Recorded lecture for HLT 138, unit 22 - Cancer

1. Unit 22 – Diet and Cancer
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2. Cancer
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 Group of >100 different diseases
 Characterized by uncontrolled cell growth
 Individual cancers differ by:
- where they develop
- how quickly they grow
- type of treatment
- impact on nutritional status
 2nd leading cause of death in the US

3. Cancer Progression
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4. Estimated Cancer Prevalence 2007
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Urinary Bladder
Thyroid
Testis
Stomach
Prostate
Pancreas
Ovary
Oral Cavity and Pharynx
Lymphoma
Multiple Myeloma
Melanoma of Skin
Lung
Liver and bile duct
Leukemia
Larynx
Kidney
Hodgkin Disease
Esophagus
Endometrial/Uterine
Colon/Rectum
Cervix
Breast
Brain/CNS

5. What Causes Cancer?
 80-90% of cancers are
initiated by environmental
factors that alter DNA
 Most factors are
modifiable

6. Causes of Cancer
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 Aflatoxins – toxin made my  Arsenic
Aspergillus fungi  Asbestos
 Ethanol - alcoholic  Chromium hexavalent cpds
beverages
 Hepatitis B and C virus
 Coal-tars
 Human papilloma viruses:
 Herbal remedies containing some genital-mucosal types
plant species of the genus
Aristolochia  Mustard gas
 Salted fish (Chinese-style)  Solar radiation
 Soot  Sunlamps or sunbeds
 Tobacco, smokeless  X-radiation and gamma
radiation
 Wood dust
 Nitrates

7. What Causes Cancer?
 Diet accounts for approx. 40% of cancer risk
- Westernized dietary intake and lifestyle increase risk
of many types of cancer
 Genetic factors account for approx. 5-42% of risk
for some cancers
- Prostate, breast, and pancreatic cancers

8. Nutrition and Cancer
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 Prevention  1/3 of all cancers are
related to dietary factors
 Intake/utilization Cancer
and/or
impairment of nutrients treatment
 Absorption/metabolism
impairment

9. Nutrition in Cancer Prevention
 Eat a variety of fruits and veggies
- 5-9 servings per day
 Antioxidants and anti-inflammatory
compounds may protect DNA from
damage
 Damaged DNA may direct abnormal cell
multiplication

10. Nutrition in Cancer Prevention
 Limit red meats and processed
meats
 High intakes of saturated fats from
meat and dairy products increase
cancer risk
 Plant proteins provide unsaturated
fats plus vitamins, minerals, fiber,
and phytochemicals

11. Nutrition in Cancer Prevention
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Excess body weight and physical inactivity
 ↑ risk of esophageal, colon/rectal, postmenopausal
breast, endometrial, and renal cancers
 Increases hormones that promote cancer cell growth
 Promotes insulin resistance and hyperinsulinism
 Promotes low levels of inflammation which can
promote cancer cell growth and development

12. Nutrition in Cancer Prevention
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 Link between excess body weight,
exercise, and cancer risk so strong that:
 Recommended BMI range:
between 21 and 23
 Limit energy-dense foods:
(particularly processed foods high in
sugar and fat, and low in fiber)
 Physical activity:
at least 30 minutes every day

13. American Institute for Cancer Research
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Recommendations
 Avoid sugary drinks
 Limit foods high in salt
 Limit alcohol to 1-2 drinks per day (if any at all)
 Don’t use supplements to protect against cancer
 Breastfeed up to 6 months
 Do not smoke or chew tobacco

14. Impact of Cancer on Nutrition
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Site Potential Effects
Brain/CNS Eating disabilities, chewing/swallowing difficulty
Head and Neck Chewing/swallowing difficulty
Esophagus Dysphagia related to obstruction, GERD
Stomach Early satiety, N&V, impaired motility,
obstruction – may require EN or PN
Bowel Maldigestion/malabsorption,
obstruction – may require EN or PN
Liver Diarrhea
Pancreas Maldigestion/malabsorption, DM

15. Impact of Cancer on Nutrition
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Metabolic Changes
 alter use of fuels (CHO, pro, fat)
 promote loss of weight and lean body mass
 Glucose intolerance / insulin resistance
 Increased energy expenditure
 Increased protein turnover
 Reduced muscle protein synthesis
 Accelerated fat breakdown
 Kcal and nutrients  redirected to supporting growth of tumor
vs. fueling the body
 Increased inflammatory/immune response  increase
metabolism

16. Impact of Cancer on Nutrition
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Anorexia
 Contributing factor to weight loss and malnutrition
 Potential causes:
- pain, depression, anxiety, fatigue, early satiety, N&V
 Treatments contribute:
- taste alterations, loss of taste, sore mouth, dry mouth,
thick saliva, esophagitis, fatigue
 Optimizing intake:
- texture/temp modification, scheduled eating, meds to

17. Impact of Cancer on Nutrition
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Cachexia:
 wasting syndrome marked by weakness,
progressive loss of body weight, fat, and muscle
 Present in approx. 80% cancer related deaths
 Hard to reverse
 Nutrition aimed at preserving muscle and fat stores
- improves quality of life
- does not guarantee increased length of survival

18. Nutrition Therapy During Treatment
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 Improve tolerance to treatment
 Enhance immune function
 Aid in recovery
 Improve quality of life
 Enhance well-being

19. Nutrition Therapy during Treatment
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 Calories
- Nonambulatory/sedentary
25-30 kcal/kg body weight
- Hypermetabolic/weight gain
30-35 kcal/kg body weight
- Hypermetabolic, severely stressed, malabsorption
35 kcal/kg body weight

20. Nutrition Therapy during Treatment
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 Protein
- Nonambulatory/sedentary
1.0-1.2 g/kg body weight
- Hypermetabolic/weight gain
1.2-1.5 g/kg body weight
- Hypermetabolic, severely stressed, malabsorption
1.5-2.5 g/kg body weight

21. Tips to increase kcals and protein
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 Add cheese
- to toast, crackers, sandwiches, baked potatoes,
veggies, soups, and noodles
 Add peanut butter
- to toast, bread, English muffins, fruit
- blended into chocolate or vanilla milkshake
 Add nuts and seeds:
- sprinkled over cereals, fruit, desserts, veggies,
salads, and pasta

22. Altered Taste/Smell
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 Taste/smell impairment occurs in
more than ¾ PTs
 Can interfere with enjoyment of
eating
 ↓ tolerance of bitter foods
 ↑ tolerance of sweet foods
 Can significantly reduce intake

23. Strategies to Reduce Food-borne
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Illness Risk – Neutropenic Diet
 Proper hand washing
 Cook meat to “well-done”
 No raw eggs, even in dressings, “over-easy” eggs
 No sushi, raw seafood, raw meats, unpasteurized milk
 Wash fruits/veggies thoroughly
 Thaw food in fridge-not on counter or in sink
 Refrigerate leftovers immediately and discard after 3d
 Avoid salad bars and buffets when eating out

24. Low-Bacterial / Low-Microbial Diet
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 Order is up to the discretion of the physician
 Foods not allowed:
- fresh fruits and vegetables
- nuts and dried fruits
- foods from multi-serving containers
- deli meats and undercooked meats

25. For More Information
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 www.cancer.org