Cumulative Deck Flashcards
1
Q
2/3 Esophageal cancers are which type vs 1/3rd
A
SCC (squamous cell cancer) vs adenocarcinomas
2
Q
7th Day Aventist Diet
A
vegan with possible egg/milk/fish; no shellfish, no pork, no caffeine. Kosher OK
3
Q
Acupuncture can help with which signs and symptoms?
A
hot flashes, xerostomia, muscoskeletal issues, peripheral neuropathy
4
Q
Anemia is most evident using which lab
A
Hgb (hemoglobin)
5
Q
Aside from folate levels, what is another way of determining low folate?
A
RBC (red blood cells)
6
Q
Assessing for malnutrition in children under 24 months
A
age, length, occiptal frontal
7
Q
Assessing malnutrition in palliative care is done through-
A
PG-SGA + MUST, MNA
8
Q
At what time should you try to push PO intake in post-op bowel surgeries
A
within 24h, full PO intake in 6-9 days
9
Q
At which dose can Omega 3 cause bleeding?
A
4000mg/day
10
Q
Avoid enteral nutrition when?
A
ascites, peritoneal mets, inoperative obstructions
11
Q
Avoid alcohol with which cancers?
A
H&N (head and neck), esophageal
12
Q
B12 is absorbed in the -
A
terminal ileum
13
Q
Billroth I vs Billroth II
A
gastroduodenal vs gastrojejunal
14
Q
Cause of dysmotility after surgeries
A
Denervation = loss of nerve fx
15
Q
Characteristics of Cachexia and protein recommendations
A
80% cancer patients, decrease in skeletal muscle, 1.5-2.5g/kg Protein
16
Q
Common complaints in those under palliative care
A
Loss of Appetite, constipation, xerostomia
17
Q
Common side effects of: Aromasin, Femara, Faslodex
A
Nausea/vomiting, hot flashes
18
Q
Complicated diarrhea is treated by:
A
octreotide, IV Fluids
19
Q
Correcting Platelet counts
A
B12, folate
20
Q
Decreased ovarian risk in post-menopausal women is r/t
A
increased hip circumfrence
21
Q
diarrhea increases the need for which nutrients?
A
electrolytes, zinc
22
Q
Diet progression for Stem Cell Treatment
A
NPO, low residue, solid, low lactose, regular
23
Q
ECOG Reference Status and Indications
A
Fully Active: 0;
OOB 50%: 2;
Disabled: 3-4,
Death is 5
24
Q
Enteral nutrition guidelines for head and neck cancer
A
Perioperative GTube ending at 6-8 wks post tx
25
Estimated calorie/protein needs in Lung Cancer
30-35kcal/kg, 1.2-1.5g/kg Protein
26
Familial Adenomatous Polyposis increases which cancer risk, inhibited by what?
colorectcal cancer, curcumin/quercetin
27
Fatness is associated with which cancers?
esophageal, pancreatic, colorectal, post-men breast, endometrial, renal, thyroid
28
Fatness may PROTECT against which cancer?
pre-menopausal breast
29
Fiber recommendations
21-25g/day (F), 30-38g/day (M)
30
Flaxseed is beneficial for which type of cancer and which chemo treatment?
protective against post-menopausal breast cancer; may enhance tamoxifen
31
For moderate/severe malnutrition, perioperative enteral nutrition should be provided within
7-14 days
32
Glutamine can offset which tx related symptom?
peripheral neuropathy
33
Goals of the RD in palliative care
reduce stress of PO intake and prevent dehydration
34
Hold EN when gastric residuals exceed
500cc
35
How do you assess central adiposity?
waist circumference
36
How do you manage fat in pancreatic cancer?
low fat (75g or less) unless patient has pancreatic enzyme replacement therapy to avoid biliary obstruction
37
How does one grade the severity of mucositis?
Oral toxicity scale, grade 0-4 with 4 being the worst
38
How long does neutropenia last following stem cell treatment?
