Cancer Flashcards
~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
2
3
breast & prostate
2nd
Lung
uncontrolled division of abnormal cells that can spread throughout the body
Cancer
a substance that induces cancer
carcinogen
a new & abnormal formation of tissue that serves no useful purpose
neoplasm
neoplasm can invade tissues and spread to distant tissues & organs
Metastasis
Transformation of cells by the interaction of chemicals, radiation, or viruses with cellular DNA
initiation
Initiated cells are activated by a promoting agent to multiply & form a discrete tumor; escape mechanisms that should destroy these cells
promotion
tumor cells aggregate and grow into malignant tumors capable of tissue invasion & metastasis
progression
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
carcinogenesis
toxin
tabacco
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
mortality
recurrence
abdominal
Red meat=> “_______ increased risk” of _______ cancer
Processed meat=> “_________ increased risk” of ______ cancer
probable
colorectal
convincing
colorectal
Sodium & potassium _______ and ______ are used in processes of salting, pickling, and smoking foods
Produce __________=> carcinogens
Possible increased risk of _______ and ________ cancer
nitrates and nitrites
nitrosamines
colorectal
gastric
Vitamin _____ & _________ can slow the conversion of nitrites to nitrosamines
C
phytochemicals
Charring or cooking meat at high temperatures (>_____° F) over an open flame=>formation of ______________
Possible increased risk of _______ cancer with frequent intake
400
polycyclic aromatic hydrocarbons (PAHs)
gastric
Higher PAH formation with:
________
________
Higher fat meats
Charcoal grilling
Industrial chemical used in the manufacturing of many hard, plastic bottles and linings of food & beverage cans
Bisphenol A (BPA)
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
plastic bottles
canned foods
very hot liquids
microwave food
Intake of foods high in dietary fiber associated with a probable decreased risk of ______ cancer
colorectal
Both_______ products & ______ supplements associated with a probable decreased risk of colorectal cancer
dairy
calcium
Coffee associated with a probable _______ risk of_____ & ________ cancer
decreased
liver
endometrial
Coffee contains ________ & ________ which may have anticancer properties
antioxidants
phenols
Non-starchy Vegetables & Fruits
- Major sources of _________ and ________
- Probable decreased risk of => oral cavity, pharynx, larynx, esophageal, stomach, colorectal, & lung cancer
phytochemicals & antioxidants
Anticarcinogenic Compounds
Antioxidants
Phytochemicals
Antioxidants include (3)
Vitamin C
Vitamin E
selenium
Phytochemicals are
biologically active components in plants
Recommended to obtain Anticarcinogenic Compounds from ____________
foods rather than supplements
Mechanism of Action of Phytochemicals
- ________ effects
- Induce _________ enzymes
- Inhibit ___________ formation
- Binding of _________ in the GI tract
- Alter ________ metabolism
- _________ modulating effects
Antioxidant effects
Induce detoxification enzymes
Inhibit nitrosamine formation
Binding of carcinogens in the GI tract
Alter hormone metabolism
Immune modulating effects
Phytochemicals (T 35-1 & T 35-3)
Carotenoids
Phenols
Indoles
Lignans
Allyl sulfides
Three carotenoids and where to get them from
Beta-carotene
- (carrots, mangos, sweet potato)
Lycopene
- (tomatoes & tomato products, papaya, pink grapefruit, watermelon)
Lutein
- (kale, spinach, collard, mustard & turnip greens)
Two Phenols and where to get them from
Flavonoids
- (berries, grapes, red wine, plums, purple cabbage, green tea)
Isoflavones
- (soybeans)
Where to get Indoles
(arugula, bok choy, cabbage, broccoli, brussels sprouts, cauliflower)
Sources of Lignans
(whole grains, legumes, flaxseed)
Allyl sulfides sources
(leeks, onion, garlic, chives)
Some studies have found increased incidence of _____ cancer for smokers who take __________ supplements
lung
beta-carotene
Soy contains_________ which are ________
Modest soy intake may ______ breast cancer especially if consumed long-term beginning before adulthood
isoflavones
phytoestrogens
protect against
Regular _______ reduces the risk of colorectal, breast cancer, & endometrial cancer
exercise
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.
