Chapter 14
NUTRITION AND CANCER
Continuation…
GENERAL CONSIDERATIONS
A. Definitions
1. Cancer - a malignant cellular tumor with properties of
tissue invasion and spreading to other parts of the body.
2. Neoplasm - any new or abnormal cellular growth,
specifically one that is uncontrolled anc progressive.
3. Tumor - a swelling composed of abnormal cells on or in the
body; may be benign or malignant.
4. Sarcoma - a tumor usually malignant, arising from the
connective tissues.
5. Oncology - science of tumors
6. Carcinogenesis - the process of cancer cell
development, which consists of initiation, promotion and
metastasis.
7. Carcinogen - a substance which causes cancer
8. Carcinoma - a malignant new growth made up of
epithelial cells, infiltrating the surrounding tissue, and
spreading to other parts of the body.
9. Oncogene - any of various genes that, when activated
as by radiation or by a virus, may cause a normal cell to
become cancerous; viral genetic material carrying the
potential of cancer and passed from parent to offspring.
10. Malignant melanoma - a tumor arising from the
skin and may appear on the skin or other body tissues;
composed of melanin, the dark pigment of skin; aggravated by
excessive exposure to sunlight.
11. Metastasis - the spread or transfer of disease
from one organ or part to another not directly connected
to the primary site.
12. Adenocarcinoma - tumor arising from
glandular tissue or in which tumor cells form glandular
structures; usually classified according to a type of
glandular cell arrangement.
B. Causes of Cancer Cell Development - The basic
cause of cancers is a fundamental loss of the natural control over
normal cell production which may be brought about by :
1. Mutation - loss of one or more regulatory genes in the cell
nucleus, may be inherited due to exposure to some environmental
agent (mutagen).
2. Chemical carcinogens - examples: nicotine in
cigarettes, natural and synthetic pesticide and fertilizer residues,
food additives, etc.
3. Radiation - may be ionizing such as from x-rays, radio-
materials, and atomic wastes, or non-ionizing such as sunlight.
4. Oncogenic virus Epidemiologic factors - which include
race, diet, region, gender, heredity and occupation.
5. Stress factors - postulated to
promote cancer development through their
effects on the thymus gland and the
immune system, or through hormonal
effects mediated by the hypothalamus
Steps in Cancer Cell
Development:
1 Exposure to a carcinogen.
2. Entry of the carcinogen into the cell.
3. Initiation, probably by the carcinogen's
somehow altering the cellular genetic material.
4. Enhancement of cancer development by
promoters, probably involving several more steps
before the cell begins to multiply out of control.
5. Disruption of normal body functions.
The Diet-Cancer Connection-
1. Food contain substances that are
potentially carcinogenic. They may be
natural components d food, formed
during storage and processing
(including cooking), intentionally added
(e.g. foo additives ), or accidental
contaminants.
Dietary Risk Factors in Cancer
Etiology:
The Diet-Cancer Connection-
2. Foods also contain substances that
protect against cancer. These include
Vitamins A, C and E carotenoids,
selenium, dietary fiber and
phytochemicals. These substances
block cancel development at the
initiation and promotion stages.
D. Eating Problems in Cancer
Patients
1. Loss of appetite - anorexia
2. Mouth problems –
a. Thrushes
b. Medications such as: topical anesthetic liquids (lidocaine)
used as sprays, mouth gels, or washes help relieve pain so
that the patient may eat.
c. Dental problems - painful teeth: clean with a cotton
swab dipped in a 3% hydrogen peroxide solution diluted with warm
water, and glycerin.
d. Salivary secretions - food with high liquid content
should be used.
3. Upper Gastrointestinal Problems such
as: nausea and vomiting, general indigestion,
bloating, specific surgery responses such as post
gastrectomy dumping syndrome. Lower
Gastrointestinal Problems such as: diarrhea,
constipation, flatulence, specific lactose
intolerance or surgery responses such as with
intestinal resections and various ostomies.
E. Cancer Therapy:
1. Surgery - cancer patients about to undergo or have
undergone surgery may need varying levels of nutrition
support depending upon their nutritional status.
