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NUTR 442 > Lecture 19: Oncology > Flashcards

Lecture 19: Oncology Flashcards

1
Q

prominent properties of cancer:

A

lack of differentiation of cells, local invasion of adjoining tissues, metastasis thru blood/lymph

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2
Q

abnormal cell / tissue change progression:

A

normal–>hyperplasia–>dysplasia–>cancer

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3
Q

most common type of cancer:

A

carcinoma

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4
Q

carcinomas formed by ____ cells

A

epithelial

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5
Q

cancer that forms in epithelial cells that produce fluid or mucus

A

adenocarcinoma

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6
Q

cancer that starts in lower/basal layer of epidermis

A

basal cell carcinoma

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7
Q

epithelial cells lie just beneath outer surface of skin/line organs

A

squamous cell carcinoma

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8
Q

other types of cancer?

A

sarcoma (bone/soft tissue), leukemia (bone marrow), multiple myelomas (plasma cell), melanoma (melanin producing cells), germ cell, neuroendocrine, carcinoid

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9
Q

carcinoid tumours are a type of ____ tumour that are usually found in ____ and are slow growing

A

neuroendocrine; GIT

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10
Q

carcinoid tumours may secrete these substances:

A

serotonin, PG’s causing carcinoid syndrome

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11
Q

most common cancers:

A

prostate, breast, lung, colorectal

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12
Q

leading cause of cancer death?

A

lung cancer

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13
Q

key factors influencing nutr state and delivery of MNT for cancer:

A

site/type/stage of cancer, metabolic alterations (tumour or treatment induced), side effects related to specific treatment modalities (physio or psych)

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14
Q

how to diagnose cancer?

A

biochem markers, med imaging, invasive techniques (biopsy, laparoscopy, cytologic aspiration)

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15
Q

types of biomarkers?

A

blood and tumour markers

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16
Q

cancer staging based on:

A

size/extent of original primary tumour, whether cancer has spread

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17
Q

cancer staging assist with:

A

treatment plan, estimating prognosis, identify clinical trials pt eligible for

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18
Q

TNM cancer staging system based on:

A

tumour size, lymph nodes, metastases

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19
Q

X in staging means:

A

can’t be measured/evaluated

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20
Q

what is stage 0 cancer?

A

group of abnormal cells that may develop into cancer later but not yet

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21
Q

S/S of cancer?

A

unexplained wt loss, fever, fatigue, pain, skin changes

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22
Q

highest risk of malnutrition associated with cancers of :

A

GIT, head and neck, liver, lung

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23
Q

malnutrition associated with these poor outcomes:

A

^ LOS, costs, infections, antibiotic use, mortality; v chemo tolerance, QOL

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24
Q

condition that results from activation of systemic inflammation by an underlying disease such as cancer

A

disease related malnutrition

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25
Q

inflam response results in:

A

anorexia, lean and fat tissue breakdown –> wt loss, altered body comp, v phys function

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26
Q

multifactorial syndrome characterized by ongoing loss skel muscle mass that cannot be fully reversed by nutr support and lead to progressive functional impairment

A

cancer cachexia

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27
Q

wt loss = __% is precachexic

A

5

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28
Q

wt loss > __% or BMI < ___ and wt loss > __% or sarcopenia and wt loss >__% is cachexic

A

5; 20; 2; 2

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29
Q

refractory cachexia is characterized by:

A

cancer disease both procatabolic and not responsive to anticancer treatment, low performance score, <3 months survival (palliative)

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30
Q

sarcopenia characterized by:

A

low muscle mass, loss of fxn, fatigue common, decreased strength

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31
Q

implications of sarcopenia for cancer pt?

A

impact ability live independently, v QOL

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32
Q

sarcopenia diagnosed by measuring:

A

mid upper arm muscle area, appendicular skel muscle index (DEXA), lumbar skel muscle index (ct), whole body fat free mass index (BIA)

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33
Q

why fat depletion in cancer?

A

^ lipolysis and impaired lipogenesis

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34
Q

tumour releases inflamm mediators and signalling metabolites that cause:

A

CNS signals anorexia, muscle wasting, liver metabolism changes, fat use and depletion

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35
Q

types of cancer therapies:

A

surgery, systemic treatments, radiation therapy, transplantation

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36
Q

types of systemic treatments:

A

chemo, hormone therapy, biologic therapy (immunotherapy)

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37
Q

this is given to shrink a tumour before the primary treatment

A

neoadjuvant

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38
Q

treatment given after primary treatment to lower risk that cancer will come back

A

adjuvant

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39
Q

surgical removal of as much tumour as possible is called:

A

tumour debulking

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40
Q

chemotherapy can be administered either __ or via ____

A

orally; IV

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41
Q

class of meds that interrupt diff stages of cell cycle replication:

A

chemotherapy

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42
Q

combo chemo referred to as:

A

cocktails

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43
Q

what is radiation therapy?