150
75
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
two-thirds
2.5 cups
whole grains
Limit processed foods high in _____, ____, or _____
Limiting these foods helps to maintain a healthy weight
fat, starches, or sugars
Limit red meat consumption to moderate amounts
(no more than _________/week)
Eat little, if any, _________ meat
12-18 oz/week
processed
There is strong evidence that regular consumption of _____________ causes weight gain, overweight & obesity
Drink mostly water and unsweetened drinks
sugar-sweetened beverages
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
1
2
12 oz
5 oz
1.5 oz
Aim to meet nutritional needs through ______
diet alone
There is strong evidence that __________ helps protect against breast cancer in mothers
Babies who are ________ are less likely to become overweight and obese
breastfeeding
breastfed
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
Dysgeusia
Metabolic Effects of Cancer
CHO abnormalities=> _______, _______, and ________
insulin resistance
increased gluconeogenesis
hyperglycemia
metabolic effects on cancer
Protein=> __________________ => ________________ and __________________
increased catabolism (gluconeogenesis) =>
skeletal muscle wasting & organ atrophy
decreased protein synthesis
metabolic effects on cancer
Fat=> _____________
Increased lipolysis
Metabolic Effects of Cancer also include
Host-Tumor competition for _______
Fluid & electrolyte imbalances
- _________
- ________
nutrients
Vomiting & diarrhea
Hypercalcemia (bone metastases)
Syndrome of progressive weight loss, anorexia, generalized wasting, weakness, increased REE, & immunosuppression ?
Major cause of morbidity & mortality
Caused in part by ________
Cancer Cachexia
cytokines
Pharmaceutical Management of Anorexia & Cachexia
Appetite stimulants
Example of appetite stimulant
megestrol acetate (Megace)
appetite stimulants effects and side effects/cons
Stimulates appetite
Promotes weight gain (especially fat)
Has not been found to increase LBM
Side effects: edema
Use of medications to promote lethal injury to cancerous cells
Chemotherapy
Chemotherapy interferes with the ___________
Systemic treatment
Affects ____________ cells
Especially _________ cells: GIT, bone marrow, hair follicles
synthesis of DNA and replication of cancer
malignant and normal
rapidly dividing
examples of Chemotherapeutic Agents
Cisplatin
5-Fluorouracil (5-FU)
Methotrexate
Doxorubicin
Nutritional Side Effects of Chemotherapy
Anorexia
N/V
Dysgeusia (altered taste)
Mucositis
Diarrhea
Fluid & electrolyte losses
Fatigue
Myelosuppression: depressed immune function, anemia, bleeding problems
hormone therapy is used for ____________ cancer
it will block ___________
estrogen receptor-positive breast
estrogen-binding sites
example of hormone therapy
tamoxifen
side effects of hormone therapy/Tamoxifen
Weight gain
hot flashes
fluid retention
nausea
if on hormone therapy, should avoid ______________
soy supplements
grapefruit
Induce, enhance, or suppress an individual’s immune response
biotherapy
biotherapy examples
interferon
interleukin-2
side effects of biotherapy
myelosuppression
anorexia
fatigue
nausea
flu-like symptoms
Use of radiation to promote lethal injury to cancerous cells=>damages the DNA
radiation therapy
radiation therapy is used for ________
Administered in ____________ doses
Effects ______________ cells
- Rapidly dividing cells (GIT, bone marrow, & hair follicles) are most vulnerable to damage
localized tumors
multiple fractionated
both normal & malignant
Nutritional Side Effects of Radiation Therapy
Common in all patients=>
- fatigue
- anorexia
- skin erythema & hair loss in the area being treated
Nutritional Side Effects of Radiation Therapy in the head and neck
- Taste & smell changes
- Xerostomia
- Mucositis=> inflammation of the mucosa of specific areas in the GIT
- Dysphagia, odynophagia
- Dental problems
Nutritional Side Effects of Radiation Therapy in the thoracic cavity
esophagitis
esophageal stricture
dysphagia
GERD
Nutritional Side Effects of Radiation Therapy in the abdomen
secondary lactose intolerance
anorexia
malabsorption
chronic radiation enteritis
intestinal strictures
fistulae
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
GI
pre-op
Malnourished
Oral Cavity surgery side effects
Chewing & swallowing difficulties
Alterations in taste & smell
May require enteral nutrition
Total or partial esophagectomy side effects
Early satiety
dumping syndrome
GERD
dysphagia
May require jejunal tube feeding
Total or partial gastrectomy side effects
Dumping syndrome
malabsorption
early satiety
anemia - vitamin B12 and iron deficiency
May require jejunal tube feeding
Pancreatic resection side effects
gastroparesis
malabsorption
hyperglycemia
Small bowel resection side effects
lactose intolerance
diarrhea
malabsorption
fluid & electrolyte imbalance
- if significant=> short bowel syndrome
Partial or total colectomy side effects
large losses of fluid & electrolytes
diarrhea
IV infusion of peripheral stem cells
hematopoietic stem cell transplantation
Prior to the hematopoietic stem cell transplant, patient receives a ___________: high dose chemotherapy with or without total body irradiation=> eradicate malignant cells
conditioning regimen
Hematopoietic Stem Cell Transplantation is used for treatment of …
Treatment for leukemia
lymphoma
multiple myeloma
Types of Stem Cell Transplant
Autologous
Allogeneic
Autologous stem cell transplant is from ______
harvested when?
from self
usually when in remission & purged of abnormal cells
Allogeneic stem cell transplant is from _______
from another person
stem cells from a donor who is a match
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
conditioning regimen prior to transplant
2-4
infection
Goal of stem cell transplant diet is to minimize the risk of ____________
- Educate
foodborne illness
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
“_______________”
thoroughly washed
canned foods & drinks
proper temperatures
expirations dates
bulk bins, salad bars and buffets
cross contamination
“When in doubt, throw out”
Complications from Stem Cell Transplant
Graft vs. host disease (GVHD)
Graft vs. host disease (GVHD)
what is the problem ?
