MNT: CANCER – Flashcards
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What is Cancer?
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Diseases that result from the unchecked growth of malignant neoplasms (tumors) Development involves mutations in the genes that regulate cell division Growth of a malignant neoplasm destroys surrounding tissues May spread to distant tissues (metastasis) Unlimited ability for cell growth that serves no purpose
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Stages of Cancer
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1. localized: occurs at original site only 2. invasive: type of localized, extends beyond surface tissue 3. Metastatic - carried by blood and lymph to other parts of the body
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Malignant VS. Benign
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Malignant: Rapid growth Require treatment to preserve health Invasive growth Metastatic Benign: Slow growth Stop growing without treatment Localized Non-metastatic
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Malignant Disease - Tissue of Origin Epithelial Connective Tissue Mucus Secreting, glands Blood-forming what is term?
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Term Carcinoma Sarcoma Adenocarcinoma Leukemia, Lymphoma
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Carcinogenesis: Three Phases
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1. Initiation Transformation of cells produced by interaction with initiators (ie: chemicals, radiation, viruses, or dietary?) - process of DNA change, alcohol and tobacco, Omega 6's - dietary initiators 2. Promotion Initiated cells multiply to form a discrete tumor Promoters may include the above along with dietary factors (dietary fats-omega-6) 3. Progression Leading to fully malignant neoplasms Potential for invasion and metastasis *Conditions must be favorable to allow tumor to grow
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What are the Symptoms? *Besides cancer cachexia?
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1. Primary symptom is unintentional and progressive weight loss (Cancer Cachexia) 2. Possible causes of weight loss... increased energy needs due to tumor growth metabolic changes (cytokines/tumor necrosis factor?) decreased intake associated with taste changes, fatigue, and anorexia (cytokines/tumor necrosis factor?) 3. Dx: cytologic tests Biochemical markers (ie: CEA carcinoembryonic antigen/ CA-125) - ovarian and prostate cancers, can be used to measure response to therapy, found in bloodstream
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New number of estimated cancers in U.S. for M + F Estimated deaths
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~800K for both (top = prostrate and breast) ~ 300K (top = lung & brochus)
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Etiology - Genetics *type of mediators?
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Inherited mutations or inherited susceptibility to mutation in genes Hormonal mediators Clear evidence with genetics, BRACA1 removed
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Etiology - Environment
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Pollution & industrial products Other chemical carcinogens Radiation Biological Tobacco use Diet
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Diet and Cancer Risk
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Red Meat: colorectal, bladder, prostate, breast, gastric, oral, pancreatic Obesity: esophagus, colon, rectum, liver, gallbladder, pancreas, kidney Metabolic Syndrome: colorectal, prostate, breast Dietary Fat/Saturated fat: breast, colon, lung, prostate Salt-cured, smoked, nitrate-cured: colorectal, esophagus, stomach High temperature cooked meats: colon Alcohol: mouth, larynx, pharynx, esophagus, lung, colon, rectum, liver, and breast Obesity: BMI >40 higher death rate for men 52% and women 62% increased risk
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Cancer Preventative Effect
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Fruits and vegetables Whole grains, fiber Vitamin D Physical Activity
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Vitamin D 1. Associated w/ what type of cancer?
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Those with abundant Vitamin D levels have lower colon cancer risk Vitamin D may improve survival in those that have colon cancer More research is needed regarding effective supplemental dose and possible issues with toxicity People who live around the equator tend to have less cancer
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Lycopene
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Red-orange carotenoid Antioxident properties Found in tomato and tomato-based foods Uncertain if this is the compound responsible for decreasing cancer risk in several studies No evidence to support use of supplements Processed vegetables - get more lycopene
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Soy 1. Contains? 2. Role in animal studies?
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Contain phytochemicals with weak estrogenic activity Isoflavones block estrogen entry into cells Appears to protect against hormone dependant cancer's in animal studies Consumption of flavonoids, including soybean, may contribute to the low incidence of hormone-dependent cancers in Asian countries No solid evidence suggests that supplements lower Ca risk
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Irradiated Foods
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Radiation does not remain in food Does not appear to increase Ca risk
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American Cancer Society's Recommendations
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Choose a diet rich in a variety of plant-based foods, whole grains Eat plenty of vegetables and fruits Maintain a healthy weight and be physically active Drink alcohol only in moderation, if at all Select foods low in fat and salt. Do not use tobacco in any form
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Cancer Treatments
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Surgery Radiation Chemotherapy Biological Reponse Modifiers Bone Marrow Transplant
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1. adjuvant combination? 2. Surgery - def 3. Role of MNT - buzzword + main goal 4. What types of cancer have biggest effects on nutrition?