A

use of high energy radiation from x-rays, gamma rays, neutrons, protons, to kill cancer cells and shrink tumours

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44
Q

how does radiation therapy work?

A

alter cell DNA

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45
Q

chemo given at same time sometimes to _____ cancer cells

A

radiosensitize

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46
Q

how does immunological therapy work?

A

antibodies bind to specific antigens expressed by cancer cells stimulating immune response that destroys cancer cells

47
Q

these mediate and regulate immune response, may inhibit growth of cancer cells and promote cell apoptosis

A

cytokines (INF, IL)

48
Q

biological targets include:

A

estrogen receptor, signal transduction inhibitors, modify enzymes that regulate gene expression, induce apoptosis, block angiogenesis, target immune sys, monoclonal antibodies, cytokines, hematopoietic growth factors

49
Q

goals of nutr therapy for cancer treatment?

A

1) address current cancer and treatment related concerns
2) minimize treatment related side effects
3) anticipate and manage acute, delayed, late occurring side effects of cancer and/or cancer treatment

50
Q

goals of nutr should be based on:

A

current nutr status, type/stage of disease, comorbidities, overall med treatment plan

51
Q

best approach for nutr therapies informed by:

A

symptom severity, fxn of GIT, pt preference

52
Q

nrg/pro requirements vary based on:

A

type of tumour, type of treatment, comorbidities, individual variables

53
Q

REE _____ with advanced cancer but TEE may ____

A

increases; decreases

54
Q

assess TEE with ___ (Preferred) or ____ (practice)

A

indirect calorimetry; wearable devices

55
Q

if REE/TEE not available, use target of ____ kcal/kg and _____ kcal/kg for clear hypermetabolism and goal of wt gain

A

25-30; 30-35

56
Q

general pro requirement:

A

1.2-2g/kg (not below 1, try 1.5+)

57
Q

why more protein?

A

promote protein anabolism

58
Q

nutr strategies for nausea/vomiting?

A

dry starchy foods (BRAT diet), sip liquids throughout day, avoid eating in rooms with odours, choose cold foods with less odours, eat upright, use club soda/salts, meds to address nausea

59
Q

causes of nausea/vomiting?

A

chemo, XRT to CNS/abdomen/pelvis, other meds, GI obstruction, dysmotility, intracranial lesions/edema

60
Q

causes of xerostomia +/- thick saliva

A

chemo, XRT to head/neck, salivary gland tumours, mouth surgery, meds

61
Q

nutr strategies for xerostomia?

A

ensure adequate fluids, sip on cold water/club soda/ice chips, moisten food with sauce/gravy, slightly acidic foods/bev, avoid dry/crumbly food, mouth rinses/artificial saliva/saliva stim, avoid highly acidic/caffeine/alcohol

62
Q

mucositis caused by:

A

chemo, XRT head and neck, oral candidiasis infection, weakened immune fxn and decreased salivary function

63
Q

chemo induced mucositis occur within __ days of beginning treatment, peaking within ___ days

A

3; 7-10

64
Q

XRT induced mucositis peaks at ____

A

completion of treatment

65
Q

nutr strategies for mucositis:

A

soft/bland/moist food, avoid alcohol/acidic/tart/spicy foods and extreme temps, straws, mouth rinses

66
Q

if mucositis severe, consider :

A

full fluid diet, EN, PN

67
Q

if develop c difficile, consider ___ until resolved

A

PN

68
Q

causes of diarrhea:

A

chemo, XRT to ab and pelvis, various meds, infections , anxiety, lactose intolerance

69
Q

causes of constipation:

A

meds (pain/opioids), tumours around bowel, v food/fluid, v mobility, neuro dysfunction

70
Q

preeminent interdisciplinary pt assessment tool in oncology

A

PG-SGA

71
Q

purpose of ECOG performance status?

A

scales/criteria used assess pt disease progression, assess ADLs, determine appropriate treatment/prognosis

72
Q

common oncology nutr diagnoses?

A

inadequate pro/energy intake, chronic disease related malnutrition, ^ energy expenditure, altered GI fxn, unintended wt loss

73
Q

what is diff between inadequate pro/energy intake and inadequate oral intake?

A

specific nutr lower than needed vs. set a goal “rate” but not getting enough

74
Q

nutr relevant risk factors for breast cancer?

A

overwt/obese, not physically active

75
Q

treatment for breast cancer to reduce risk of recurrence:

A

hormone therapy (ER + BrCA: presence of estrogen promotes cell growth)

76
Q

tamoxifen is example of ____ drug

A

anti-estrogen

77
Q

metabolic side effect of tamoxifen?

A

^ TG

78
Q

metabolic side effects of aromatase inhibitors?

A

^ bone loss and risk of osteoporosis, wt gain?

