MNT Cancer , surgery, bariatric surgery Flashcards
Cancer overview
uncontrolled growth, proliferation , and spread of abnormal cells
-occurence involves
-Genetics- oncogenes and tumor suppressor genes
-Exposure to carcinogens-chemicals, physical agents, radiation, infectious microorganisms.
Second leading cause of death in the U.S.
Cancer prevention
Nutrition can modify carcinogenic process at any stage but prevention is key.
-35% of cancers can be prevented through diet and lifestyle changes.
-Limit alcohol, saturated fat, red meat (grilled/boiled due to PAH & HCA), highly processed foods.
-Increase fiber foods, Organic fruits and veggies, small wild caught fish
-Dietary carcinogen inhibitors include:
1. Antioxidants
a. Vitamin A, C, E
b. Selenium
c. Zinc
2. Phytochemicals
a. lycopene (tomato, grapefruit)
b. Anthocyanidins (Berries, grapes, plums)
c. Lutein, Zeaxanathin (spinach, avocado, honeydew)
d. Sulforofanes, Indoles (cruciferous veggies)
e. Ally sulfides (leeks, onion, garlic)
3. Coffee and Tea
a. Major source of antioxidants
b. Shown to have antiangiogenesis and antiproliferative properties for cancer prevention.
4. Soy and phytoestrogens
a. Can prtoect against prostate, breast and cervical cancer.
b. not recommended for hormone sensitive cancers
Cancer prevention guidelines
Maintain a healthy weight throughout life.
-Balance calorie intake with physical activity
-avoid excessive weight gain throughout life
-Physical activity
a. Adults: 30 minutes of moderate to vigorous activity 5 days per week. 45-60 minutes of intentional physical activity are preferable.
b. Children/adolescents: Engage in at least 60 minutes per day of moderate to vigorous activity at least 5 days.
-Eat a Healthy Diet (Plant focused)
-Eat 5 or more servings of vegetables and fruits every day.
-Limit processed and red meats.
-Limit alcohol: one drink for Women, two drinks for Men
Cancer MNT
-Inadequate nutritional intake is frequently observed in cancer patients- screen for malnutrition
1. Energy:
a. weight gain: 30-40 kcal/kg/day
b. Hypermetonolic: 35 kcal/kg/day
c. Normometanolic: 25-30 kcal/kg/day
2. Protein
a. based on individual needs
b. non stressed: 1.0-1.5
c. Typical stress: 1.5-2.0g/kcal/day
d. up to 2.5 g/kg/day in patients with severe stress.
3. Cancer Cachexia
a. Progressive weight loss, anorexia, generalized wasting, weakness, imunnosupression, increased, lipolysis, altered BMR
b. Caused by cytokines-TNFa, TNFb, IL1, IL6
c. Can be tumor specific-more common in Lunh & Gi cancer
d. Nutrition invervention ?
Cancer treatments: chemotherapy
a. Nutrition related side effects
-Nausea and vomiting (acute, delayed, anticipatory)
- Oral changes (thrush, xerostomia: dry mouth, dysgeusia: metallic taste)
-mucositis
-alopecia
-anemia
-most lethal to cells under continual replication (Gi tract and hair follicales)
b. Nutrients that can improve effectiveness
-Melatonin
-Green Tea
c. Antioxidants during treatment
-may inhibit antitumor effects of radiation and chemotherapy
cancer treatments: radiation
a. nutrition related side effects depend on site.
-fatigue
-nausea
b. Nutrients that can enhance effectiveness
-melatonin
-flavanoids
-ashwagandha
-glutamine-protects mucus membrane during radiation
Nutrition related effects of radiation
a. central nervous system (brain/spinal cord): nausea, vomiting, fatigue, loss of appetite, Hyperglycemia associated with corticosteroids
Late effects >90 days : headache, lethargy
b. head and neck: Xerostomia, mucositis, sore mouth and throat, Dysphagia, alterations in taste and smell, fatigue, loss of appetite.
Late effects: >90 days
Mucosal atrophy and dryness
salivary glands (serostomia, fibrosis)
Osteoradionecrosis
c. Thorax (esophagus, lung, breast)
Esophagitis, Dysphagia, heartburn, fatigue, loss of appetite, Late effects >90 days: Esophageal, cardiac, pulmonary,
d. abdomen and pelvis: nausea, vomiting, changes in bowel function (diarrhea, cramping, bloating), urinary function ( increased frequency, burning)
acute colitis
lactose intolerance
fatigue, loss of appetite
Late effects >90 days: Diarhhea, malabsorption, maldigestion, chronic colitis, hematuria, cystitis,
cancer Treatments
-Hematopoietic stem cell transplantation
-used for hematologic cancers, aplastic anemia,
-stem cells are obtained from a donor or the patient
-total body irradiation is performed in preparationfor transplantation and can lead to nausea, vomiting mucosities
-Biologic Therapies:
-monoclonal antibodies, interleukins, and other immunomodulating agents.
- fatigue, fever, anorexia, rashes, flu like symptoms.
Cancer treatments
-Eat small, more frequent nutrient dense meals and snacks.
-Add protein and calories to favorite foods
-use protein and calorie containing supplements (whey or soy powder)
-keep nutrients dense food close
-capitalize on time when feeling well.
Eat meals and snacks in apleasant environement
-Be as physically active as possible,
sip on cool or room temperature clear liquids (nausea)
-avoid high fat, greasy, spicy foods (Nausea)
-avoid strong odor (nausea)
-Eat bland, soft, easy to digest foods on scheduled treatment days (Nausea)
-Consume clear liquids (diarrhea)
-decrease intake of high fiber foods (nuts, raw fruits, veg)
-avoid sugar alcohol containing foods
-eat applesauce, banan , canned peaches,
-increase intake of high fiber (constipation)
-drink fluids
- eat and snack at the same time each day.
