CANCER
Melanie Crane, Melanie Dueck,
Victoria Gerhardt, Amy Hanson,&
Heidi Smith
CANCER
A general term referring to any malignant
neoplasm
 ~100 disorders caused by ~300 different growths
 3 progressive phases

Initiation
 Promotion
 progression


1/3 of cancer deaths in US attributed to nutrition
and lifestyle behaviors (poor diet, physical
inactivity, overweight and obesity, alcohol use)
ETIOLOGY



Hyperplasia: increase in the number of cells
within a tissue, leading to an increase in the size
of that tissue or organ
Metaplasia: dividing cells differentiate into
types of cells not usually found in the area
Dysplasia: an abnormality in the differentiation
of proliferating cells, resulting in an abnormal
degree of variation in size, shape, and
appearance and arrangements of the cells
PROTOONCOGENES/ONCOGENES


Protooncogenes: cellular genes whose functions
are to encourage and promote the normal growth
and division of cells
Oncogenes: cells that have mutated forms of
genes have a high probability of progressing to
malignancy
ETIOLOGY: NEOPLASIA


Neoplasia: “New growth.” Abnormal mass of
proliferating cells that used to be normal cells
Characteristics of Neoplasia:
Autonomous
 Grow at an independent rate from the needs and
homeostatic controls of the host
 Progressive growth
 No benefit to host; often harmful

MALIGNANT NEOPLASMS
CHARACTERISTICS




Unencapsulated
Invade surrounding
tissue
Hard to separate
Metastasis: spread of
malignant neoplasms
CANCER: GENETICS



Debatable if there is any relation to heredity
Even though all cancer is genetic, just a small portion-perhaps 5 or 10 percent--is inherited.
Information on evidence-based methods of delivering
cancer genetic risk assessment services is scarce
Cancer risk assessment can help reduce psychological
stress
STATISTICS



One third of cancer deaths can be attributed to
diet and physical activity habits.
Another third of deaths from cancer are caused
by exposure to tobacco products.
Almost one in two men and women—
approximately 41 percent of the population—will
be diagnosed with cancer during their lifetime.
DEVELOPMENT

Carcinogen is physical, chemical, or viral agent
that induces cancer.


Can modify progression at any stage
Cancer development mimics pattern of
environment
GENETICS AND CANCER PREVENTION

Gene damage
Cell growth and maturation
 Acquired through lifetime

Current research in diet/genetic interactions
 Those with gene damage should be particularly
careful of diet, physical activity and alcohol or
tobacco use.

DIET

Fruits and Vegetables
Antioxidants and phytochemicals
 Weight maintenance


Whole grains
Support weight maintenance
 Fiber


Limit high fat foods
Meat and dairy
More omega-3
 <20% energy from fat



Soy



Part of healthy plant-based diet
Supplements can be harmful
Difficult to isolate specific chemicals


Long latency period
Interactions
FOOD PREPARATION AND PRESERVATION

High-heat

Grilling, broiling, barbecuing, smoking
Some risk with processed meats
 N-nitrosocompounds






Smoke,salted, pickled foods
Nitrates
Tobacco smoke
Vitamin C from fruits and vegetables can slow
conversion
Acrylamide
ANTIOXIDANTS AND FREE RADICALS
Molecules that can block detrimental effects of
activated oxygen molecules
 Include vitamins, minerals and other bioactive
substances.
 Results are mixed with supplements
 American Cancer Society recommends
antioxidants from food sources rather than
supplements

Fruits and Vegetables
 Whole grains

TOBACCO
Tobacco use is the most preventable cause of
death from cancer.
 Leads to cancers of lung, larynx, mouth,
esophagus, bladder, kidney, throat, stomach,
pancreas, or cervix.
 Smokeless tobacco lead to mouth cancer.
 Nitrites

ALCOHOL
If used, should be limited to 2 a day for men and
1 for women.
 Stronger affect on tissues exposed to the alcohol.
 Malnutrition


Inhibits folate absorption in women.
PHYSICAL ACTIVITY

Physical activity can help control your weight
and reduce body fat.