2-3 weeks
39
How much weight loss can decrease survival in lung cancer
5%
40
How much weight loss would be indicated in a woman with breast cancer (and what to avoid)
2# per week with physical exercise; avoid linoleic acid; lignans OK
41
How to avoid Refeeding Syndrome
replete e- THEN provide 25% needs over 3-5 days
42
In an anastomosis, you should feed ________ to the site
proximally
43
In Liver Cancer, you can use what to build LBM (lean body mass)
BCAA (branched chain amino acids)
44
In malignant bowel obstructions (r/t tumor progression or compression), MNT is:
NG for suction or GTube for drainage
45
In post-men breast CA, how much weight loss is considered beneficial?
2lb per week
46
Inititating Tube Feeds via infusion and bolus/gravity
Infusion: 10-50mL/hr; Bolus: 60-120mL
47
Inpatient nutrition assessments should be done within ? hours of admission
24
48
Isothiocyanate is found in which foods and can decrease which cancer risk?
cruciferous veggies, decrease lung cancer risk
49
Karnofsky Performance Scale Ranges and Indications
Normal: 100-80%, Limited to home: 70-50%, Disabled/Dying: 40-10%
50
Lack of exercise can cause which 3 cancers?
breast, colon, endometrial
51
Li Fraumeni Syndrome
TP53 defect
-
increases risk of breast, leukemia, bone/muscle sarcomas
52
Long Term implications of Bladder Cancer
change in bowel movements
53
Long Term implications of Breast Cancer
bone health, weight, heart issues
54
Long Term implications of Colorectal Cancer
increased LFTs, malabsorption, weight changes, bowel obstructions/change in bowel movements
55
Long Term implications of Leukemia
kidney stones, bone health, metabolic syndrome, hypothyroid
56
Long Term implications of Lung Cancer
respiratory decline, esophageal function/dysphagia
57
Long Term implications of NHL (Non-Hodgkin's Lymphoma)
hypothyroid, metabolic syndrome
58
Long Term implications of Oropharyngeal Cancer
tooth decay, xerostomia, dysphagia
59
Long Term implications of Ovarian Cancer
bone health
60
Long Term implications of Pancreatic Cancer
anorexia, malabsorption, change in BM
61
Long Term implications of Prostate Cancer
bone health, diarrhea
62
Long Term implications of Renal Cancer
HTN, CKD/ARF, increased Creatinine
63
Long Term implications of Uterine Cancer
bone health
64
Low Vitamin D can increase risk of which 3 cancers?
breast, prostate, colorectal
65
Lynch Syndrome
impacts colon Cancer, increases genetic risk
66
Main side effects of Abd/Stomach Radiation Therapy?
fatigue, hair loss, diarrhea, N/V, bladder changes
67
Main side effects of Breast Radiation Therapy?
fatigue, hair loss
68
Main side effects of Chest Radiation Therapy?
fatigue, hair loss, N/V, throat changes
69
Main side effects of H&N Radiation Therapy?
fatigue, hair loss, thoat changes
70
Main side effects of Pelvic Radiation Therapy?
fatigue, diarrhea, bladder changes
71
Main side effects of Rectal Radiation Therapy?
fatigue, hair loss, diarrhea, bladder changes
72
Main 3 side effects of Tamoxifen
menstrual s/s, fluid retention, thromboembolic issues
73
Main treatment side effects of Colorectal Cancer
mucositis, nausea, vomiting, diarrhea
74
Micronutrients at risk of loss with alcoholic liver disease
folate, thiamine, pyridoxine, Vitamin A
75
Micronutrients at risk of loss with GI fistulas
zinc, selenium
76
Micronutrients at risk of loss with inflammation
Zinc, Iron, Copper, Selenium
77
Micronutrients at risk of loss with surgery
Thiamin, Riboflavin, B12, folate
78
Micronutrients at risk of losses with diarrhea
electrolytes, zinc, selenium
79
MNT for ascites
2g Na rx, 1.5g/kg PRO
80
MNT for gastric/duodenal obstruction
stenting with low fiber PO diet OR Gtube for draining, JTube for feeding
81
Recommend supplements in HCT (Stem Cell Tx) and LBM assessment
glutamine, Ca/D supplements, NO IRON SUPPLEMENTS, and measure muscle/adipose using arm anthropometrics
82
Moderate Acute Malnutrition
1-2% weight loss in 1 week, 5% loss in 1 mos, 7.5% loss in 3 mos; <75% intake of needs in 1 week
83
Moderate Chronic/Social Malnutrition
5% loss in 1 mos, 7.5% loss in 3 mos, 10% loss in 6 mos; <75% intake of needs in 1 month
84
Neutropenia means neutrophils are
<1500
85
Normal Range for MCV
80-100
86
Normal Range for Platelets
150-400
87
Nutrient of interest when on 5FU, Xeloda (and why?)
