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Medical Nutrition Therapy > Cancer > Flashcards

Cancer Flashcards

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USMLE® Step 1 flashcards
1
Q

~1.9 million new cases of cancer diagnosed yearly in the U.S.
1 in ____ males and 1 in ___ females will be diagnosed with cancer in their lifetime
Occurrence of cancer increases with age
Most common cancers are ________
_____ leading cause of death in the U.S.
_______ cancer causes the most cancer deaths

A

2
3
breast & prostate
2nd
Lung

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2
Q

uncontrolled division of abnormal cells that can spread throughout the body

A

Cancer

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3
Q

a substance that induces cancer

A

carcinogen

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4
Q

a new & abnormal formation of tissue that serves no useful purpose

A

neoplasm

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5
Q

neoplasm can invade tissues and spread to distant tissues & organs

A

Metastasis

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6
Q

Transformation of cells by the interaction of chemicals, radiation, or viruses with cellular DNA

A

initiation

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7
Q

Initiated cells are activated by a promoting agent to multiply & form a discrete tumor; escape mechanisms that should destroy these cells

A

promotion

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8
Q

tumor cells aggregate and grow into malignant tumors capable of tissue invasion & metastasis

A

progression

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9
Q

Alcohol has a causal role in ___________
- Oral cavity, pharynx, larynx, esophagus, stomach, colorectal, gallbladder, pancreas, liver, & breast cancers

  • Direct cell ________
  • Acts synergistically with________
  • May replace nutrient dense foods in the diet
A

carcinogenesis

toxin
tabacco

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10
Q

Obesity is associated with:
- Increased incidence of breast, endometrial, renal, liver, colorectal, esophageal, & pancreatic cancer
- Increased risk of cancer _______
- Increased cancer _______
- Greater risk with ________ obesity

A

mortality
recurrence
abdominal

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11
Q

Red meat=> “_______ increased risk” of _______ cancer

Processed meat=> “_________ increased risk” of ______ cancer

A

probable
colorectal

convincing
colorectal

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12
Q

Sodium & potassium _______ and ______ are used in processes of salting, pickling, and smoking foods

Produce __________=> carcinogens

Possible increased risk of _______ and ________ cancer

A

nitrates and nitrites

nitrosamines

colorectal
gastric

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13
Q

Vitamin _____ & _________ can slow the conversion of nitrites to nitrosamines

A

C
phytochemicals

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14
Q

Charring or cooking meat at high temperatures (>_____° F) over an open flame=>formation of ______________

Possible increased risk of _______ cancer with frequent intake

A

400
polycyclic aromatic hydrocarbons (PAHs)

gastric

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15
Q

Higher PAH formation with:
________
________

A

Higher fat meats
Charcoal grilling

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16
Q

Industrial chemical used in the manufacturing of many hard, plastic bottles and linings of food & beverage cans

A

Bisphenol A (BPA)

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17
Q

BPA May have carcinogenic effects

To reduce exposure:
- Reduce use of ________ & _________ or choose BPA-free products (check labels)
- Don’t put ________ in plastic containers made with BPA
- Don’t _________ in plastic containers

A

plastic bottles
canned foods

very hot liquids
microwave food

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18
Q

Intake of foods high in dietary fiber associated with a probable decreased risk of ______ cancer

A

colorectal

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19
Q

Both_______ products & ______ supplements associated with a probable decreased risk of colorectal cancer

A

dairy
calcium

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20
Q

Coffee associated with a probable _______ risk of_____ & ________ cancer

A

decreased
liver
endometrial

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21
Q

Coffee contains ________ & ________ which may have anticancer properties

A

antioxidants
phenols

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22
Q

Non-starchy Vegetables & Fruits

  • Major sources of _________ and ________
  • Probable decreased risk of => oral cavity, pharynx, larynx, esophageal, stomach, colorectal, & lung cancer
A

phytochemicals & antioxidants

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23
Q

Anticarcinogenic Compounds

A

Antioxidants
Phytochemicals

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24
Q

Antioxidants include (3)

A

Vitamin C
Vitamin E
selenium

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25
Q

Phytochemicals are

A

biologically active components in plants

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26
Q

Recommended to obtain Anticarcinogenic Compounds from ____________

A

foods rather than supplements

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27
Q

Mechanism of Action of Phytochemicals

  • ________ effects
  • Induce _________ enzymes
  • Inhibit ___________ formation
  • Binding of _________ in the GI tract
  • Alter ________ metabolism
  • _________ modulating effects
A