2. Radiotherapy such as x-ray, radioactive isotope,
atomic particles
3. Chemotherapy –
a. Combined therapy - combinations of drugs are
used in a coordinated and sequential manner,
allowing time between series for normal tissue
recovery.
b. Adjuvant therapy - chemotherapy may be
used in conjunction with other treatments such as
surgery or radiotherapy to increase the cure rate.
F. Toxic Effects of
Chemotherapy:
1. Bone marrow effects –
including interference with production of red cells, white
cells and platelets.
2. Gastrointestinal effects - including nausea and
vomiting, stomatitis, anorexia, ulcers and diarrhea.
3. Hair follicle effects - including alopecia (baldness)
and general hair loss. These effects are largely due to the
anti-vitamin property of the chemotherapeutic agents
used, e.g., amethopterin is a folic acid antagonist. Hence
the effects of its use are basically those of folic acid
deficiency
Major Treatment Modes:
1. Radiation Therapy - effects depend upon site
of irradiation.
a. Anorexia
b. Impaired taste acuity
c. Reduced food intake Tooth decay and gum disease
e. Difficulty in swallowing
d. Intestinal obstruction
f. Malabsorption
g. Diarrhea
2. Surgical Therapy
a. Tube feeding mandatory if food ingestion is
impaired.
b. Malabsorption and dumping syndrome upon
removal of part of the gastrointestinal system;
fluid and electrolyte imbalance
c. Possible low blood glucose after gastric
resection.
d. Insulin deficiency from resection of the
pancreas.
3. Chemotherapy
a. Multiple disturbances of nutritional status similar to
those that occur with radiation therapy from the use of
different categories of drugs.
b. Body fluid and electrolyte disturbances from the use of
corticosteroids and other hormones.
c. Specific intestinal damage from drugs
d. Swallowing ability and saliva production
e. Nausea and vomiting
f. Ulceration of buccal mucosa
g. Diarrhea
h. Weight and protein loss
Nutritional Care of
Patients with Cancer:
1. Stages of Cancer Therapy and
Nutritional Objectives
• Curative Stage
- is when treatment is aggressive or radical
(e.g., radiotherapy chemotherapy and surgery)
and the aim is to eliminate the disease and cure
the patient. overall goal is the prolongation of life
and survival. Dietary management at this point is
aimed at the treatment-related side effects of the
medical/surgical therapy as well as the effects of
the disease itself.
• Palliative Stage
- is when cure is not the expected outcome but
rather the improvement of the quality of life. Diet
therapy at this stage is less restrictive. A major
consideration is the patient's informed preference for
the level of nutrition support acceptable to him.
• Terminal Stage
- is when death appears imminent (within weeks
or hours) and management is aimed solely at comfort.
The continuation of aggressive nutrition support at this
time becomes an analytical question. The wishes of
the patient and his relatives may be followed.
2. Dietary Management of
Cancer:
a. Dietary strategies for the management of
nutrition-related problems associated with
cancer and its treatment (anorexia, nausea,
and vomiting, altered taste perception, dry
mouth, esophagitis, malabsorption and
diarrhea) are given.
b. Cancer patients are usually in a
hypercatabolic state. Hence, nutritional
support - enteral or parenteral is indicated.
3. General Guidelines in Feeding
Cancer Patients-
a. Alcohol may stimulate appetite; doctor’s order
required.
b. Common favorite food includes cold food such
as carbonated drinks, ice tea, jello, watermelon
and grapes. Cold meats and eggs are usually
better tolerated than when served warm. All
meats are sometimes rejected; cheese, milk,
and egg sources of protein should be
substituted.
c. Additions of salt, sugar, lemon juice or spices
are often welcome.
d. Food should be offered at a time when the pain
is at its lowest level.
e. People who tire easily should be served food
that require little chewing.
f. If there is inflammation in the mouth, cold bland
food and fluids in semisolid form should be
offered. Good mouth care is essential.
4. Dietary Recommendations for
Reducing Cancer Risk:
a. Reduce dietary fat intake to 30% or less of energy.
b. Increase dietary fiber intake to 20 to 30 grams per
day.
c. Include a variety of fruits and vegetables in the
diet. Avoid obesity. Consume alcohol in moderation.
d. Minimize the consumption of salt-cured, pickled or
smoked food.
TENKS POR LISTENING
