Chapter 10

1. Chapter 10 Cancer: Nutrition Prevention and Treatment

2. Learning Objectives • 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.

3. Physiologic Precursors of Cancer 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: 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)

4. Etiology Genetics—associated with correlates of the metabolic syndrome Associated with: 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 levelsassociated inflammation and oxidative damage) Low vitamin D status

5. Non-Diet Risk Factors Associated with low level of physical activity Smoking/chewing tobacco Alcohol intake, especially excessive Exposure to UV light Exposure to carcinogens in the environment Particles and chemicals in the air Nitrates in processed meats Inorganic arsenic in water supplies

6. American Institute for Cancer Research 30% to 40% reduction in cancer risk with: 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 Monounsaturated and omega-3 fats have neutral/ protective effect No tobacco in any form Store and prepare foods safely – Aflatoxins, Acrylamide & Nitrosamines

7. Nutrition & Different Cancers Bladder cancer Breast cancer Colorectal cancer Endometrial & Ovarian cancer Esophageal cancer Lung cancer Prostate cancer Thyroid cancer

8. Impact of Cancer on Food Choices Taste changes (dysgeusia): 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 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

9. Effect of Cancer and Treatmenton Nutritional Status Altered metabolism with hypermetabolic state Cancer cells take nutrition from regular cells Requires some form of nutrition support (enteral or parenteral) Diarrhea from radiation or surgery in the abdominal area. If villi are damaged, digestive enzymes are diminished and diarrhea occurs Low-lactose milk products or alternatives advised Steroid therapy my cause high blood sugars and fluid retention May need to decrease carbohydrate and sodium intake

10. Cancer Cachexia *Omega-3 fats may be helpful to decrease inflammation and control of hypermetabolism with cancer cachexia

11. Nutrition Goals for Cancer Treatment Maintain body weight—sweet foods may be best accepted Include adequate protein Alternatives to meat: Eggs Cheese/yogurt/milkshakes Peanut butter or nuts Bean-based soups Ensure adequate fluid intake

12. Nutrition Goals (continued) Replace minerals/electrolytes lost from vomiting/diarrhea 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

13. Monitor Altered Nutritional Needs for Cancer Survivors Osteoporosis with estrogen/androgen deficiency, secondary tumors DXA scans to r/o osteoporosis Promote increased exercise for bone health, weight goals Promote MyPyramid/Dietary Guidelines for CA prevention With gastric surgery, pellagra may develop 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

14. With Cancer Remission for Prevention of Recurrence Promote lifelong positive nutrition behaviors 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 Encourage regular physical activity Encourage avoidance of excess alcohol Encourage avoidance of tobacco

15. Study Guide • Vocabulary • Carcinogen • Nitrates • Cruciferous vegetables • Lycopene • Nitrosamines • Acrylamide • Dysgeusia • Dysphagia • Hypermetabolic state • Cancer cachexia • Pellagra • Aflatoxins

16. Study Guide (continued) • 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?