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411 Oncology > L4 - Nutrition & Cachexia > Flashcards

L4 - Nutrition & Cachexia Flashcards

1
Q

Why is the site of cancer important to consider when managing cancer?

A

Cancers near the head & neck will impact how patients eat/chew e.g oral cancer vs breast cancer

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2
Q

How can radiotherapy affect management of cancer?

A

If radiotherapy is given for the head/neck, it may have significant impacts on the ability to eat & the sense of taste

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3
Q

Why are side effects of treatment important to consider when managing cancer?

A

Nausea & vomiting is common with chemotherapy –> may hinder ability to keep food down

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4
Q

Why is patient age important to consider when managing cancer?

A

Elderly patients tend to be poorly nourished & frail –> may not be able to tolerate treatment well

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5
Q

What is one of the most important markers of morbidity, mortality, & ability to tolerate treatment?

A

Weight loss

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6
Q

Which cancers have the most acute & chronic weight loss?

A

Cancers relating to GI tract

–> but these cancers also tend to respond to nutritional support best

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7
Q

What is the relationship between body weight loss & total body protein loss?

A

Lean body mass = lean functional tissue mass

Whenever weight is lost, protein is also lost –> important to try maintain weight

Proportion of weight loss from original weight will indicate median survival time

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8
Q

What is cachexia?

A

Wasting away of the body

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9
Q

What is the pathophysiology of cachexia? (FOUR steps)

A
  1. Tumour’s drive to produce pro-inflammatory cytokines
  2. Increased pro-inflammatory response (interleukins, TNFa etc.)
  3. Endocrine dysfunction
  4. Increased protein degradation, decreased protein synthesis
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10
Q

What FOUR things does cachexia lead to?

A

Decreased survival

Alterations in body image

Decreased function & strength

Caregiver distress

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11
Q

What is precachexia?

A

Weight loss <5%

Anorexia & metabolic change

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12
Q

What is cachexia? (stages)

A

Weight loss >5%, may have sarcopenia (decrease in skeletal muscle) or decreased BMI

Reduced food intake

Systemic inflammation

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13
Q

What is refractory [resistant] cachexia?

A

Cancer disease procatabolic & unresponsive to treatment

Low performance score

< 3 months survival

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14
Q

How is fat breakdown caused?

A

Tumour –> lipid mobilising factor –> fat breakdown

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15
Q

How is anorexia caused?

A

Tumour –> cytokines –> hypothalamus –> anorexia

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16
Q

How is increased energy expenditure caused?

A

Tumour –> cytokines –> hypothalamus –> increased energy expenditure

17
Q

How is the inflammatory response caused?

A

Tumour –> cytokines –> liver –> inflammatory response

Tumour –> hormonal changes –> skeletal muscle –> liver –> inflammatory response

18
Q

How is protein breakdown caused?

A

Tumour –> proteolysis inducing factor –> skeletal muscle –> protein breakdown

19
Q

Is glucose tolerance in cachexia increased or decreased?

A

Decreased

20
Q

Is insulin sensitivity in cachexia increased or decreased?

A

Decreased

21
Q

Is glucose turnover in cachexia increased or decreased?

A

Increased –> tumour uses glucose to develop

22
Q

Is hepatic gluconeogenesis in cachexia increased or decreased?

A

Increased

23
Q

Is serum lactate level in cachexia increased or decreased?

A

Increased –> more lactic acid produced for extra energy

24
Q

Is lactic acid cycle level in cachexia increased or decreased?

A

Increased –> more lactic acid produced for extra energy

25
Q

Is serum triglyceride level in cachexia increased or decreased?

A

Increased –> mobilisation of fat stores

26
Q

Is protein turnover in cachexia increased or decreased?

A

Increased –> proteolysis inducing factor –> breakdown of proteins to produce energy for tumour

27
Q

Is skeletal muscle catabolism in cachexia increased or decreased?

A

Increased –> proteolysis inducing factor –> breakdown of proteins to produce energy for tumour

28
Q

Which treatment is weight loss most common in?

A

All

Chemotherapy
Radiation
Surgery
Immunotherapy

29
Q

What treatment is fatigue most common in?

A

All

Chemotherapy
Radiation
Surgery
Immunotherapy

30
Q

What treatment is nausea & vomiting most common in?

A

Chemotherapy
Radiation
Surgery

NOT immunotherapy –> more targeted

31
Q

What treatment is oral mucositis most common in?

A

Chemotherapy –> systemic cytotoxic
Radiation –> local
Immunotherapy

NOT surgery –> cells in mouth not damaged since surgery is localised

32
Q

What treatment is taste disturbance most common in?

A

Chemotherapy

Radiation

33
Q

What treatment is constipation most common in?

A

Chemotherapy

34
Q

How does physical impairment of swallowing contribute to malnutrition in cancer? (FOUR points)

A

Effects on chewing/swallowing mechanisms

Reduction in saliva production (xerostomia)

Radiation-induced or chemotherapy-induced mucositis (painful to eat)

Surgical interruption of swallowing mechanism

35
Q

How does alterations in physiology contribute to malnutrition in cancer? (THREE points)

A

Malabsorption/maldigestion due to tumour or therapy

Constipation/GI immotility

Removal of part of GI tract

36
Q

How does insufficient dietary intake contribute to malnutrition in cancer? (TWO points)

A

Suppression of appetite (nausea, vomiting)

Food aversion

37
Q

What is enteral feeding?

A

Any method of feeding involving GI tract to deliver nutrition

May involve oral or NG tube

38
Q

How is food delivered parenterally?

A

Simplest building block

Protein - amino acid
Carbohydrate - glucose
Fat - fatty acids, triglycerides & combination
Micronutrients - vitamins, minerals (eg. iron, calcium, zinc), trace elements (eg. boron)
Fluid balance - electrolytes

411 Oncology (9 decks)

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