Produced by aspergilus species (mold) high heat and humidity infects before or after harvest areas of endemic soil contamination _Found in:_ corn, cereals, wheat, rice peanuts and sunflower seeds spices including pepper and ginger nuts Hepatocellular cancer higher in Aspergillus flavus endemic areas.

Benefits of Vegetables

1. Sources of vitamins and minerals: Vit A retinoic acid is a differentiation agent Folate reduces cancer risk 2. Dietary Fiber Binds carcinogens Shortens transit time Increases bulk Recommmended intake 25 g for women 38 g for men 3. Induction of Phase II Enzymes Conjugation of carcinogens with glutathione, glucuronidation, sulfation Isothiocyanates or organosulfur molecules Broccoli, cauliflower, cabbage, radishes, garlic, onion

Source of: 1. Vitamins 2. Monoterpenes _reduces farnesylation of G-protein receptors_ may _decrease growth factor-mediated proliferation of cancer cells_

Nutrition and Cancer Flashcards by Quynh Tran

Carcinogenesis Pathways

Genetic
- oncogenes, proto-oncogenes, tumor suppressor genes
Biologic
- transforming viruses
Physical
- radiation, UV → DNA damage
Chemical carcinogens
- procarcinogens → activation → DNA damage
- inflammation → free radicals → DNA damage
- excess growth hormone → cancer progression

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Alcohol

Associated Cancers

Known increased risk:
- mouth
- larynx
- pharynx
- esophagus
- liver
Observed increased risk:
- breast
- colon

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Alcohol

Cancer Mechanism

Excess acetaldehyde
- EtOH → acetaldehyde by alcohol dehydrogenase in liver
- Acetaldehyde → Krebs cycle ⟾ energy
- Excess acetaldehyde → systemic ⟾ impaired mitochondrial function & cirrhosis
Excess NADH
- ⊕ pyruvate → lactic acid ⟾ ⊖ gluconeogenesis ⟾ acidosis & hypoglycemia
- ⊕ lipogenesis ⟾ obesity
- ⊕ ETC in mitochondria & ⊖ lipid metabolism ⟾ ⊖ Krebs cycle & acetyl CoA accumulation ⟾ hyperlipidemia and ketosis
Induces hepatic Phase I enzymes (cyto-P450 enzymes) ⟾ hydroxylation/oxidation ⟾ activation of compounds

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Obesity Associated Cancers

Clear Increased Risk

Clear increased risk:
- post-menopausal breast cancer
- endometrial (uterine) cancer
- colon ca
- esophageal ca
- kidney ca

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Obesity Associated Cancers

Observed Increased Risk

Observed increased risk:
1. pancreas
2. gallbladder
3. thyroid
4. ovary
5. cervix
6. prostate

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Obesity

Cancer Mechanism

Breast & endometrial ca
- peripheral fat hormone production ⟾ ↑ estrogen
Colon ca
- associated with IGF-1/insulin
Esophageal & gastric ca
- increased reflux ⟾ Barrett’s esophagus
Kidney ⟾ unknown

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Meat

Associated Cancers

Epidemiological studies
- colon
- pancreatic
- prostate
Animal studies
- breast
- colon
- liver
- skin

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Meat

Carcinogenic Compounds

Nitrates/nitrites
- preservatives in processed meats
- binds proteins to form nitrosamines
- vit C inhibits reaction
Byproducts of combustion
- polycyclic aromatic hydrocarbons
  - generated by combustion of fat in high heat (grilling)
  - from coal tar and auto exhaust
- heterocyclic amines
  - amino acids + creatine combine in heat

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Meat

Cancer Mechanism

Benzopyrene (a polycyclic aromatic hydrocarbon) activated by Phase I enzymes ⟾ becomes carginogenic.

Active benzopyrene diol epoxide intercalates into DNA ⟾ replication errors.

p53 tumor suppressor gene possible target.

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Aflatoxin

Produced by aspergilus species (mold)
- high heat and humidity
- infects before or after harvest
- areas of endemic soil contamination
Found in:
- corn, cereals, wheat, rice
- peanuts and sunflower seeds
- spices including pepper and ginger
- nuts
Hepatocellular cancer higher in Aspergillus flavus endemic areas.

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Aflatoxin

Cancer Mechanism

Hepatic Aflatoxin B1 metabolism ⟾ ROS.

Epoxide binds DNA ⟾ DNA adducts.

p53 is a target.