B6 for Hand Foot Syndrome
88
Nutrients of interest when on Cetuximab and Oxaliplatin
Mg, Ca
89
Nutrient of interest when on Panitumumab
Mg
90
Nutrients of interest when on Pemetrexed
Folic Acid/B12
91
Nutrients of interest when on Tacrolimus
Mg, Potassium
92
Nutrients of interest when on Velcade
avoid green tea
93
Nutrients of interest when on Zometa
Ca, D
94
Nutrition Goals of Prostate Cancer
protect bone health and LBM, decrease sat fat, promote genistein (soy), plant based eating to focus on allium veggies
95
Nutrition impact of Gallbladder Cancer
abd pain, jaundice, Loss of Appetite, dysgeusia
96
Nutrition interventions for SIADH
3% saline and fluid rx
97
Nutrition issues for treatment of brain tumors
N/V, dysphagia, oral/gut complaints, vertigo
98
Nutrition side effects of: Paclitaxel
| & which 3 nutrients are at risk of deficiency?
N/V/D, mucositis, decreased Mg, K, Vit D
99
Nutrition side effects of: 5FU
N/V/D, mucositis
100
Nutrition side effects of: Abraxane
N/V/D, mucositis, LE edema, increased LFTs; used as second line therapy for met breast cancer
101
Nutrition side effects of: Anastrozole
NVDC, hot flashes
102
Nutrition side effects of: Avastine, Pertuzumab
NVDC, mucositis
103
Nutrition side effects of: Carboplatin
N/V, renal toxicity
104
Nutrition side effects of: Cytoxan
N/V, SIADH
105
Nutrition side effects of: Decarbazine
N/V, flu like s/s
106
Nutrition side effects of: Etoposide
may enhance coumadin, N/V, hypersentivity
107
Nutrition side effects of: Gemzar
N/V, flu like s/s
108
Nutrition side effects of: Herceptin
N/V/D, flu like symptoms, anemia
109
Nutrition side effects of: Ifosfomide
N/V, loss of appetite, renal toxic so use Mesna (chemoprotectant)
110
Nutrition side effects of: Irinotecan
diarrhea, N/V, loss of appetite
111
Nutrition side effects of: Kadcyla
Toxic to cardiac, liver, lung + constpation + thrombocytopenia
112
Nutrition side effects of: Lupron
NVDC
113
Nutrition side effects of: Navelbine
N/V/C, loss of appetite
114
Nutrition side effects of: Oncovin
constipation and renal toxicity
| peripheral neuropathy
115
Nutrition side effects of: Oxaliplatin
cold sensitivity, N/V/D
116
Nutrition side effects of: Taxotere
fluid retention, N/V
117
Nutrition side effects of: Xeloda
N/V/D, Hand Foot Syndrome, Mucositis
118
Nutrition side effects of: Zoladex
N/V/C
119
Nutrition support for myeloablative transplant
TPN with high dose chemoRT
120
Nutrition support for nonmyeloablative transplant
Enteral with low dose chemoRT
121
Ovarian cancer may mets to:
liver, lung, GI, urinary
122
Pancreatic cancer may be associated with these other issues
gastroparesis, malansorption, blockage of bile duct or duodenum
123
Pancreatic surgeries can lead to these nutrition issues:
DM, EPI, possible dumping, lactose intolerance, gastroparesis
124
Pareve Kosher focuses on
any food that is NOT: meat/dairy SO they can be eaten with all foods
125
PERT guidelines for pancreatic cancer
10-40K lipase/meal, use MCT oil, monitor B12, use PPI/H2B
126
Physical activity beneficial for which cancer?
