Chapter 18: MNT for Breast CA

Question 1

What are breast cancer risk factors?

Answer 1

increased age
weight gain after 18
being overweight/obese for postmenopausal breast CA
use of hormone therapy
very dense breast tissue
high bone mineral density
never having children/first child after 30

Question 2

Name the common breast CA genes?

Answer 2

BRCA1 and BRCA2 - up to 80% of women with gene will get breast CA, usually bilaterally

Question 3

How is Breast CA staged?

Answer 3

using the TNM model plus hormone-receptive variants

Question 4

What hormone therapies are used for ER+, PR+, ER+/PR-, ER-/PR+, or ER/PR- cancers?

Answer 4

If positive, they respond to endocrine therapies to various degrees. These therapies are:
Selective ER response modulators - tamoxifen or Raloxifene - prevent binding
Aromatase inhibitors - stop estrogen production (only in postmenopausal women)
Estrogen-receptor downregulators - block effects of estrogen on tissues
LHRH agents - Lupron Depot/Zoladex - shut down ovaries to stop producing estrogen

Combo +/- CAs aren’t as responsive to hormone therapy

Question 5

What are the hormone therapies for HER2+ CAs?

Answer 5

Monoclonal antibodies - herceptin

Question 6

What are the hormone therapies for Triple Negative CA (TNBC)?

Answer 6

There are none, its not typically effective. Chemo can be used. However, TNBC have a poorer prognosis than others

Question 7

What supplements should be taken when on Tamoxifen?

Answer 7

Vitamin D (D3) and Calcium if needed

Evaluate their diet to make sure it is high in Vitamin D and Ca. Recommend bone-strengthening activities (weight bearing exercise)

Question 8

Name the most common chemotherapies used for Breast CA?

Answer 8

Xeloda
Paraplatin (Carboplatin)
Cytoxan
Taxotere (docetaxel)
Adriamycin
Elieance
5-FU
Gemzar
Ixempra
MTX (Methotrexate)
Taxol
Abraxane
Navelbine

Question 9

What are the common biologic therapies used for Breast CA?

Answer 9

Arimidex
Aromasin
Femara

Question 10

What are the common monoclonal antibodies used for Breast CA?

Answer 10

Avastin
Perieta
Tykerb
Herceptin

Question 11

What is the recommended treatment for lymphedema?

Answer 11

aerobic physical activity
resistance training
weight management

Question 12

What is the recommended energy intake for normal-weight Breast CA survivors in active treatment? Protein needs? Diet makeup?

Answer 12

25-30 kcal/kg
1-1.5 g/kg depending on stress levels

metabolic syndrome is common so controlling refined carbs may be key.
High in F/V is often recommended (>25 g/d of Fiber)
low fat has been studied to reduce recurrance
Fish intake of 8 oz/week (Fatty Acids) is recommended
Soy containing foods, not soy products

Question 13

What is the MNT for Breast CA treatment and healthy survivorship?

Answer 13

1) promote gradual loss of fat stores/preserve lean body mass.
2) enhance QoL during treatment - side effect management
3) promote post-op recovery - aid in wound healing
4) promote post-treatment recovery - transition to healthy diet like ACS or AICR guidelines