lecture 18 Flashcards
What is Cancer?
Disorder of cell growth and proliferation
– Unregulated proliferation of cells
– Prominent properties
• Lack of differentiation of cells
• Local invasion of adjoining tissues
• Metastasis à spread to distant sites through bloodstream or lymphatic system
– Will not occur in all cancers
• Umbrella term for a collection of > 200 related diseases
• Carcinoma:
Most common type of cancer
– Formed by epithelial cells (that cover inside/outside surfaces of the body)
– Those that begin in different epithelial cell types have specific names
• Adenocarcinoma: cancer that forms in epithelial cells that produce fluid or mucus
»Most common: breast, colon, prostate
• Basal cell carcinoma: cancer that begins in the lower or basal (base) layer of the epidermis
(outer layer of skin)
• Squamous cell carcinoma: epithelial cells that lie just beneath outer surface of the skin or
line organs
»i.e. stomach, intestines, lungs, bladder, kidneys
• Transitional cell carcinoma: cancer that forms in transitional epithelium (made up of many
layers of epithelial cells that can get bigger/smaller)
»i.e. bladder, ureters, parts of kidneys
• Sarcoma:
Form in bone and soft tissues (muscle, fat, blood and lymph vessels,
fibrous tissues)
Multiple myelomas:
Begins in plasma cells (type of immune cell).
– Abnormal plasma cells (myeloma cells) build up in bone marrow forming tumours in
bones and throughout body
Melanoma: C
: Cancer that begins in cells that make melanin
– Most form on skin; can form in other pigmented tissues, i.e. eye
• Germ cell tumours:
begin in cells that give rise to sperm or eggs
i.e. ovarian, testicular
• Neuroendocrine tumours:
from from cells that release hormones
into the blood in response to a signal from the CNS
• Carcinoid tumours:
type of neuroendocrine tumour.
– Slow growing, usually found in GIT
– May secrete substances such as serotonin or PG’s causing carcinoid
syndrome
Key Factors Influencing Nutritional State and Delivery of
MNT in Individuals with Cancer
Site / type / stage of cancer – Where patient is at in the trajectory of illness (pre/during/post-treatment) • Metabolic alterations – Tumour induced – Treatment induced • Side effects related to specific treatment modalities – Physiological – Psychological
Cancer classified based on:
– Size and/or extent of original (primary) tumour
– Whether the cancer has spread
• Staging assists with:
– Treatment plans
– Estimating prognosis
– Identifying ongoing clinical trials a patient may be eligible for
TNM (Tumour Node Metastasis) Cancer Staging System
• TMN staging examples:
– Prostate cancer T2 N0 M0
• Tumor located in prostate that has not spread to lymph nodes or elsewhere in the body
– “X” (i.e. TX, NX, MX) means can’t be measured/evaluated
• These combinations correspond to stages of cancer
T:
1: less than 3cm
2: more than 2cm
3: any size but near airway
4: in airwqay
N:
0: no lymph nodes are affected
1: spread to nearby nodes on same side of the body
2: nodes further away but on same side of body
3: nodes on other side of body
M:
1: no metastasis
2: has spread to other regions on teh body
Nutritional Implications of Cancer
• Cancer patients are at high risk for malnutrition
• Prevalence of malnutrition is __20-70%____ in hospitalized pt’s with CA • Highest risk of malnutrition associated with cancers of:
– GI- stomach, intestine, pancreatic, ETC.
– Head and neck
– liver
– lung
• Malnutrition associated with poor outcomes
– ↑ hospital LOS, hospital costs, surgical site infections, antibiotic use, mortality
– ↓ chemotherapy tolerance, QOL
– Significant implications for advocacy of more aggressive nutrition therapies
Disease-Related Malnutrition (DRM)
• Disease related malnutrition (DRM) o A condition that results from activation of systemic inflmamtion by an underlying disease such as cancer • Inflmamtory response results in: o Anorexia o (lean and fat) tissue breakdown • Leads to o Signid=ficant weight loss o Alterations in body compositions o Declining physical function
Cancer Cachexia
“Multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment.
The pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism”
Precachexia
Weight loss <5%
anorexia and metabolic changes
Cachexia
Weight loss >5% or BMI <20 and weight loss >2% or sarcopenia and weight loss >2% Often reduced food intake/ systemic inflammation
Refractory cachexia
Variable degree of cachexia Cancer disease both procatabolic and not responsive to anticancer treatment Low performance score <3 months expected surviva
Definition of Sarcopenia in the Context of
Diagnosing Cancer Cachexia
• Mid upper-arm muscle area à TESTED HOW?
– Men <32 cm2;women <18 cm2)
• Appendicular skeletal muscle index à TESTED HOW?
– Men <7.26 kg/m2; women <5.45 kg/m2)
• Lumbar skeletal muscle index à TESTED HOW?
– Men <55 cm2/m2; women <39 cm2/m2)
• Whole body fat-free mass index à TESTED HOW?
– FFM / height2
– Men <14.6 kg/m2; Women <11.4 kg/m2)
Relationship Between Systemic Inflammation in
Cancer and DRM
anorexia, weight loss, fatigue and pain, depression
Anorexia, Cachexia and Sarcopenia in Cancer:
The Perfect Storm for DRM
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Types of Cancer Therapies
Surgery • Systemic treatments – Chemotherapy – Hormone therapy – Biologic therapy (i.e. immunotherapy) • Radiation therapy (XRT) • Transplantation (i.e. bone marrow) Types of Cancer Therapies Therapies can be given in combination / multiple therapies administered over the course of treatment
• Neoadjuvant
– Treatment given as first step to shrink the tumor prior to primary treatment: ie. Neoadjuvant chemotherapy given prior to surgery
• Adjuvant
– Treatment given after the primary treatment to lower the risk that cancer will come back
▪ May include cancer, chemo, XRT, hormone , targeted, biological therapy
Cancer Therapy: Surgery
Removal of the tumour
– May be the only treatment required or adjuvant
• Tumour debulking
• Palliative surgery
• Tumour debulking
– Surgical removal of as much of a tumor as possible (I.E. IF CANCER has metastasized)
▪ May increase chance chemo +/- XRT will kill all the tumor cells
• Palliative surgery
– Ameliorate disease or treatment related symptoms
– Ie. Resection of a tumor causing spinal cord compression
– Not curative