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Benefits

Vegetables

Sources of vitamins and minerals:
- Vit A
  - retinoic acid is a differentiation agent
- Folate
  - reduces cancer risk
Dietary Fiber
- Binds carcinogens
  - Shortens transit time
  - Increases bulk
- Recommmended intake
  - 25 g for women
  - 38 g for men
Induction of Phase II Enzymes
- Conjugation of carcinogens
  - with glutathione, glucuronidation, sulfation
- Isothiocyanates or organosulfur molecules
- Broccoli, cauliflower, cabbage, radishes, garlic, onion

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Benefits

Fruits

Source of:

Vitamins
Monoterpenes
- reduces farnesylation of G-protein receptors
  - may decrease growth factor-mediated proliferation of cancer cells

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Vitamin Supplementation

Tocopherols (Vit E) and carotenoids (Vit A)
- membrane-associated antioxidants
Vit C
- serum/ECF associated antioxidant
- recharges tocopherol back to antioxidant state
Selenium
- needed for glutathione peroxidase
Manganese
- used by antioxidants
Iron
- used by superoxide dismutase

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American Cancer Society

Nutrition & Physicial Activity Guidelines

Maintain a healthy weight
- balance activity and intake
- avoid excess gain
- achieve healthy weight if overweight
Adopt a physically active lifestyle
- 30 mins of moderate activity 5 days a week
Consume a healthy diet with emphasis on plant sources
- portion control
- 5 servings of variety of fruits and vegetables
- whole grains
- limit processed and red meats
Limit alcohol consumption
- 1 drink for women, 2 for men

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Cancer Cachexia

Causes

May be due to:

Depression
Decreased PO intake
Increased BEE due to IL-1, IL-6, and TNF-𝛼
Preferential muscle catabolism

Surgical and Radiation Therapy

Considerations

Perioperative NPO status
Head, neck, and esophagus ca
- dysphagia, odynophagia
- xerostomia (dry mouth)
- ageusia, dysgeusia (lost/impaired taste sensation)
GI/GYN/GU ca
- early satiety
  - tumor compression or surgical restriction
- partial/complete obstruction
  - adhesions or tumors
Hepatic/pancreatic ca
- impaired digestion/absorption

Cytotoxic Chemotherapy

Considerations

Nausea/vomiting
Anorexia
Taste alterations
Cytotoxic effects:
- intestinal lining
  - enteritis, colitis, typhlitis, perforation
- hair and nails
  - cosmetic, depressing
- neuropathy
  - pain and reduced sensation
- nephropathy
  - acute/chronic renal insufficiency
- hepatotoxicity
  - reduced ability to detoxify
  - increased fatty replacement
  - reduced synthetic function

Other Chemotherapy

Considerations

Steroids
- immunosuppression
- centripetal obesity
- muscle wasting
- insulin resistance
Anti-estrogen therapy
- weight gain
Anti-androgen therapy
- muscle wasting

Herceptin

Molecular Target Drugs

Effects

cardiomyopathy

Erbitux

Molecular Target Drugs

Effects

skin toxicity

Gleevec

Molecular Target Drugs

Effects

colitis

Sorafenib

Molecular Target Drugs

Effects

muscle wasting

Bevacizumab

Molecular Target Drugs

Effects

muscle wasting

Nutritional Interventions

How to combat cachexia: 1. **Increase PO intake / dietary supplements** * no efficacy 2. **Increase appetite** * progestational agents * medroxyprogesterone * cannabinoids ⟾ better in HIV 3. **Combat catabolism** * androgens ⟾ not effective 4. **Block TNF** * 3 randomized controlled trails ⟾ negative

Enteral Nutrition

_Tube Feeding_ 1. **Nasogastric tube** * short-term solution * least invasive * aspiration risk * not an option for upper GI surgeries 2. **Gastrostomy tube** * minimally invasive * aspiration risk * long lasting * not an option for upper GI surgeries 3. **Jejunostomy tube** * moderately invasive * no aspiration risk * long lasting * can be used immediately post-op for almost any surgery

Parenteral Nutrition

1. **Peripheral line (PPN)** * temporary * non-invasive * **can provide up to 1/3 of nutritional requirements** * risk of local phlebitis/infection 2. **Total parenteral nutrition (TPN)** * temporary or long term * depends on type of central catheter * minimally invasive * **can provide all caloric and nutritional requirements** * slows or stops catabolism * may increase weight * infection risk, hepatotoxiity

Treatment for N/V, anorexia, and taste alterations

1. **Anti-emetic medications** * Zofran * Compazine 2. **Dietary Modifications** * beverages * nutrient dense * limited aroma * cold, mild flavored foods * high moisture foods

Treatment for Hepatic and Pancreatic Insufficiency

1. **Diet modifications** * low fat diet * branched chain AA * probiotics * reduce nitrogen production 2. **Medications** * pancreatic enzyme replacement * insulin * lactulose * acidify colon and reduce ammonias

Treatment for Immunosuppression

1. **Diet** * maintain healthy food sources * avoid uncooked meats * increase 𝜔-3 FA intake * increase Vit B and Folate 2. **Mediations** * GM-CSF * antibiotics * vaccines

Neutropenic Diet

* Avoid all fresh fruits and vegetables, including garishes. * Avoid raw or rare-cooked meat, fish, and eggs. * Avoid salad bars, fruit bars, and deli-counters. * Avoid raw nuts. * All diary must be pasteurized. * Avoid yogurt and products with live cultures. * Safe food handling. * Water * may use tap * bottled water must be reverse osmosis, distillation, or filtered through 1 micron or smaller * well-water must be boiled for at least 1 min