Antioxidant effects
Induce detoxification enzymes
Inhibit nitrosamine formation
Binding of carcinogens in the GI tract
Alter hormone metabolism
Immune modulating effects

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28
Q

Phytochemicals (T 35-1 & T 35-3)

A

Carotenoids
Phenols
Indoles
Lignans
Allyl sulfides

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29
Q

Three carotenoids and where to get them from

A

Beta-carotene
- (carrots, mangos, sweet potato)

Lycopene
- (tomatoes & tomato products, papaya, pink grapefruit, watermelon)

Lutein
- (kale, spinach, collard, mustard & turnip greens)

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30
Q

Two Phenols and where to get them from

A

Flavonoids
- (berries, grapes, red wine, plums, purple cabbage, green tea)

Isoflavones
- (soybeans)

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31
Q

Where to get Indoles

A

(arugula, bok choy, cabbage, broccoli, brussels sprouts, cauliflower)

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32
Q

Sources of Lignans

A

(whole grains, legumes, flaxseed)

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33
Q

Allyl sulfides sources

A

(leeks, onion, garlic, chives)

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34
Q

Some studies have found increased incidence of _____ cancer for smokers who take __________ supplements

A

lung
beta-carotene

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35
Q

Soy contains_________ which are ________

Modest soy intake may ______ breast cancer especially if consumed long-term beginning before adulthood

A

isoflavones
phytoestrogens

protect against

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36
Q

Regular _______ reduces the risk of colorectal, breast cancer, & endometrial cancer

A

exercise

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37
Q

Aim for a minimum of ______ minutes of moderate intensity or _____ minutes of vigorous intensity activity each week

Doing some physical activity above usual activity, no matter one’s level of activity, can have many health benefits

Limit sedentary behavior such as sitting, watching TV, etc.

A

150
75

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38
Q

Aim to fill at least _______ of your plate with vegetables, fruits, whole grains and beans

Eat at least ______ cups of vegetables & fruits each day

Choose _______ instead of refined grain products

A

two-thirds

2.5 cups

whole grains

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39
Q

Limit processed foods high in _____, ____, or _____
Limiting these foods helps to maintain a healthy weight

A

fat, starches, or sugars

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40
Q

Limit red meat consumption to moderate amounts
(no more than _________/week)

Eat little, if any, _________ meat

A

12-18 oz/week

processed

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41
Q

There is strong evidence that regular consumption of _____________ causes weight gain, overweight & obesity

Drink mostly water and unsweetened drinks

A

sugar-sweetened beverages

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42
Q

For cancer prevention, its best not to drink alcohol

For those who do drink alcohol, limit to no more than ____ drink per day for women and ____ drinks per day for men

1 drink = ____ oz. beer, ___ oz. wine, _____ oz. distilled spirits

A

1
2

12 oz
5 oz
1.5 oz

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43
Q

Aim to meet nutritional needs through ______

A

diet alone

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44
Q

There is strong evidence that __________ helps protect against breast cancer in mothers

Babies who are ________ are less likely to become overweight and obese

A

breastfeeding

breastfed

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45
Q

Factors that can decrease oral intake:

Anorexia
Treatment side effects
GI symptoms & distress
Depression
Fatigue
Difficulty chewing or swallowing
______ (change in taste)
Food aversions
Economic factors

A

Dysgeusia

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46
Q

Metabolic Effects of Cancer

CHO abnormalities=> _______, _______, and ________

A

insulin resistance
increased gluconeogenesis
hyperglycemia

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47
Q

metabolic effects on cancer

Protein=> __________________ => ________________ and __________________

A

increased catabolism (gluconeogenesis) =>

skeletal muscle wasting & organ atrophy
decreased protein synthesis

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48
Q

metabolic effects on cancer
Fat=> _____________

A

Increased lipolysis

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49
Q

Metabolic Effects of Cancer also include

Host-Tumor competition for _______

Fluid & electrolyte imbalances
- _________
- ________

A

nutrients

Vomiting & diarrhea
Hypercalcemia (bone metastases)

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50
Q

Syndrome of progressive weight loss, anorexia, generalized wasting, weakness, increased REE, & immunosuppression ?

