detect inadequate intake, malnutrition, altered GI function
Intervention: Minimize effects of nutrition-impairing symptoms
Monitoring & Evaluation: Continuously track treatment effects on nutritional status.

Nutrient Needs

Energy: 25-35 kcal/kg/day, determined by indirect calorimetry, standardized equations, and repletion/hypermetabolism.
Protein: 1-1.5 g/kg/day according to patient condition and treatment.
Micronutrients: From food; MVI = 100% DRI if needed
Fluid: 20-40 ml/kg or 1 ml/kcal

Medical Nutrition Therapy Interventions

Effects on appetite
Cachexia therapy
Pharmacologic therapies for cachexia and anorexia
Energy, protein, fat, CHO metabolism interventions
Other metabolic abnormalities

Depletion of Nutrient Stores and Appetite

Factors impacting appetite include endocrine abnormalities, secondary infections, medications, cytokines, social/cultural factors, learned aversions, physical factors, and economic factors

Cancer Cachexia

Syndrome characterized by weight loss, anorexia, asthenia, anemia, problems with protein, carbohydrate, and fat metabolism, and increased energy expenditure related to cytokine production.

Nutrition Interventions (Table 35-6)

Symptom and consequent Nutrition Intervention strategy for nausea, vomiting, anorexia, dysphagia, odynophagia, dysgeusia, xerostomia, diarrhea, fatigue, neutropenia

Other Nutritional Interventions

Medications (appetite stimulants, antiemetics, anti-diarrhea, oral lidocaine, others)
Tube feeding: formula choice based on condition
Parenteral nutrition
Palliative care

Complementary and Integrative Medicine (CIM)

Approximately 40-50% of cancer patients use CIM
Common forms include supplements, orthomolecular medicine, acupuncture, massage, and mind-body practices.
Further research needed on the effectiveness of CIM.

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Description

This quiz covers critical aspects of cancer, including its causes, pathophysiology, and treatment options. Learn how nutrition and lifestyle can impact cancer outcomes and understand the different medical interventions available for cancer treatment. Test your knowledge on this vital health topic.