-increase physical activity
eat soft, moist foods (sore throat)
-avoid dry, course, foods
-avoid alcohol, citrus, caffeine, tomatoes, vinegar, hot peppers
-experiment with foods (warm, cool, soft…) Sore throat
-Maintain good oral hygiene )thrush, mucositis, sore mouth)
-eat soft, most foods
-avoid alcohol, citrus, caffeine
-room temp or cool fluids,
-consume easy to prepare, east to eat foods (fatigue)
-keep nutrient dense snacks close at hand and snack frequently
-drink plenty of healthy fluids
-be as physical active as possible
Cancer surgery
-nutrition concerns based on iste and type
-Dysgeusia
-Xerostomia (dry mouth)
-Alterations in smell
-Difficulty speaking
-Dumping syndrome
-steatorrhea
-electrolyte/fluid imbalance
Cancer surgery (Nutrition related facts)
Oral cavity: Difficulty with chewing and swallowing, aspiration potential, sore mouths and throat, xerostomia, alteration in taste and mouth
Larynx: normal swallowing, aspiration potential, dysphagia
Esophagus: gastroporesis, indigestion, acid reflux, alteration of normal swallowing, dysphagia, decreased swallowing, anastonomic leak
Lung: SOB, early satiety
stomach: dumping syndrome, dehydration, early satiety, gastroporesis, fat malabsoprtion, vitamin and mineral malabsorption (B12, D3, Iron, Calcium)
Gallbladder/Bile duct: Gastroporesis, hyperglycemia, fluid and eleectrolyte imbalance, fat malabsoprtion, vitamin A, D, E, K, magnesium, calcium
Liver: Hyperglycemia, Hypertriglyceridemia, fluid and electrolyte malabsoprtion, Vitamin A, D, E, K B12, folic acid, magnesium
Pancreas: Gastroporesis, fluid and electrolyte imbalance, hyperglycemia, fat malabsoprtion: A,D, E, K, calcium, Zinc, iron, B12
small. bowel: Chyle leak, lactose intolerance, bile acid depletion, diarrhea, fluid and electrolyte imbalance, vitamin and mineral malabsoprtion (A, D, E, K, b12, calcium)
colon and rectum: Increased transit time, Diarrhea, dehydration, bloating, cramping, gas, fluid and electrolyte imbalance, B12, sodium, magnesium, potassium )
Ovaries and uterus: Early satiety, bloating, cramping, gas,
Brain: Nausea, vomiting, hyperglycemia associated with corticosteroids.
Surgery
Malnutrition and overnutrition increase surgical risks and can lead to post-operative complications—pre-op nutrition screening should be performed.
General anesthesia can result in lack of motility of ilium and lead to constipation 24-48 hours after surgery
Major surgeries result in metabolic stress–nutritional needs are increased for healing and repair
-Energy: 25-35 kcal/kg/day
-protein: 1.2-1.5 kcal/kg/day
Patient should be progressed from NPO to solid food asapafter surgery
Nutrients that are altered during metabolic stress and support post surgical healing
-omega 3 fatty acids
-glutamine
-arginine
-vitamin C & E
-selenium
-Zinc
-Pre/probiotics
Bariatric Surgery Types
Restrictive-limit calorie intake by decreasing stomach capacity
1. adjustable gastric band
a. compartmentalizes upper stomach with adjustable band creating a 15 mL pouch
2. vertical sleeve gastrectomy
a. Greater curvature of stomach is removed and tubular stomach is created
Malabsorption and restrictive
1. Roux-en-Y
a. Gastric pouch is created, jejunum is cut and attached to pouch. Bypass majority of stomach, all of duodenum, and part of jejunum
b. Gold standard & most common type of bariatric surgery performed
Bariatric Surgery Criteria
Criteria:
-BMI of 40, or 35 with comorbid consitions (diabetes, sleep apnea, severe joint disease)
-Previously failed non-surgical weight loss interventions
-Display commitment to enduring lifestyle and nutritional changes
Benefits:
-Moat effective modality for weight management
-Proven to reduce morbidity and mortality
-can reduce diabetes, hyperlipidemia, hypertension
Risks
-surgical risks
-weight regain
Bariatric surgery (Pre-operative, post- operative)
Pre-op: anthropometrics (systematic measurements: height, weight)
b. Diet/weight history
c. medical/social history
d. psychosocial history
e. labs
f. physical activity
g. post op expectations
**Pre-op weight loss reduces liver volume and can improve outcomes in patients with enlarged or fatty liver disease
Post-Op (need to monitor)
a. protein
b. iron -decreased ability to convert Fe3–Fe2 due to low HCL
c. calcium
d. vitamin D
e. vitamin B12-less if available
f. folate
g. thiamin
h. other less common deficiencies–Zinc, vitamin A, K, E
post-op diet:
a. week 1 - full liquid, 1/4 c. per meal, 5-6x per day.
b. week 2-pureed
c. week 3- mechanical soft
Long term management:
-20-30 mins at each meal
-fluids between meals, wait at least 30 mins after eating
-minimal protein intake is 60 g/day
-routine blood tests
-supplements
a. multivitamin/mineral tablets containing iron, folic acid, thiamin
b. vitamin B12, 500-1000 mg
c. calcium citrate, 1200-1500 mg
d. vitamin D, 2000-3000 IU
e. iron, 45-60 mg
