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IMS: Nutrition > Nutrition and Cancer > Flashcards

Nutrition and Cancer Flashcards

1
Q

Carcinogenesis Pathways

A
  1. Genetic
    • oncogenes, proto-oncogenes, tumor suppressor genes
  2. Biologic
    • transforming viruses
  3. Physical
    • radiation, UV → DNA damage
  4. Chemical carcinogens
    • procarcinogens → activation → DNA damage
    • inflammation → free radicals → DNA damage
    • excess growth hormone → cancer progression
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2
Q

Alcohol

Associated Cancers

A
  1. Known increased risk:
    • mouth
    • larynx
    • pharynx
    • esophagus
    • liver
  2. Observed increased risk:
    • breast
    • colon
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3
Q

Alcohol

Cancer Mechanism

A
  1. Excess acetaldehyde
    • EtOH → acetaldehyde by alcohol dehydrogenase in liver
    • Acetaldehyde → Krebs cycle ⟾ energy
    • Excess acetaldehyde → systemic ⟾ impaired mitochondrial function & cirrhosis
  2. ​Excess NADH
    • ⊕ pyruvate → lactic acid ⟾ ⊖ gluconeogenesis ⟾ acidosis & hypoglycemia
    • ⊕ lipogenesis ⟾ obesity
    • ⊕ ETC in mitochondria & ⊖ lipid metabolism ⟾ ⊖ Krebs cycle & acetyl CoA accumulation ⟾ hyperlipidemia and ketosis
  3. Induces hepatic Phase I enzymes (cyto-P450 enzymes) ⟾ hydroxylation/oxidation ⟾ activation of compounds
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4
Q

Obesity Associated Cancers

Clear Increased Risk

A
  1. Clear increased risk:
    • post-menopausal breast cancer
    • endometrial (uterine) cancer
    • colon ca
    • esophageal ca
    • kidney ca
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5
Q

Obesity Associated Cancers

Observed Increased Risk

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

Obesity

Cancer Mechanism

A
  1. Breast & endometrial ca
    • peripheral fat hormone production ⟾ ↑ estrogen
  2. Colon ca
    • associated with IGF-1/insulin
  3. Esophageal & gastric ca
    • increased reflux ⟾ Barrett’s esophagus
  4. Kidney ⟾ unknown
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7
Q

Meat

Associated Cancers

A
  1. Epidemiological studies
    • colon
    • pancreatic
    • prostate
  2. Animal studies
    • breast
    • colon
    • liver
    • skin
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8
Q

Meat

Carcinogenic Compounds

A
  1. Nitrates/nitrites
    • preservatives in processed meats
    • binds proteins to form nitrosamines
    • vit C inhibits reaction
  2. 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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9
Q

Meat

Cancer Mechanism

A

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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10
Q

Aflatoxin

A
  • 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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11
Q

Aflatoxin

Cancer Mechanism

A

Hepatic Aflatoxin B1 metabolism ⟾ ROS.

Epoxide binds DNA ⟾ DNA adducts.

p53 is a target.

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12
Q

Benefits

of

Vegetables

A
  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
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13
Q

Benefits

of

Fruits

A

Source of:

  1. Vitamins
  2. Monoterpenes
    • reduces farnesylation of G-protein receptors
      • may decrease growth factor-mediated proliferation of cancer cells
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14
Q

Vitamin Supplementation

A
  1. Tocopherols (Vit E) and carotenoids (Vit A)
    • membrane-associated antioxidants
  2. Vit C
    • serum/ECF associated antioxidant
    • recharges tocopherol back to antioxidant state
  3. Selenium
    • needed for glutathione peroxidase
  4. Manganese
    • used by antioxidants
  5. Iron
    • used by superoxide dismutase
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15
Q

American Cancer Society

Nutrition & Physicial Activity Guidelines

A
  1. Maintain a healthy weight
    • balance activity and intake
    • avoid excess gain
    • achieve healthy weight if overweight
  2. Adopt a physically active lifestyle
    • 30 mins of moderate activity 5 days a week
  3. 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
  4. Limit alcohol consumption
    • 1 drink for women, 2 for men
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16
Q

Cancer Cachexia

Causes

A

May be due to:

  1. Depression
  2. Decreased PO intake
  3. Increased BEE due to IL-1, IL-6, and TNF-𝛼
  4. Preferential muscle catabolism
17
Q

Surgical and Radiation Therapy

Considerations

A
  1. Perioperative NPO status
  2. Head, neck, and esophagus ca
    • dysphagia, odynophagia
    • xerostomia (dry mouth)
    • ageusia, dysgeusia (lost/impaired taste sensation)
  3. GI/GYN/GU ca
    • early satiety
      • tumor compression or surgical restriction
    • partial/complete obstruction
      • adhesions or tumors
  4. Hepatic/pancreatic ca
    • impaired digestion/absorption
18
Q

Cytotoxic Chemotherapy

Considerations

A
  1. Nausea/vomiting
  2. Anorexia
  3. Taste alterations
  4. 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
19
Q

Other Chemotherapy

Considerations

A
  1. Steroids
    • immunosuppression
    • centripetal obesity
    • muscle wasting
    • insulin resistance
  2. Anti-estrogen therapy
    • weight gain
  3. Anti-androgen therapy
    • muscle wasting
20
Q

Herceptin

Molecular Target Drugs

Effects

A

cardiomyopathy

21
Q

Erbitux

Molecular Target Drugs

Effects

A

skin toxicity

22
Q

Gleevec

Molecular Target Drugs

Effects

A

colitis

23
Q

Sorafenib

Molecular Target Drugs

Effects

A

muscle wasting

24
Q

Bevacizumab

Molecular Target Drugs

Effects

A

muscle wasting

25
Q

Nutritional Interventions

A

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
26
Q

Enteral Nutrition

A

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
27
Q

Parenteral Nutrition

A
  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
28
Q

Treatment

for

N/V, anorexia, and taste alterations

A
  1. Anti-emetic medications
    • Zofran
    • Compazine
  2. Dietary Modifications
    • beverages
    • nutrient dense
    • limited aroma
    • cold, mild flavored foods
    • high moisture foods
29
Q

Treatment

for

Hepatic and Pancreatic Insufficiency

A
  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
30
Q

Treatment

for

Immunosuppression

A
  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
31
Q

Neutropenic Diet

A
  • 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

IMS: Nutrition (15 decks)

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