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Nutrition in Health and Disease > Nutrition and Oncology > Flashcards

Nutrition and Oncology Flashcards

1
Q

Name the hallmarks of cancer.

A
  • Deregulation cellular energetics
  • Sustaining proliferative signaling
  • Evading growth suppressors
  • Avoiding immune destruction
  • Enabling replicative immortality
  • Tumor-promoting inflammation
  • Activatin invasion and metastasis
  • Inducing angiogenesis
  • Genome instability and mutation
  • Resisting cell death
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2
Q

Name risk factors for cancer.

A
  • Smoking
  • Alcohol
  • Nutrition/obesity
  • Inactivity
  • Profession
  • Environmental pollution
  • (UV) radiation
  • Medication
  • Infection
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3
Q

BRCA1 and BRCA2 are two genes that are known to cause cancer upon mutation. What function do these genes normally have?

A
  • Repair of DNA proteins
  • Control of cell cyclus
  • Activation of p53 (oncogene) that stimulates apoptosis of damaged cells/DNA.
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4
Q

What is a catabolic alteration in cancer? And what consequences does this catabolic alteration have for patients with cancer?

A

Muscle protein depletion, i.e. cachexia (muscle wasting), leading to decreasing physical performance, quality of life and treatment tolerance.

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5
Q

Name another catabolic alteration in cancer patients besides cachexia. And what consequences does this catabolic alteration have for patients with cancer?

A

Systemic inflammation syndrome characterized by:
* altered protein turnover
* loss of fat and muscle mass
* increase/decrease of production of acute phase proteins
* insulin resistance and impaired glucose tolerance

This leads to:
* fatigue, impaired physical activity, anorexia, weight loss
* impairs/prevents recovery of skeletal muscle mass

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6
Q

Tumors release inflammatory cells and other factors. Describe how this affects the following organs:
* Brain
* Muscle
* Liver
* Fat

A
  • Brain: altered appetite signals from the CNS cause anorexia
  • Muscle: anabolic/catabolic imbalance
  • Liver: stimulation of acute-phase protein production, repressing drug clearance leading to increased risk of cancer treatment toxicity.
  • Fat: cytokines stmiulate increased lipolysis
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7
Q

Describe anorexia-cachexia syndrome.

A

The inflammatory and metabolic changes, accompenied by cancer symptoms (organ damage, pain, treatment, malaise, etc.) leads to a reduction in appetite, decreased food intake and physical activitry, ultimately leading to weight loss, muscle tissue loss, and weakness/frailty.

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8
Q

Name diagnostic criteria of cachexia.

A

A patient with cachexia should have weight loss of at least 5% in 12 months or less and should meet 3 out of 5 criteria:
* Decreased muscle strength
* Fatigue
* Anorexia
* Low fat-free mass index
* Abnormal biochemistry (increased inflammatory markers, anemia, low serum albumin)

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9
Q

Name therapies of cancer.

A
  • Radiation
  • Chemotherapy
  • Surgery
  • Hormone therapy
  • Immune therapy
  • Monoclonal antibodies
  • Tyrokinase inhibitors
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10
Q

Answer the following questions in regard to radiation therapy:
* How does radiation destroy/treat cancer?
* How to prevent that radiation kills only cancer cells and not healthy cells?
* In radiation therapy, a measurement term is Gray. What is the meaning of this term?

A
  • By releasing energy (i.e. radiation) which causes damage to DNA of (cancer) cells.
  • Most of the times, MRI or CT are used before and during radiation therapy. In this way, the exact location of the tumor is always known. On top of this, radiation therapy is often delivered in fractions. Here, a total dose is divided into smaller doses, i.e. fractions. A fraction is given each day and repeated over many days to add up to the total dose of radiation.
  • Gray is the quantity of absorbed ionised radiation.
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11
Q

What is a major downside of radiation therapy?

A

Adverse effects of radiation such as:
* mucosal damage (80% in head and neck cancer)
* Skin damage
* Pain
* Bleeding
* Stenosis
* Diarrhea
* Nausea

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12
Q

What is the Mosteller formula?

A

A formula to calculate the total surface area of a human body based on length and weight.

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13
Q

Sacropenia is defined as muscle atrophy. Why is the mosteller formula not the appropriate tool to estimate whether or not someone has sacropenia?