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1. Chemo plus surgery 2. localized therapy to remove and examine tumor (primary) Palliative= alleviate symptoms, but do not cure MNT: optimize nutrition status pre/post OP Surgeries that involve resection of the stomach or small intestine, esophagus or tongue will have the greatest impact on nutrition (ie: difficulty chewing/swallowing, malabsorption) Mostly helping to maintain weight
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Radiation Therapy 1. How it works
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Delivered with electromagnetic rays and charged particles Destroys cancer cells by altering cellular and nuclear material (DNA)
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Radiation Therapy 1. What cells are most sensitive? 2. Benefit of radiation 3. MNT 4. Often used to treat*?
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Cells that are continually proliferating are most sensitive to the effects of radiation (epithelial cells, bone marrow cells, lymph tissue, and hair cells) Toxicity is localized to the region being irradiated (does effect normal cells in that area) often in combination with surgery/used to shrink tumor prior to surgery cure attempt in localized tumor controls growth of tumor MNT: based on site and symptoms Radiation is LOCALIZED, effects not as widespread as chemotherapy
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Radiation 1. Pelvic Region - Side FX 2. MNT - for mild and severe SX's 3. Oral/Cervical Region 4. MNT - for mild and severe SX's
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1. Abdominal pain, diarrhea, malabsorption, lactose intolerance 2. MNT: Severe sxs: elemental diet, TPN (food to vein) Mild sxs: lactose free diet, decreased insoluble fiber, small frequent meals 3. Stomatitis (pain swelling, sores in mouth), mucositis (painful inflammation of mucous membranes lining GI tract), xerostomia (dry mouth), dysgeusia (difficulty tasting), odynophagia (painful swallowing) MNT: Severe sxs: TPN Mild sxs: soft, bland diet, liquid supplements, enteral nutrition (any method of feeding using GI tract)
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Chemotherapy 1. TYPE of drug 2. Affects what cells?
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Systemic drug Rx to destroy CA cells by interrupting various phases of cell cycle Person connected to IV, medication circulating through out body Affects other rapidly dividing cells, GI tract (turnover of cells)
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1. Chemotherapeutic agents are most lethal to: 2. MNT for chemo
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Chemotherapeutic agents are most lethal to cells undergoing continual proliferation (ie: cells of the epithelial lining of the GI tract, cells of the hair follicles) MNT: based on controlling side effects (N/V, stomatitis /xerostomia, altered taste, early satiety, diarrhea, malabsorption, constipation)
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MNT & cancer
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NOT focused on cancer prevention so much
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Biologial Response Modifiers 1. Definition 2. Includes? 3. MNT?
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1. Agents used to boost or restore the ability of the immune system to combat cancer 2. Include interferons, interleukins, monoclonal antibodies, growth factors, gene therapy, and non specific immunomodulating agents 3. MNT: control symptoms (N/V and other flu-like sxs)
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Hematopoietic Stem Cell Transplant
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1. Healthy donor: preparation for stem cell harvest w/ cytokines and GF 2. Collection - stem cells collected from donor's bone marrow or peripheral blood 3. Processing - isolate, concentrate and prepare cells for storage 4. Cryopreservation - stem cells preserved by freezing at extremely low temps to keep cells alive 5. Chemotherapy - destroy cancer cells and develop bone marrow failure 6. Infusion - Stem cells infused into healthy pt 7. Maintain transported cells w/ immunosuppressant therapy
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1. Allogeneic 2. Autologous 3. Syngeneic 4. Can come from?
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Allogeneic - other donor, get stem cells from other Autologous - harvest person's own cells Syngeneic - Stem cells from identical twin Can come from peripheral blood or bone marrow
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Bone Marrow Transplant 1. Used for what type of cancers? 2. Begins w/? Followed by? 4. MNT
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1. Used for certain hematological cancer's (leukemia, lymphoma) and solid tumors 2. Begins with cytotoxic* chemotherapy to suppress immunologic activity and kill malignant cells 3. Followed by IV infusion of marrow or stem cells 4. MNT: Nutrition support during first few weeks post-tx, neutropenic diet during immune suppression period Neutropenic - for people w/ weakened IS, helps prevent bacterial contamination
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Neutropenic Diet
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No fresh fruits and vegetables 1st serving from a can No aged cheeses Bottled water Well cooked meat Practice food safety guidelines Trying to avoid bacterial contamination
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Factors Contributing to Malnutrition in Cancer Patients (main 3 + explanations)
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1. Reduced intake: early satiety, altered taste/smell anorexia, psychological factors, fad diets, side effects of treatments - cytokine production, which causes poor appetite, nausea 2. Increased energy expenditure increased fuel consumption by tumor hormonal influences alterations in metabolism 3. Malabsorption GI resections (SBS) - malabsorption due to surgical removal of SI side effects of treatments
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Cancer Cachexia 1. How common in pts? 2. Seen is what type of disease? 3. Characterizations? 4. Different than starvation how? 5. May be related to?