breast, colon, ovarian, prostate
127
Preferred Malnutrition Screening Tool
PG-SGA or SGA. MSTC/MUST is for inpatients only
128
Preventing Refeeding
25% needs or 20kcal/kg
129
Prophylactic cranial radiation occurs with which cancer
SCLC/lung cancer d/t increased risk of mets
130
Protein for Frailty
1.2g/kg
131
Proven mind-body-medicine techniques
stress reduction, biofeedback, hypnosis, guided imagery, art/music therapy, yoga/taichi
132
RAI tx for thyroid cancer can cause
Nausea/xerostomia/dysgeusia
133
Recommended physical activity for cancer risk reduction
30 minutes per day / 150min moderate/wk, 75min vigorous/wk, weights 2x/wk
134
Reference Range for: Calcium
8.5-10.5
135
Reference Range for: Chloride
97-107
136
Reference Range for: Mg
1.5-2.5
137
Reference Range for: Potassium
3.5-5.3
138
Reference Range for: Sodium
136-145
139
Risk Factors for adenocarcinoma of esophagus
GERD/Barretts
140
Risk Factors for SCC Esophageal cancer
ETOH, HPV, esophageal achalasia
141
S/S of GVHD and nutrition recs
N/V, abd pain, diarrhea, loss of appetite; low: lactose, fiber, acid, fat
142
Sarcopenia incidence and assessment
50% in advanced cancer; characterized by increased fat / decreased muscle; assess with BIA, DXA
143
Selenium is protective against which cancer
prostate cancer
144
Selenium may help which cancer treatment?
may benefit Paclitaxel
145
Sinosoidal Obstructive Syndrome: clinical implications and nutrition treatment
hepatic veno-occlusive disorder, a post treatment complication that may present with thrombocytopenia, weight gain, ascites.
Treatment includes glutathione, cysteine, IVF, e-, correct hypotension, monitor TG, low-fat/low protein
146
Special areas of concern in liver cancer
hypercalcemia, hypoglycemia
147
Supplements bad for prostate cancer
Calcium over 1500mg, Vitamin E
148
Supplements: Beta Carotene
may decrease CRC risk
149
Supplements: CoQ10
| what does it do and for which cancer treatment?
limits cardiac/renal toxicity of doxorubicin
150
Supplements: Milk Thistle
may benefit Cisplatin
151
Supplements: Oleic Acid
| May benefit which chemo? Food sources?
may benefit Herceptin (found in avocados, nuts/seeds, oils)
152
Supplements: Theanine
| May benefit which 2 chemos
may benefit doxorubicin, idarubicin
153
Systemic Inflammation is best measured by
CRP
154
The compound in tea is called ? and which cancers is it beneficial toward?
EGCG, breast/ovarian/endometrial
155
Thrombocytopenia means platelets are ?
<100K
156
Tube Feeding for H&N, GE, and Panc cancer requires
100cm Jejunum, 150cm Ileum with valve
157
Tumor Lysis Syndrome causes?
hyper-Phosp/kalemia/uremia, hypo-Ca;
| it is a metabolic issue r/t tumor destruction
158
Turmeric is good for (1) which cancers (2) which chemo (3) combined with?
panc and colorectal
cisplatin
fat and black pepper
159
Types of Thyroid Cancer and Commonality
1. Follicular, 2. Papillary 3. Anaplastic (stage IV), Medullary
160
Typical mets from CRC is to
liver
161
Uncomplicated diarrhea is treated by:
fiber, water, low lactose
162
Under palliative chemoRT, which nutrition support is best
TPN
163
What % weight loss can reduce treatment response?
6%
164
What chemos can cause hypoalbuminemia
cisplatin, paclitaxel
165
What 5 chemotherapies can benefit from Omega 3?
paclitaxel, cisplatin, irinotecan, doxorubicin, vincristine
166
What do you do with protein needs r/t encephalopathy
decrease
167
What is ablation?
destruction of tumor
168
What is achlorydria and what is the main concern?
decrease of gastric acid; bacterial overgrowth
169
What is biofeedback?
meditation, relaxation techniques
170
What is embolization?
restriction of blood flow to tumor
171
What is RECIST?
tumor progression scale that considers location and extend of progression/mets
172
What is the gold standard for assessing LEVEL of malnutrition?
indirect calorimetry
173
What non-obvious foods are avoided in the immunosuppressed diet?
lunchmeat, tofu, blue and uncooked soft cheeses, unpasterized juice/honey, veggie sprouts
174
What nutrients are of concern in gastric surgeries?
Zn, B12, folate, iron
175
What nutrition support do you provide in GVHD?