A

Because the mosteller formula uses length and weight to calculate the total body surface area. But this doesn’t say anything about the composition of the body (e.g. fat, muscle mass).

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14
Q

What is the TNM classification?

A

The classification of cancer by anatomic disease extent. The classification is a major determinent of appropriate treatment and prognosis.
* T stands for primary tumor site and size (TX-T1-T4).
* N stands for regional lymph node involvement (NX-N0-N1)
* M stands for presence of distant metastatic spread (MX-M0-M1)

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15
Q

Name examples of the following types of surgery:
* Curative
* Palliative
* Preventive
* Reconstructive

A
  • Curative: tumor resection (removal of tumor)
  • Palliative: where tumor resection is not possible, tumors can be partly resected to e.g. alliviate symptoms.
  • Preventive: mastectomy in people who have a high (genetic) risk of breast cancer.
  • Reconstructive: e.g. breast reconstruction after a mastectomy.
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16
Q

For which organs is hormone therapy usually applied?

A
  • Breast
  • Prostate
  • Uterus
17
Q

Name examples of targeted therapy.

A
  • Monoclonal antibodies (antibodies that recognize specific cancer cells (i.e. their antigenes) and destroy it).
  • Small molecules (bind to certain receptors on cancer cells thus blocking signal pathways needed for tumor survival).
  • Immune therapy (enhancing/unleashing the immune system against cancer)
18
Q

Which factors determine what nutrition plan is set up for patients?

A
  • Energy: basal metabolic rate, amount of physical activity, and disease burden.
  • Protein: extent of malnourishment or complications.
  • Generally: sufficient carbohydrates, fat, fibres, vitamins, minerals and liquids.
19
Q

What are ways to deal with or prevent side symptoms?

A
  • Sufficient water intake (prevention acute renal failure during chemotherapy)
  • Anti-nausea medication
  • Pain medication
  • Laxatives
20
Q

What is important when dealing with the side symptom: loss of appetite?

A

What the underlying problem is of the loss of appetite (diarrhea, obstipation, mucositis, nausea/vomiting, taste alterations)

21
Q

What are effects of high dose intake of vitamins (>200% of recommended daily intake)?

A
  • Decrease side effects of treatment
  • Enhance tumor growth
  • Toxic effects
  • Interact negatively with treatment
22
Q

People with cancer often adopt lifestyle changes with intention to influence and improve their health status. What is the problem with this?

A

For example, food supplement use increases by 3-fold after cancer diagnosis. The simultaneous use of supplements and anti-cancer drugs may negatively influence treatment outcome. An example of this is omega-3 supplements, where quality of the supplement is not always ensured, but also the effect of omega-3 supplements on cancer growth and/or treatment outcome is not always certain. On top of this, most patients do not consult with health care providers. As a result, in 2021 supplements with fish oil are advised against in the period of 24 hours before, during and until 24 hours after administration of certain anti-cancer medicine/therapies.

23
Q

What is Continuous Update Project (CUP)?

A

Systematic reviews and meta-analyses based on worldwide literature, bundled and published in paper and online guides meant as a ‘blueprint for cancer prevention’.

24
Q

Name recommendations for people in general, but especially for cancer patients (so what they can do themselves to improve health outcomes).

A
  • Breastfeed your baby (if you can)
  • Be physically active
  • Sun wisely
  • Be a healthy weight
  • Limit alcohol consumption
  • Don’t smoke and avoid other exposure to tabacco
  • Limit red and processed meat
  • Cut down on sugary drink
  • Limit ‘fast food’
  • Make wholegrains, vegetables, fruit and beans a major part of your usual diet
  • Do not use supplements for cancer prevention
25
Q

What is disease-focused palliation?

A
  • Tumor control
  • Life prolonging
  • Stabilize or improve nutrional status
  • Maintain weight and muscle mass
  • Nutrition at 100% of requirements (energy, protein)
26
Q

What is symptomatic palliation?

A
  • Decrease symptoms of tumor
  • Accept decline of nutritional status
  • Comfort feeding
  • Focus on: quality of life, autonomy of patient
27
Q

What is the aim of palliative care at the end of life stage?

A

Care is primarily based on the quality of dying proces, such as symptoms as:
* Reduce/stop food intake
* Hunger and thirst disappear, as natural in end of life
* Nutrition absorption is impaired
* Can cause severe discomfort

Nutrition in Health and Disease (9 decks)

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