79
Q

used for treatment of breast cancer in premenopausal women

A

ovarian suppression

80
Q

types of ovarian suppression?

A

surgical (oophorectomy) and luteinzing hormone-releasing hormone agonists

81
Q

nutr considerations for breast cancer?

A

during treatment don’t promote wt loss and monitor for common nutr-related side effects; recovery wt gain is common

82
Q

why recovery wt gain

A

reduced metabolism related to estrogen suppression, reductions in PA, diet quality more fat than recommended

83
Q

diet recommendations post-treatment:

A

reduce risk of recurrence by managing other comorbidities, ^ V and F, v fat (<30% kcal), minimize cured/pickled/smoked foods, limit alcohol, healthy wt

84
Q

common therapy in head and neck cancers?

A

chemoradiation, particularly toxic antineoplastic regimen

85
Q

chemoradiation in head and neck cancer commonly result in:

A

xerostomia, dysgeusia, dysphagia, nausea, early satiety, fatigue, odynophagia, severe mucositis

86
Q

v nutr status lead to:

A

treatment toxicities, v QOL, interruptions/delays in treatments

87
Q

nutr considerations fro HNC:

A

prophylactic PEG (at surgical resection or initiation of XRT)

88
Q

why prophylactic PEG?

A

v rate ER visits, v hospitalizations, v interruptions in treatment, v wt loss

89
Q

malnourished pt undergoing tumour resection should receive ___ days preop EN because ___

A

7-10; v morbidity and ^ QOL

90
Q

predictors for need of preop EN?

A

recent heavy alcohol use, tongue base involvement, surgery, XRT, tumour size

91
Q

strategies to limit mucositis:

A

good oral hygiene, opiate analgesics, nutr support therapy providing adequate pro for wound healing

92
Q

nutr impact symptoms of esophageal cancer:

A

anorexia, dysphagia, odynophagia, heartburn, N/V, diarrhea, mucositis

93
Q

nutr issues after esophagectomy?

A

early satiety, gastroparesis, dysphagia, dysmotility, dumping

94
Q

post-esophagectomy nutr recommendations:

A

eat slowly , small frequent meals on schedule, chew well, avoid foods poorly tolerated, anti dumping diet

95
Q

symptoms of ovarian ca

A

stomach/pelvic pain, early satiety, involuntary wt loss, ab swelling

96
Q

malignant obstructions in ovarian ca related to:

A

tumour location, radiation enteritis, carcinomatosis, disease progression (need intestinal surgery 30-50% of time)

97
Q

conservative management of malignant bowel obstructions of advanced CA:

A

NG suction, bowel rest, symptom management, IV fluids

98
Q

process that involves IV infusion of hematopoietic stem cells collected from bone marrow, peripheral blood or placental cord blood into pt after treatment with cytoreductive conditioning system

A

hematopoietic stem cell transplantation

99
Q

purpose of cytoreduction?

A

kill cancer cells, immune cells (to avoid transplant rejection), bone marrow cells to make room for new blood forming stem cells

100
Q

types of HSCT:

A

autologous (infuse pt own stem cells), allogenic (infusion from histocompatible donor)

101
Q

HSCT pt receive ________ regimen

A

pre transplant conditioning

102
Q

adverse effects/complications of HSCT develop dependent on:

A

conditioning regimen, age, presence of comorbidities, time between treatment and followup

103
Q

non-infectious complications fo HSCT?

A

fluid/electrolyte abnormalities, sinusoidal obstruction syndrome, kidney injury, compromised cardiopulmonary fxn, graft-vs-host disease

104
Q

S/S of sinusoidal obstruction syndrome

A

ab pain/swelling, evidence of portal HTN, ^ liver enzymes, jaundice

105
Q

clinical presentation of graft vs host disease?

A

derangements in skin, liver, GIT

106
Q

s/s related to GIT for graft vs host disease;

A

N/V, ab cramps, diarrhea, anorexia, xerostomia, mucositis, altered nutr rqts

107
Q

nutr therapy for HSCT

A

low microbial diet for oral diet

108
Q

what is low microbial diet?

A

well washed foods, exclude unpasteurized milk/raw meat/herbal products/aged cheese/unwashed V and F, safe food handling

109
Q

if autologous, low microbial diet for ___ months after transplant, if allogenic, up to ___ yr(s) + if remain on immunosuppressive therapies

A

3; 1

110
Q

why no iron?

A

cuz risk iron overload

111
Q

NG probs?

A

increase infectious risk, mucosal bleeding, worsen GI symptoms

112
Q

HSCT energy requirements for severely malnourished is ____ and for non severe malnourished is ____

A

3-5x BEE or 30-35 kcal/kg; 25-30 kcal/kg

113
Q

protein rqts for HSCT first 1-3 months after transplant:

A

1.5-2g/kg

NUTR 442 (34 decks)

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