TPN
176
What osmolarity is the limit for PPN
900mosm/L
177
What should the RD be concerned with re: Cisplatin
increasing water needs,
check renal fx and electrolytes (provide selenium to reduce kidney toxicity),
SIADH, N/V/D, dysgeusia, HLD/CVD risk
178
What type of EN to provide with esophageal surgeries
J Tube
179
When to provide post-pyloric EN feeds
gastroparesis, gastric outlet/duodenal obstruction, fistulas
180
When to use TPN in Stem Cell Tx
GI toxicity, refractory gut GVHD
181
where do you report adverse effects of dietary supplements?
medwatch
182
Which cancer is most common in PEDS
leukemia
183
Which cancer is the second leading cause of cancer and cancer death in women?
breast
184
Which cancer therapies can cause thromboembolic issues and hot flashes?
tamoxifen, aromasin, femara, anastrozole
185
which dietary supplemnets are considered unsafe/illegal?
chaparral, ephedra, comfrey
186
Which foods may benefit Tamoxifen?
soy, flax
187
Which growth chart do you use for PEDS (0-2 years) and (2-20 years)
(0-2) WHO ht/age, weight/ht (2-20) CDC charts
188
Which is the detoxifying enzyme?
glutathione S transferase
189
Which malnutrition assessment tool is used in PEDS?
subjective global nutrition assessment (SGNA)
190
Which nutrients are of most concern in PEDS
Ca, D
191
Which surgery can increase the risk of bacterial overgrowth
colon
192
Who accredits CA centers?
ACOS (Commission on CA)
193
Whole grains can help prevent which cancer?
colorectal
194
Nutrition side effects of: Adriamycin
N/V/D, loss of appetite, mucositits
195
Nutrition side effects of: Bleomycin
N/V, loss of appetite, wt loss, mucositis
196
Nutrition side effects of: Cetuximab
N/V/D, loss of appetite, low Mg, cardiac/respiratory distress
197
Nutrition side effects of: Mitomycin
N/V/D, loss of appetite, mucositis, shortness of breath, renal/lung toxicity, discolored urine
198
Nutrition side effects of: Sorafenib
N/V/D, loss of appetite
199
Nutrition side effects of: Topotecan
N/V/D, loss of appetite, mucositis
200
Nutrition side effects of: Aletuzumab
Hypotension, Anemia; given for B-Cell Lymphoma
201
Nutrition side effects of: Taxol
may decrease Mg, K levels; may cause N/V, fatigue
202
Nadir
typically refers to low white blood count
203
FOLFIRINOX: what type(s) of cancers, what treatments compromise this regimen, micronutrient concerns?
Pancreatic; Folinic Acid + 5FU + Irinotecan + Oxaliplatin. Check for Calcium, Magnesium.
204
Name the 3 most common medicinal mushrooms beneficial to the cancer population.
maitake, shittake, enokitake
205
What is the Budwig Diet?
flaxseed, cottage cheese; avoids meat/poultry/overt animal products
206
What is the Essiac Plan?
essiac tea 1-3x daily; may include laxatives
207
What is the Gerson Protocol?
15-20lbs fruit and vegetable juice consumed daily, up to 5 coffee enemas daily, use of digestive enzymes
208
What is the Gonzalez Diet?
extracts from animal organs; use of digestive enzymes; coffee enemas
209
What is the Livingston-Wheeler Diet?
Uses a "vaccine" made from patient's own blood/urine; mostly vegetarian
210
What is the Macrobiotic Diet?
organic, plant-based, fish/seafood acceptable
211
What is the Raw Diet?
foods may be heated no more than to 105 degrees F; Vegan diet
212
Primary Role of Protein Target Therapies
Therapies that signal internal cellular pathway targets to cause cell apoptosis
213
Primary Role of Cytokines
Stimulates a broad immune response to encourage cell growth and destroy target (cancer) cells
214
Primary Role of Angiogenesis Inhibitors
Hinders the formation of new blood vessels to tumors
215
Primary Role of Monoclonal Antibodies
Signal external cellular pathway targets (outside of cell) to activate internal pathways to cause cell apoptosis
216
Components of R-CHOP
Rituxan, Cyclophosphamide, Doxorubicin, Oncovin, Prednisone