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Common in patients with *advanced neoplastic disease*, present in 80% at death Characterized by progressive weight loss, anorexia, generalized wasting, immunosuppression, altered basal metabolic rate, abnormalities in fluid and energy metabolism Different than pure starvation due to disproportionate loss of lean body mass (increased protein turnover) May be related to increased cytokines (TNF, IL-1, IL-6, and interferon-γ)
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Nutrition Goals in Cancer Treatment
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Maintain/achieve optimal body weight Reverse downward trend of nutrition status Enable tolerance of effects of therapy Minimize side effects of therapy Assist pt to complete therapy and maximize tumor response Enhance quality of life
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Nutrition Interventions: Nutrition assessment 1. Focus on? 2. Albumin? 3. Check what in body? 4. Explore?
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Medical hx: wt changes w/ context of time Accurate anthropometrics Albumin associated with prognosis - Albumin - related to disease and not PRO status Function of gastrointestinal tract Alternative medicine evaluation
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Kcal and Protein Needs 1. What equation? 2. Obese pts? 3. Non-ambulatory? 4. Slightly & severely hyper metabolic Protein needs Amount in 4 circumstances
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Using Harris Benedict: 1.3-1.5 x REE Using kcal/kg Obese patients: 21-25 kcals/kg Non-ambulatory/sedentary: 25-30 kcal/kg Wt gain, slightly hypermetabolic: 30-35 kcal/kg Severely stressed/hypermetabolic: 35 kcal/kg+ Protein in gm/kg/d Non-stressed cancer: 1-1.5 Non-stressed cancers - not as much weight loss, breast or prostate cancer BMT: 1.5 Extreme wasting: 1.5-2.5 Hepatic or renal compromise: 0.5-0.8
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Nutrition Diagnosis 1. Depends primarily on? 2. Includes?
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Varies depending on primary tumor site and extent of tumor burden Includes: Involuntary weight loss Increased energy and protein needs Altered GI function Inadequate oral food/beverage intake
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Managing Symptoms 1. How to overcome N/V?
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Nausea/vomiting (N/V) Small, low fat meal prior to treatment Avoid favorite foods after chemo Try fortified fruit drinks Anti-emetics (medications to control N/V) Alternative tx including acupressure/acupuncture (think pregnancy) Fat and fiber stay in stomach longer - Can make it nutrient dense
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Managing Symptoms 1. Satiety 2. Mucositis
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Early satiety Small, frequent meals Liquids between meals Motility agents - help move food through GI tract Mucositis Encourage good oral hygiene Soft, non-acidic foods until healed Eat foods cold or at room temperature Nutritional supplements may be helpful
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1. Diarrhea 2. Dysgeusia
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Prevent dehydration (small amount of fluids throughout the day) Clear liquid nutritional supplements Avoid large amounts of fruit juices (altered taste) Balance sweet or metallic tastes w/ spicy or salty Non-meat protein sources: cottage cheese, soy, nut butters
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Xerostomia Anorexia
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(dry mouth) Artificial saliva Sour, sugar-free candies/gum Poor appetite Exercise/fresh air/pleasant meal experience Megestrol acetate (Megace) - increase appetite ? Arginine/glutamine supplementation, omega 3's - mixed results for Arg/glu
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Enteral vs. Parenteral Nutrition 1. Effect on cancer cachexia 2. TPN benefits & downsides
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Neither shown to reverse cancer cachexia TPN may benefit malnourished patients who cannot be fed enterally or orally, who are undergoing therapy, the intent of which is cancer cure or control Increased infection rates in patients on TPN Enteral support associated with better outcome than TPN (poor study designs and patients with severe malnutrition were omitted) Not indicated for palliative or end of life care
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Counseling Strategies (6)
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Recognize psychosocial impact patient as well as family members Communicate importance of nutrition and goals Individualize (include patient in goal setting) Consider timing** Maintain a positive attitude Discuss alternative therapies without judgement