Side effect - ___________
Major complication of ________ stem cell transplant
donor cells attack tissues of the host=> GIT, skin, liver
Severe secretory diarrhea
allogeneic
GVHD Diet Phase 1
Bowel rest=> NPO with TPN
GVHD Diet Phase 2
TPN
Begin isotonic, clear liquids
GVHD Diet Phase 3
TPN weans
progress to lactose free
low fiber/residue
low fat
bland solids
GVHD Diet Phase 4
Continue TPN wean
monitor intake
continue restrictions
GVHD Diet Phase 5
Progress to regular stem cell transplant diet
Discontinue TPN when oral diet meets needs
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
tumor
stage
side effects
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 ________
nutritional deficiencies
weight ; LBM
symptoms
benefits
quality of life
for cancer patients use _________ or _______for energy requirements
indirect calorimetry
Kcal/kd method
Physically inactive, non-stressed cancer patients:
___kcal/kg
25-30
For cancer patients requiring repletion & weight gain:
_____ kcal/kg
30-35
Hypermetabolic, stressed cancer patients:
_____ kcal/kg
35
After stem cell transplant: _____ kcal/kg
30-35
Acute GVHD: ______ kcal/kg
> 35
Protein for Non-stressed patients with cancer: _____ g/kg
0.8-1
Protein for Nutrition repletion: _____ g/kg
1.0-1.5
Protein for Hypermetabolic, stressed: ________ g/kg
1.5 – 2.5
Protein for Stem cell transplant: ______ g/kg
1.5
Hypovolemia or dehydration due to=> vomiting, diarrhea, decreased oral intake
Hypervolemia from ___________________
Monitor weight, physical exam, intake & output records, serum _____, ______, osmolality
CHF, renal disease, IV medications
Na
BUN (blood urea nitrogen)
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
100%
antioxidant
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
restrictions
kcal
protein
Texture
GI surgery
what is Xerostomia
dryness in the mouth from less saliva
what to do for Xerostomia
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
what is mucositis
mouth becomes sore and inflamed
what to recommend for mucositis
avoid rough textured foods, spicy, very hot or cold, acidic, salty food and alcohol
Rx bland, soft, moist foods
increase fluids
what to recommend for swallowing or chewing difficulty
SLP to evaluate swallowing
modified consistency diet
add sauces and gravies
MNT for Nausea and Vomiting
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
what is Dysgeusia
altered taste
MNT for Dysgeusia
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
MNT for Diarrhea
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
MNT for anorexia
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
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
meals on wheels
most hungry
between
enteral
Often necessary due to anorexia, malnutrition, oral & GIT tumors and surgery
enteral nutrition
enteral access device types
short term
long term
different locations
formulas for enteral nutrition should be _______
if malabsorption, ________
high protein
semi-elemental
Due to infection risk and other complications, only use if necessary
parenteral nutrition
Indication for parenteral nutrition ?
Non-functional GI tract (small bowel)
Radiation enteritis
Small bowel obstruction
Small bowel fistula
Severe prolonged V/D
Post-op small bowel ileus
GVHD
supportive methods that are used to complement evidence-based treatment, control symptoms, & improve quality of life
Complementary therapies
supportive methods that are used to complement evidence-based treatment, control symptoms, & improve quality of life
Complementary therapies
treatments that are used instead of conventional treatments
- unproven
- safety questionable
alternative therapies
examples of complementary therapies
ginger (anti-nausea properties)
omega-3 FA supplements
curcumin/tumeric (alleviate side effects)
alternative therapies an be ______ therapies or ________ therapies
metabolic
diet
metabolic therapies focus on ________
- ex: _______, _______, and ______
detoxification
- fasting
- colonics
- supplements
colonics may cause __________________
may cause dehydration
electrolyte imbalances
colitis
bowel perforation
example of a metabolic therapies
Gerson therapy
- strict raw vegetarian diet
- with some supplements
Two examples of alternative therapies
macrobiotic diet
ketogenic diet
what is macrobiotic diet?
deficient in ?
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
What is the ketogenic diet ?
High fat, low carb diet
thought to create unfavorable environment for cancer cells
Some side effects of ketogenic diet
N/V
HA (headaches)
fatigue
dizziness
insomnia
difficulty in exercise tolerance
constipation