Major cause of morbidity & mortality
Caused in part by ________

A

Cancer Cachexia

cytokines

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51
Q

Pharmaceutical Management of Anorexia & Cachexia

A

Appetite stimulants

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52
Q

Example of appetite stimulant

A

megestrol acetate (Megace)

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53
Q

appetite stimulants effects and side effects/cons

A

Stimulates appetite
Promotes weight gain (especially fat)

Has not been found to increase LBM
Side effects: edema

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54
Q

Use of medications to promote lethal injury to cancerous cells

A

Chemotherapy

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55
Q

Chemotherapy interferes with the ___________
Systemic treatment
Affects ____________ cells
Especially _________ cells: GIT, bone marrow, hair follicles

A

synthesis of DNA and replication of cancer
malignant and normal
rapidly dividing

56
Q

examples of Chemotherapeutic Agents

A

Cisplatin
5-Fluorouracil (5-FU)
Methotrexate
Doxorubicin

57
Q

Nutritional Side Effects of Chemotherapy

A

Anorexia
N/V
Dysgeusia (altered taste)
Mucositis
Diarrhea
Fluid & electrolyte losses
Fatigue
Myelosuppression: depressed immune function, anemia, bleeding problems

58
Q

hormone therapy is used for ____________ cancer

it will block ___________

A

estrogen receptor-positive breast

estrogen-binding sites

59
Q

example of hormone therapy

A

tamoxifen

60
Q

side effects of hormone therapy/Tamoxifen

A

Weight gain
hot flashes
fluid retention
nausea

61
Q

if on hormone therapy, should avoid ______________

A

soy supplements
grapefruit

62
Q

Induce, enhance, or suppress an individual’s immune response

A

biotherapy

63
Q

biotherapy examples

A

interferon
interleukin-2

64
Q

side effects of biotherapy

A

myelosuppression
anorexia
fatigue
nausea
flu-like symptoms

65
Q

Use of radiation to promote lethal injury to cancerous cells=>damages the DNA

A

radiation therapy

66
Q

radiation therapy is used for ________
Administered in ____________ doses
Effects ______________ cells
- Rapidly dividing cells (GIT, bone marrow, & hair follicles) are most vulnerable to damage

A

localized tumors
multiple fractionated
both normal & malignant

67
Q

Nutritional Side Effects of Radiation Therapy

A

Common in all patients=>
- fatigue
- anorexia
- skin erythema & hair loss in the area being treated

68
Q

Nutritional Side Effects of Radiation Therapy in the head and neck

A
  • Taste & smell changes
  • Xerostomia
  • Mucositis=> inflammation of the mucosa of specific areas in the GIT
  • Dysphagia, odynophagia
  • Dental problems
69
Q

Nutritional Side Effects of Radiation Therapy in the thoracic cavity

A

esophagitis
esophageal stricture
dysphagia
GERD

70
Q

Nutritional Side Effects of Radiation Therapy in the abdomen

A

secondary lactose intolerance
anorexia
malabsorption
chronic radiation enteritis
intestinal strictures
fistulae

71
Q

Surgery is primary therapy for _______ malignancies

The nutritional status of the patient _______ is critical

__________ patients have higher incidence of infections and delayed wound healing post-op

Nutritional side effects depend on location of tumor and extent of removal

A

GI

pre-op

Malnourished

72
Q

Oral Cavity surgery side effects

A

Chewing & swallowing difficulties
Alterations in taste & smell
May require enteral nutrition

73
Q

Total or partial esophagectomy side effects

A

Early satiety
dumping syndrome
GERD
dysphagia
May require jejunal tube feeding

74
Q

Total or partial gastrectomy side effects

A

Dumping syndrome
malabsorption
early satiety
anemia - vitamin B12 and iron deficiency
May require jejunal tube feeding

75
Q

Pancreatic resection side effects

A

gastroparesis
malabsorption
hyperglycemia

76
Q

Small bowel resection side effects

A

lactose intolerance

diarrhea

malabsorption

fluid & electrolyte imbalance
- if significant=> short bowel syndrome

77
Q

Partial or total colectomy side effects

A

large losses of fluid & electrolytes
diarrhea

78
Q

IV infusion of peripheral stem cells

A

hematopoietic stem cell transplantation

79
Q

Prior to the hematopoietic stem cell transplant, patient receives a ___________: high dose chemotherapy with or without total body irradiation=> eradicate malignant cells

A

conditioning regimen

80
Q

Hematopoietic Stem Cell Transplantation is used for treatment of …

A

Treatment for leukemia
lymphoma
multiple myeloma

81
Q

Types of Stem Cell Transplant

A

Autologous
Allogeneic

82
Q

Autologous stem cell transplant is from ______
harvested when?

