Oncology

Question 1

Neo-adjuvant

Answer 1

Therapeutic agent administered before main treatment

Question 2

Adjuvant

Answer 2

Treatment in addition to main/primary treatment

Question 3

Allotransplantation

Answer 3

Transplantation to recipient from genetically non-identical donor

Question 4

Surgery

Answer 4

Remove or debulk the tumour

ERAS (enhance recovery after surgery)
- optimise nutritional status before + after surgery

Question 5

Chemotherapy

Answer 5

Use of variety of drugs
Interfere with ability of cancer cells to divide + reproduce
Undesirable damage to normal cells can occur as drugs not selective
Given in combo w/ other drugs (targeting different aspects)
Cycles of treatment (good/bad days)
Side effects dependent type, dose, other medications

Question 6

Radiotherapy

Answer 6

More targeted than chemo
High energy radiation to shrink tumours + kill cancer cells
DNA damage
X-rays, gamma rays, charged particles
Causes localised problems

Question 7

Biological therapy

Answer 7

Use body’s immune system to fight cancer or lessen side effects

Multi-modality treatment may increase risk malnutrition

Question 8

Allogenic stem cell transplant

Answer 8

Relapsed ALL/AML
10-20% mortality risk
56% matched to unrelated donors
Length stay - 3-6wk may have decreased appetite
Rejection - immune response, graft verses host disease

Question 9

Cachexia

Answer 9

Complex metabolic process
Significant negative effect on prognosis + survival
Experienced by 40%
Increased complications of treatment

Symptoms - abdo pain, taste changes, malabsorption, muscle wasting, rapid weight loss

Question 10

Possible nutritional consequences (10)

Answer 10

Cachexia
N+V
Weight gain
Dysphagia 
Taste changes
Pain
Altered bowel habits
Oral mucositis
Oropharangeal candidiasis 
Social isolation

Question 11

Weight gain

Answer 11

Medications and/or chemo
Seen in - breast, prostate, ovarian
Could be change eating pattern due to stress or low P.A

Question 12

Dysphagia

Answer 12

Infection/inflammation can affect oral phase swallowing

Question 13

Taste changes

Answer 13

Dysgeusia, hypogeusia, ageusia

Due to - chemo, infections, dry mouth
Advice - marinade, herbs/spices

Question 14

Pain

Answer 14

Symptom/marker recurrence
May be related to tissue destruction
May be tumour damaging or travelling along nerves

Question 15

Fatigue

Answer 15

Acute or chronic
Depends site, stage, treatment (4-96%pt)
Impacts appetite, cook, shop

Question 16

Altered bowel habits

Answer 16

Fats may be hard to digest
Constipation
Diarrhoea
Lactase production may be impaired

Question 17

N+V

Answer 17

Caused by treatments
Immediately or days later (understand pattern to maximise nutritional status)
Risk increased with radiation dose

Triggers - anxiety, pain, motion, poor blood flow, irritation, gas in stomach, taste, smell

Question 18

Oral mucositis

Answer 18

Inflammation of mucosal membranes lining GI tract
Ulceration may occur
Can be exacerbated by infections
Drug treatment
Self limiting

Question 19

Oropharangeal candidiasis

Answer 19

White coating on tongue
Foul smelling breath
Often decreased oral intake

Question 20

Promoting appetite

Answer 20

Short term success with drugs

Not suitable for all

Question 21

Social isolation

Answer 21

Can develop as interest in food declines
Social/religious events revolve around food
Don’t want people to see them struggling

Question 22

Family conflict

Answer 22

Pressure to eat
Wastage
Express love through food so tension if refused

Question 23

Dietary advice

Answer 23

Find right time
Reminders
Tailored literature

Question 24

Neutropenic diet

Answer 24

Controversial as restriction when vulnerable

Avoid - raw meat, egg, unpasteurised milk, buffets, pate

Question 25

Survivorship

Answer 25

May have unmet needs
May struggle with consequences of treatment
Lifestyle changes
Long term follow up