Decrease circulating estrogens, androgens, insulin,
and insulin-like factor associated with cell and tumor
growth
Calorie restriction inhibits growth
 30 minutes of moderate physical activity on 5 or
more days of the week.
 BMI between 18.5 and 25
 Community support

OTHER RISK FACTORS





Age
 One of most important risk factors.
 Most cancers occur in people over the age of 65.
UV Radiation
 Leads to early aging in the skin and skin damage
that can result in cancer.
Ionizing Radiation and Chemicals
 Radiation
 Pesticides
 Food preparation and preservation
Hormones
Viruses and Bacteria
HOW TO DIAGNOSE CANCER

Screening

PET scan

Symptoms

Endoscopy

Tissue samples

Endoscopic Ultrasound

CT scan

Biopsy

MRI

Barium Swallow
MRI
SCREENINGHELP OR HARM FOR BREAST CANCER?
Cochrane Review 2011, Issue 1
Breast cancer screening
Results:
Women were diagnosed with cancer who didn’t have it
10 in 2000 screened would be diagnosed and treated
despite an actual need to (30% estimated over diagnosed
and treated)
False positives lead to psychological distress
15% estimated mortality reduction
PROGNOSIS
The chance of recovery or reoccurrence predicted using
statistics
Effected by:
location, stage and grade, type of cancer, age, health, and
treatment response
Survival rate- percent of people who survive with the same type
and stage of cancer
5 year survival rate- those with few or no cancer symptoms 5
years after diagnosis
Favorable: controllable
Unfavorable: difficult to control
PROGNOSIS
Favorable:
Carcinoma insitu
Areas of occurrence: cervix, skin, mouth,
esophagus, bronchus, stomach, endometrium, breast,
and large intestine
PROGNOSIS
Unfavorable:
Invasion
Cellular Multiplication
Mechanical Invasion
Lytic enzymes
Decreased Cell Adhesion
Increased Motility
GENERAL SIGNS AND SYMPTOMS
Pain
Fatigue
Fever
Skin Changes
Unexplained weight loss
Cachexia
a syndrome that consists of anorexia, weight loss,
altered taste, anemia, sever malnutrition causing
muscle wasting, loss of adipose tissue, emaciation,
and altered protein, lipid, and carbohydrate
metabolism
SIGNS AND SYMPTOMS OF SPECIFIC
CANCERS

Change in bowel and bladder

Unhealing sores

White spots in mouth(leukoplakia)

Blood

Lump

Skin change

Persistent cough

Dysphagia
STAGES OF CANCER
Staging: conducting texts to determine the extent of the disease
by observing the spread of the disease from its original site.
T Stage (tumor size)
T0- free of tumor
T1- lesion <2 cm in size
T2- lesion 2-5 cm
T3- skin and/or chest wall invaded
N Stage (lymph node)
N0- no axillary nodes
N1- mobile nodes
N2- fixed nodes
M Stage (metastases)
M0- no metastases
M1- Demonstrable metastases
M2- suspected metastases
STAGING
GRADES OF CANCER
How normal the cells look under microscope
G0- not detectable
G1- well differentiated
G2- moderately differentiated
G3- poorly differentiated
G4- undifferentiated
TYPES OF CANCER
The name of a cancer is derived from where the cancer originated in
the body.
Carcinomas- epithelial tissue
Adenocarcinomas- ducts or glands
Sarcoma- connective tissue
Lymphomas- lymphatic tissue
Leukemias- bone marrow
Myelomas- hematopoietic bone marrow
PREVALENCE
PREVALENCE
INCIDENCE
INCIDENCE
CHEMOTHERAPY
is a systemic treatment that uses drugs
which spread throughout the entire
body and destroy wherever cancer
cells are located.
•
•
•
•
•
Discovery of chemotherapy
How cancer cells are affected
Balance- cancerous cells vs. tissue
cells
Cause of side effects
Timing of the dosage
ADMINISTRATION OF
CHEMOTHERAPY
When administering chemotherapy the dosage is
usually calculated based on the individual’s body
surface area. It can be given:
Oral
 Intravenous
 Intraosseous
 Intramuscular
 Subcutaneous

RADIATION THERAPY
Radiation therapy uses high-energy radiation to
shrink tumors and kill cancer cells.
Types of radiation used for cancer treatment:
 X-rays
 gamma rays
 charged particles
Administration methods:
 External-beam radiation therapy Internal-beam radiation therapy-
ACTIONS OF RADIATON THERAPY
-Effects of Radiation on the cell
-When and why a patient undergoes radiation


SURGERY
Primary and oldest treatment for many cancers. It
helps determine what cancer is present and how far it
has spread throughout the body. Offers the greatest
chance of survival for cancer that has not spread.
Minor surgeries are called procedures and major
surgeries are called operations.
There are many factors that decide what type of surgery
you will receive for your situation:
 Location
 Size
 Type
 Grade
 Stage
 Age
 General health
TYPES OF SURGERY