A

from self

usually when in remission & purged of abnormal cells

83
Q

Allogeneic stem cell transplant is from _______

A

from another person

stem cells from a donor who is a match

84
Q

Side Effects of Stem Cell Transplant

The side effects are due to the __________

1st ______ weeks=> N/V/D; anorexia, fatigue, dysgeusia, xerostomia, oral & esophageal mucositis

High _______ risk

A

conditioning regimen prior to transplant

2-4

infection

85
Q

Goal of stem cell transplant diet is to minimize the risk of ____________

  • Educate
A

foodborne illness

86
Q

Stem Cell Transplant Diet

Fresh fruits & vegetables must be ________
Wash the tops of ______________
Ensure ___________ for cooking, cooling & reheating
Check _______________ on all foods

Avoid ____________________________
Prevent _________ between raw meat and ready to eat foods
“_______________”

A

thoroughly washed
canned foods & drinks
proper temperatures
expirations dates

bulk bins, salad bars and buffets
cross contamination
“When in doubt, throw out”

87
Q

Complications from Stem Cell Transplant

A

Graft vs. host disease (GVHD)

88
Q

Graft vs. host disease (GVHD)

what is the problem ?

Side effect - ___________

Major complication of ________ stem cell transplant

A

donor cells attack tissues of the host=> GIT, skin, liver

Severe secretory diarrhea

allogeneic

89
Q

GVHD Diet Phase 1

A

Bowel rest=> NPO with TPN

90
Q

GVHD Diet Phase 2

A

TPN
Begin isotonic, clear liquids

91
Q

GVHD Diet Phase 3

A

TPN weans

progress to lactose free
low fiber/residue
low fat
bland solids

92
Q

GVHD Diet Phase 4

A

Continue TPN wean
monitor intake
continue restrictions

93
Q

GVHD Diet Phase 5

A

Progress to regular stem cell transplant diet

Discontinue TPN when oral diet meets needs

94
Q

Nutritional assessment of patient including…

  • Consider ______ site, ______, treatment _______, & goal of treatment
  • Other comorbidities
  • Anthropometrics: BMI, weight change
  • Nutrition-focused physical examination
  • Diet History
  • GI status
  • Biochemical data
A

tumor
stage
side effects

95
Q

goals of MNT for cancer patients is to…

Prevent or correct __________
Minimize _______ loss; preserve ____
Reduce _______ secondary to disease and treatment
Maximize _________ of therapy
Improve or maintain ________

A

nutritional deficiencies
weight ; LBM
symptoms
benefits
quality of life

96
Q

for cancer patients use _________ or _______for energy requirements

A

indirect calorimetry
Kcal/kd method

97
Q

Physically inactive, non-stressed cancer patients:
___kcal/kg

A

25-30

98
Q

For cancer patients requiring repletion & weight gain:
_____ kcal/kg

A

30-35

99
Q

Hypermetabolic, stressed cancer patients:
_____ kcal/kg

A

35

100
Q

After stem cell transplant: _____ kcal/kg

A

30-35

101
Q

Acute GVHD: ______ kcal/kg

A

> 35

102
Q

Protein for Non-stressed patients with cancer: _____ g/kg

A

0.8-1

103
Q

Protein for Nutrition repletion: _____ g/kg

A

1.0-1.5

104
Q

Protein for Hypermetabolic, stressed: ________ g/kg

A

1.5 – 2.5

105
Q

Protein for Stem cell transplant: ______ g/kg

A

1.5

106
Q

Hypovolemia or dehydration due to=> vomiting, diarrhea, decreased oral intake

Hypervolemia from ___________________

Monitor weight, physical exam, intake & output records, serum _____, ______, osmolality

A

CHF, renal disease, IV medications

Na
BUN (blood urea nitrogen)

107
Q

If poor intake, a daily MVI with minerals providing no more than ______ of DRIs may be recommended

Assess and replace losses from:
- Malabsorption, vomiting, diarrhea, ostomies, fistulae
- Food-drug interactions
- Recommended to avoid taking ________ supplements during treatment

A

100%

antioxidant

108
Q

Oral nutrition should be Individualized
- Regular, well-balanced diet preferred=>avoid ________if possible
- High _____, high ______ diet

