Transcript No Slide Title

Chapter 10
Cancer: Nutrition
Prevention and Treatment
Learning Objectives
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Describe cancer prevention strategies.
Explain how cancer and its treatments
affect nutritional status.
Discuss the eating problems associated
with cancer and possible solutions.
Explain why nutritional needs must be met
during cancer treatment.
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.
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Physiologic Precursors of Cancer
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Chronic inflammation as induced by obesity, diet,
inactivity
Free radicals inducing chromosomal changes (DNA)
Angiogenesis (the creation of blood vessels)
Hyperinsulinemia promoting insulin-like growth
factor; insulin resistance and hyperinsulinemia found
with:
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Gynecologic cancers
Digestive tract cancers
Bladder and prostatic cancers
Leukemia
Non-Hodgkin’s lymphoma (Pisani, 2008; Pischon et al., 2008; Renehan et al.,
2008; Suba and Ujpal, 2006)
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Etiology
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Genetics—associated with correlates of the
metabolic syndrome
Associated with:
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High intake of saturated fat, polyunsaturated fat,
excess CHO (sugar), low fiber
Low intake of plant-based foods/antioxidants
Excess salt
Low intake omega-3 fatty acids (fatty fish)
Possible excess iron intake (high iron levels
associated inflammation and oxidative damage)
Low vitamin D status
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.
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Non-Diet Risk Factors
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Associated with low level of physical activity
Smoking/chewing tobacco
Alcohol intake, especially excessive
Exposure to UV light
Exposure to carcinogens in the environment
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Particles and chemicals in the air
Nitrates in processed meats
Inorganic arsenic in water supplies
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American Institute for
Cancer Research
30% to 40% reduction in cancer risk with:
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Diet rich in a variety of plant-based foods, especially
fruits and vegetables; magnesium-rich foods (“beans
and greens”) lower inflammation; flavanoids
associated with reduced risk
Maintenance of a healthy weight and physical
activity
Alcohol consumed in moderation
Diet low in fat (i.e., saturated and polyunsaturated
fats) and salt
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Monounsaturated and omega-3 fats have neutral/
protective effect
No tobacco in any form
Store and prepare foods safely – Aflatoxins,
Acrylamide & Nitrosamines
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Nutrition & Different Cancers
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Bladder cancer
Breast cancer
Colorectal cancer
Endometrial & Ovarian cancer
Esophageal cancer
Lung cancer
Prostate cancer
Thyroid cancer
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.
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Impact of Cancer on Food Choices
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Taste changes (dysgeusia):
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Reduced threshold for bitter tastes
(meat aversion is common)
 Increased threshold for sweetness
(high-sugar foods more acceptable)
 Increased threshold for salt and sour flavors
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Nausea and vomiting from chemotherapy
or toxins generated from cancer cells
Dysphagia (impaired swallowing), dry
mouth (with greatly increased risk of dental
decay), and sore mouth/esophagitis from
radiation or surgery of the neck area
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Effect of Cancer and Treatment
on Nutritional Status
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Altered metabolism with hypermetabolic state
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Diarrhea from radiation or surgery in the
abdominal area. If villi are damaged, digestive
enzymes are diminished and diarrhea occurs
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Cancer cells take nutrition from regular cells
Requires some form of nutrition support (enteral or
parenteral)
Low-lactose milk products or alternatives advised
Steroid therapy my cause high blood sugars and
fluid retention
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May need to decrease carbohydrate and sodium intake
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Cancer Cachexia
*Omega-3 fats may be helpful to decrease inflammation and control of hypermetabolism with cancer cachexia
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Nutrition Goals for
Cancer Treatment
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Maintain body weight—sweet foods may
be best accepted
Include adequate protein
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Alternatives to meat:
• Eggs
• Cheese/yogurt/milkshakes
• Peanut butter or nuts
• Bean-based soups
Ensure adequate fluid intake
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Nutrition Goals (continued)
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Replace minerals/electrolytes lost from
vomiting/diarrhea
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Use commercial products
Include bean-based soups (potassium,
magnesium, and sodium)
Citrus fruits (potassium)
Other soups (sodium)
Whole grains (magnesium and potassium)
Maintain as good a nutritional status as
possible with a variety of foods or reliance
on commercial liquid supplements
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Monitor Altered Nutritional
Needs for Cancer Survivors
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Osteoporosis with estrogen/androgen deficiency,
secondary tumors
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With gastric surgery, pellagra may develop
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DXA scans to r/o osteoporosis
Promote increased exercise for bone health, weight goals
Promote MyPyramid/Dietary Guidelines for CA prevention
Monitor s/s: dermatitis, diarrhea, delirium/dementia,
possible neurologic changes and prevent/tx with vitamin B3
Intestinal resections increase risk for variety of
nutrient deficiencies
Radiation therapy to throat increases risk for dental
carries
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.
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With Cancer Remission
for Prevention of Recurrence
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Promote lifelong positive nutrition
behaviors
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Encourage high-fiber diet and emphasis on
monounsaturated fats
Encourage moderate kilocalorie intake to
manage weight and avoidance of excess salt
Encourage high-quality diet per the MyPyramid
Food Guidance System
Promote positive lifestyle
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Encourage regular physical activity
Encourage avoidance of excess alcohol
Encourage avoidance of tobacco
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.
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Study Guide
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Vocabulary
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Carcinogen
 Nitrates
 Cruciferous
vegetables
 Lycopene
 Nitrosamines
 Acrylamide
 Dysgeusia
 Dysphagia
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Hypermetabolic
state
Cancer cachexia
Pellagra
Aflatoxins
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Study Guide (continued)
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Dietary & non dietary risk factors cancer
Diet & lifestyle changes associated with reduced risk
What percentage of risk reduction is seen with diet and
lifestyle changes?
What kind of taste changes often occur with cancer?
Effect of cancer/treatment on nutrition status
What factors play a part in the development of cancer
cachexia?
Nutrition goals for treatment
What are a few altered nutritional needs a cancer
survivor may face?
Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.
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