Preventative surgery-

Diagnostic surgery-

Curative surgery-

Palliative surgery-

Reconstructive surgery-
OTHER TYPES OF CANCER
TREATMENT

Proton therapy-

Angiogenesis Inhibitors Therapy-

Hyperthermia-

Laser therapy-

Cyrosurgery-
FUTURE THERAPIES IN CANCER
TREATMENT

Gene Therapy-

Immunotherapy-

Biological therapy-
ALTERNATIVE THERAPIES












Relaxation therapy
Lifestyle diets
Herbal Medications
Homeopathy
High-dose vitamin
therapy
Energy healing
Biofeedback
Chiropractic medicine
Massage therapy
Imagery
Spiritual healing
Self-help groups
• Commercial weight
loss programs
• Hypnosis
• Acupuncture
• Folk remedies
POST TREATMENT LIFESTYLE
Join a support group
 Meet with a social worker if emotional support is
needed
 May not be able to do everything as easily but a
return pre-treatment lifestyle is expected.
 Return to the doctor for follow-up care is
recommended every 3-4 months
 Make changes to improve lifestyle:






Quit smoking
Eat a healthier diet
Exercise
Reduce stress
Limit alcohol intake
SIDE EFFECTS OF CANCER TX
Different treatments cause a range of symptoms
including:
 Anorexia
 Cachexia
 Nausea and vomiting
 Constipation
 Mucositis
 Diarrhea
 Xerostomia
 Relief of symptoms is best accomplished when therapy
is directed at underlying causes

DRONABINOL

Primary orexigenic component of marijuana

Stimulates appetite in patients with AIDS and
cancer-related anorexia

Side effects: dizziness, euphoria, somnolence,
poor concentration

Contraindications:give with caution when
given with sedatives and other psychoactive
meds
MEGESTROL ACETATE
Synthetic, orally active progestational agent used
widely for Tx of metastatic breast cancer
 Most potent appetite stimulant
 Effects on appetite and weight are dose
dependent (higher dose, higher benefit)
 Glucocorticoid effects-interferes with normal
endocrine activities




impotence in men
adrenal insufficiency
decrease glucose tolerance
CORTICOSTEROIDS

Appetite improvement
 Short lived
 Unknown
mechanism of action, but exhibit
peripheral and central effects

Prolonged use may result in








proximal muscle weakness
Osteoporosis
Delirium
fluid retention
adrenal suppression
glucose intolerance
Hyperglycemia
electrolyte disturbances
OXANDROLONE

Synthetic, oral anabolic agent


offset the protein catabolism associated with the
prolonged administration of steroids.
Increase in total and lean tissue weight with Tx
of oxandrolone and progressive resistance
exercise and good nutrition
Β-HYDROXY Β-METHYLBUTYRATE
AKA(JUVEN)
 Dietary
(HMB)
supplement made of combination
of three nutrients-a metabolite of leucine,
L-glutamine, and L-arginine
 Each has been shown to decrease protein
breakdown
 Increase in lean body mass
 May be of benefit especially with
resistance exercise program
METOCLOPRAMIDE
 Antiemetic
and prokinetic agent
 Early
satiety as a result of delayed gastric
emptying and gastroparesis
 May
relieve cancer-related anorexia
SIDE EFFECTS: NAUSEA AND VOMITING

Prolonged emesis can lead to dehydration, weight
loss, metabolic abnormalities, and electrolyte
imbalance

Most feared side effect of cancer treatment

Antiemetics offer relief of symptoms

Most effective when used preventatively rather than
to treat existing nausea and vomiting
ETIOLOGY OF NAUSEA AND
VOMITING

Complex neural pathways interact

Final common pathway is emetic center, located in brain
stem

Stimulation of emetic center comes from chemoreceptor
trigger zone (CTZ) located adjacent to fourth ventricle

CTZ is stimulated by a variety of chemicals

Emetic center also stimulated by tumors and increased
intracranial pressure
ANTIEMETICS

Phenothiazines-block dopamine receptors in the CTZ

Butyrophenones-dopamine receptor antagonists.

Substituted Benzamides-(like metoclopramide) block
dopamine receptors in the CTZ


peripherally increase esophageal sphincter tone, improve gastric
emptying, and increase transit through the small bowel.
Serotonin antagonist-block serotonin receptors peripherally
in the upper GI or in the area postrema located in the CTZ.