  • Frequent small feedings
  • ______ alterations as needed
  • Modified diets after ________
  • Obtain food preferences
  • Provide high kcal/protein snacks and oral supplements between meals as needed
A

restrictions
kcal
protein

Texture
GI surgery

109
Q

what is Xerostomia

A

dryness in the mouth from less saliva

110
Q

what to do for Xerostomia

A

Eat soft, moist food and avoid dry foods
- add sauces and gravies

8-10 cups of water per day

lemon drop candies

artificial saliva or saliva stimulant meds

avoid alcohol and alcohol containing mouthwash

111
Q

what is mucositis

A

mouth becomes sore and inflamed

112
Q

what to recommend for mucositis

A

avoid rough textured foods, spicy, very hot or cold, acidic, salty food and alcohol

Rx bland, soft, moist foods

increase fluids

113
Q

what to recommend for swallowing or chewing difficulty

A

SLP to evaluate swallowing

modified consistency diet

add sauces and gravies

114
Q

MNT for Nausea and Vomiting

A

avoid foods with strong odors
provide dry, bland foods
smaller more frequent meals
serve cold foods
no fried, greasy, spicy foods
sip cool fluids frequently, separate from meals
avoid favorite foods when nauseous
fluid and electrolyte replacement

115
Q

what is Dysgeusia

A

altered taste

116
Q

MNT for Dysgeusia

A

provide cold foods
drink fluids with meals
experiment with flavors and seasonings
- tart like lemon, vinegar, spices
if meat aversions, provide alternative sources of protein
use plastic utensils if metallic taste is issue
rinse mouth
good oral hygiene

117
Q

MNT for Diarrhea

A

determine cause
increase fluid
replace electrolytes
small frequent meals
avoid sugar alcohols, caffeine, prune juice, alcohol
limit insoluble fiber
provide soluble fiber sources
possible restrictions of lactose and fat

118
Q

MNT for anorexia

A

obtain food preferences
provide and educate on nutrient dense foods
limit low energy foods
small, frequent meals on a set schedule
consume fluids between meals, not with

119
Q

for anorexia, if fatigue occurs, provide social support or ___________

concentrate dietary energy during time of day when they are _______

provide oral nutrition supplements ______ meals

_______ may be needed

A

meals on wheels
most hungry
between
enteral

120
Q

Often necessary due to anorexia, malnutrition, oral & GIT tumors and surgery

A

enteral nutrition

121
Q

enteral access device types

A

short term
long term
different locations

122
Q

formulas for enteral nutrition should be _______
if malabsorption, ________

A

high protein
semi-elemental

123
Q

Due to infection risk and other complications, only use if necessary

A

parenteral nutrition

124
Q

Indication for parenteral nutrition ?

A

Non-functional GI tract (small bowel)

Radiation enteritis
Small bowel obstruction
Small bowel fistula
Severe prolonged V/D
Post-op small bowel ileus
GVHD

125
Q

supportive methods that are used to complement evidence-based treatment, control symptoms, & improve quality of life

A

Complementary therapies

126
Q

supportive methods that are used to complement evidence-based treatment, control symptoms, & improve quality of life

A

Complementary therapies

127
Q

treatments that are used instead of conventional treatments
- unproven
- safety questionable

A

alternative therapies

128
Q

examples of complementary therapies

A

ginger (anti-nausea properties)

omega-3 FA supplements

curcumin/tumeric (alleviate side effects)

129
Q

alternative therapies an be ______ therapies or ________ therapies

A

metabolic
diet

130
Q

metabolic therapies focus on ________
- ex: _______, _______, and ______

A

detoxification
- fasting
- colonics
- supplements

131
Q

colonics may cause __________________

A

may cause dehydration
electrolyte imbalances
colitis
bowel perforation

132
Q

example of a metabolic therapies

A

Gerson therapy
- strict raw vegetarian diet
- with some supplements

133
Q

Two examples of alternative therapies

A

macrobiotic diet
ketogenic diet

134
Q

what is macrobiotic diet?

deficient in ?

A

vegetarian diet with no meat or dairy

allow whole grains, veggies, beans, fermented soy products, fresh organic fruits, white fish

kcal, protein, calcium, vit B12, vitamin D

135
Q

What is the ketogenic diet ?

A

High fat, low carb diet

thought to create unfavorable environment for cancer cells

136
Q

Some side effects of ketogenic diet

A

N/V
HA (headaches)
fatigue
dizziness
insomnia
difficulty in exercise tolerance
constipation

Medical Nutrition Therapy (12 decks)

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