Prescribed for acute, chemotherapy-induced nausea and
vomiting.
ANTIEMETICS CONTINUED



Benzodiazepines-treats anxiety related to
anticipated nausea or vomiting.
Corticosteroids-Drug of choice for nausea and
vomiting caused by intracranial pressure and GI
obstruction.
Anticholinergic-used for nausea associated with
motion sickness.


Block acetylcholine in emetic center
Side effects: urinary retention, dry eyes, constipation
CONSTIPATION AND DIARRHEA TX
LAXATIVES
Bulk forming agent-absorbs water from intestine
and holds water in stool
 Antimotility agent-inhibits persistalsis, prolongs
transit time.
 Stool softener-reduces surface tension of the stool to
allow softening
 Stimulant-stimulates GI
 Hyperosmotic laxative-local irritation
 Lubricant-lubricate intestinal mucosa and soften
stool
 Saline laxative-retains water in intestinal lumen.

MUCOSITIS



Frequent complication for chemotherapy and
radiation therapy
Mouth care is important to prevent possible
infection and/or further irritation
Oral candidiasis is leading infectious cause
PALIFERMIN

Tx for oral mucositis

Decreases incidence and duration
XEROSTOMIA
 Xerostomia

Radiation of head and
neck requires saliva
stimulants or artificial
saliva
 Amifostine-protects
cells against
radiation
 Side effect of
amifostine:

nausea, vomiting,
hypotension, allergic
reaction, and venous
catheter
complications
NUTRITION THERAPY GOALS
Provide nutrients that are missing
 Maintain nutritional health
 Preserve lean body mass
 Decrease side effects of treatment
 Improve quality of life

NUTRITION CARE
Calories: Determined by diagnosis, presence of other
diseases, intent of treatment, anticancer therapies, and
presence of infection.
 Protein: Based on actual body weight & according to
stress level.


.8- 2.5 g/kg
Cancer patients need:
HIGH PROTIEN & HIGH CALORIES
NUTRITION CARE

Fluid: Ensure maintenance of hydration, tissue
perfusion, and electrolyte balance.


Daily requirement method: 1 ml of fluid per 1 kcal of
estimated needs
Micronutrients: Vitamin and mineral
supplements may be used
HOW TO INCREASE CALORIES
Use whole milk
 Add cheese to dishes
 Stir granola in foods
 Beat eggs into sauces or vegetables
 Add hard-boiled eggs to casseroles or salads
 Put gravy, butter, sour cream, or other toppings
on food items

HOW TO INCREASE PROTEIN
Melt cheese on sandwiches or add to soups
 Use milk instead of water in cooking
 Use nonfat instant dry milk
 Add eggs and nuts in diet
 Spread peanut butter on toast or pancakes
 Add meat and beans to casseroles, soups or
salads

NEUTROPENIC DIET

Needed for those with ANC below 500/mm3






Avoid raw foods
Avoid self serve restaurants
Only drink pasteurized products
Hot foods hot, cold foods cold
No cross contamination
Thaw/cook properly
NUTRITIONAL SIDE AFFECTS
LOSS OF APPETITE
NAUSEA
Eat small meals every
1-2 hours
 High protein and kcal
 Eat foods that smell
good
 Always carry snacks
with you
 Eat large meals when
you feel well
 Drink meal
replacements

Small meals
 Avoid greasy, sweet,
and spicy foods
 Sip fluids all day but
drink less during
meals
 Rest after meals
 Avoid eating in a room
with strong odors or
too warm

TASTE/SMELL CHANGES
Eat favorite foods
 Rinse mouth with water often
 Use plastic utensils
 Increase flavor and seasonings
 Make foods sweeter

DRY MOUTH
MUCOSITIS
Drink plenty of liquids
 Eat moist foods with
gravies or sauces
 Eat foods that are
sweet or tart
 Suck on hard candy or
chew gum
 Rinse mouth often
 Keep lips moist with
moisturizer

Bland liquids and soft
solids
 Avoid citrus fruits,
spicy or salty foods,
and dry/rough food
 Eat foods at room
temperature

DIARRHEA
Plenty of fluids
 Eat foods that contain
Na and K
 Avoid greasy foods,
caffeine, high fiber, and
be careful with milk
products
 Small meals

CONSTIPATION
High fiber diet if ok with
doctor
 8-12 C. fluid a day
 Exercise regularly
 Drink hot liquids

WEIGHT LOSS
Eat when it is time
 Small meals
 Tube feeding

WEIGHT GAIN
Fruits and vegetables
 High fiber
 Lean meats
 Low-fat milk
 Small portions
 Less salt

NUTRITION AFTER TREATMENT
Patients should try to consume a healthy diet
 Return to healthy eating by:

Making simple meals you like
 Go easy of fat and salt
 Eat many different foods
 Whole grains, fruits, and vegetables

ASSESSING QUALITY OF LIFE

Health-related quality of life (HRQOL)
Measures perceived physical/mental health over time
 Effects on patients or clients of chronic illness


Criteria for assessment include







Symptoms of cancer
Adverse effects of treatment
Physical functioning
Social interaction
Psychological adjustment
Sexual function
Body image
QUALITY OF LIFE IN CANCER PATIENTS

Unrelieved Pain







Isolation
Exhausted caregivers

Disturbed sleep
Ability to work is
 Depression
impaired
 Decreased will to
Exhaustion
survive
Diminished appetite
 Increased vulnerability
to infection
Can’t enjoy simple
pleasures (family, food,
etc.,)
Trips of vacations are
uncomfortable
IMPLICATION FOR FAMILY MEMBERS
Family members or other supporting individuals
for cancer patients are also effected by the
disease.
 One study showed mental component of HRQL
assessment lower in family members and suggest
therapy for both.

NUTRITION
ASSESSMENT
A Closer Look at the Case Study
ASSESSMENT
Age: 58
Height: 6’3”
Weight: 198 lb
BMI: 25= over weight
Ideal Body Weight: 101%
BIOCHEMICAL
Albumin: 3.0 (moderate depletion)
Total Protein: 5.7 (below normal)
Prealbumin: 12 (moderate deficient)
Transferrin: 175 (mild depletion)
RBC: 4.3
HGB: 13.9
HCT: 38
ESR: 17 (high)
CLINICAL
Distressed, thin, pale
BP: 132/92mmHg
Sunken eyes
Dry mucous membranes
Muscle wasting but no edema
Epigastic tenderness
Lost 30 lb in the last month
DIETARY
REE: 1806kcal x 1.1-1.3= 1986-2347kcal
Protein requirement based on visceral protein
status is 1.2g/kg
24-HOUR RECALL
Patient consumed about 28% of daily
recommended calories
 9% Protein, 52% CHO, 40% Fat
 Deficient most vitamins and minerals (ok in iron)
 Low in all food groups
 Diet affected by dysphagia

EPIDEMIOLOGY-ESOPHAGEAL CANCER
Rates are per 100,000 persons.
DIAGNOSIS
Stage IIB (T1, N1, M0) adenocarcinoma
(chest x-ray, endoscopy brushings and biopsy, CT
scan)
What does this mean?
T1: <2cm, grown in to muscus lining and/or
submucosa but not outside esphoagel tissue
N1: cancer has spread to 1-2 nodes near the
esophagus
M0: no metastais
FUNCTIONAL
Dysphasia- inability to swallow
Odynophagia- pain when swallowing
GENETICS
Mother died of liver cancer at age 59
HISTORIES
Smoking
Tums 2-3 pill 2-3 times/day
Alka-Seltzer: 2 pills 1-2 times/day
Long history of heart burn
Drinks alcohol
TRANSHIATAL ESOPHAGECTOMY

Removing Esophagus
without opening the
chest
CASE STUDY- JEJUNOSTOMY


Surgery affected ability
to digest
Problems are found in:



Chewing, swallowing,
tasting, smelling, and
making saliva
Enteral nutrition
needed
Individuals may
progress to oral intake
with special dietary
recommendations
MNT- ESOPHAGEAL CANCER
Puree/soft foods
 Cut food into small bites
 Eat slowly
 Dumping syndrome diet

SAMPLE DIET- ESOPHAGEAL CANCER

Breakfast




Snack



1 ½ C. Oatmeal
½ C. Puree squash
Dinner




1 ½ C. Soup with noodles
1 ½ C. Applesauce
Snack



1 ½ C. Cream of wheat
¾ C. Puree broccoli
Lunch



1 C. Fruit milkshake
2 scrambled eggs
¼ C. Cheese
4 oz. Pureed chicken
¼ C. Gravy
½ C. Mashed potatoes
Snack


1 C. Yogurt
Banana
CASE STUDY- TUBE FEEDING
Surgery affected ability to digest
 Problems are found in:


Chewing, swallowing, tasting, smelling, and making
saliva
Reliance on enteral nutrition is needed
 Individuals may progress to oral intake with
special dietary recommendations

PES STATEMENT
Swallowing difficulty related to Stage IIB (T1, N1,
M0) adenocarcinoma of the esophagus as
evidenced by reports of odynophagia and imaging
procedures.