Week 9 Oncology Flashcards
How many Canadians are diagnosed with Cancer during this 3 hour lecture?
66
What is the leading cause of death in Canada?
Cancer (followed by heart disease)
how many Canadians will develop cancer during their lifetime?
40% - 2 in 5
How costly is cancer in canada?
$4.4 billion
Cancer is the 7th most costly illness in Cnada
1 in ____ men will develop cancer
1 in ____ women will develop cancer
1 in 2.2. for men (45%)
1 in 2.4 for women (42%)
what are the most common cancers in men? women?
men:
- lung
- colorectal
- prostate
women:
- lung
- colorectal
- breast
what are 2 common characteristics of all cancers?
- uncontrolled cellular proliferation
- ability of cells to metastasize or migrate from IG site to distant site
what are the 10 risk factors for cancer?
- age
- tobacco
- sun exposure
- carcinogen exposure
- family history
- bacteria
- alcohol
- dietary factors
- lack of physical activity
- excess weight
what are 5 direct causes of cancer?
- genetics
- error in cell division
- carcinogens
- radiation
- UV
what are 6 nutrition risk factors for cancer?
- lots of red meat (sausage, bacon, and then pork, beef, lamb)
- smoking, salting, pickling
- high temp cooking
- high total fat intake
- low fruit and veggie intake
- high alcohol consumption
what are 4 nutrition protective factors for cancer?
- fruits and veggies
- whole grains
- fibre
- vitamin D - ALL spfs block vitamin D
what are the 2 types of cancer genes?
- oncogenes (control cell division)
- tumor suppressor genes (cause apoptosis)
Cancers are characterized by 3 things:
- unregulated cell growth
- tissue invasion
- metastasis
How would you define cancer?
- it is a genetic disease that causes cells to divide abnormally and spread into surrounding areas
- a disorder of cell growth and regulation
- abnormal cells divide without control and are able to invade other tissues
- a group of >100 multifactorial diseases in which abnormal cells reproduce in an uncontrolled manner
According to the WHO, which food group (and 3 foods in it) cause cancer
processed meats:
- sausages/hotdogs
- bacon
- salami
According to the WHO, which food group (and 3 foods in it) probably cause cancer
red meats
- pork
- beef
- lamb
How many Canadian deaths are due to behavioural and dietary risk factors?
1/3
the original cancer, with the original specific area, is called the:
primary cancer
Cancer screening tests include 3 general types of tests:
- lab tests
- imaging tests
- biopsy tests
calcitonin and CA-125 are ____
tumor markers - substances produced by cancer cells or by other cells in response to cancer
What are 7 examples of possible imaging scans for cancer?
- CT scan
- MRI
- nuclear scan
- bone scan
- ultrasound
- x-ray
- PET scan
What type of imaging scan uses radioactive material attached to glucose
Pet scan
radioactive material travels through the body, collecting in cells that us a lot of energy (cancer cells)
____ works because radioactive material travels to the area where there is more energy concentration becauce cancer cells produce the most energy
PET Scan
In most cases, a ____ test is required to diagnose cancer
biopsy test
In a biopsy test, how do you obtain a sample of the tissue? there are 3 ways
- needle
- endoscopy
- surgery
Tumors are classified and assigned a stage using 1 of 2 methods
- the tumor node metastases staging system (TNM)
- overall staging group
What are the 7 main treatment modalities for cancer?
- chemotherapy
- radiation
- immunotherapy
- target therapy
- hormone therapy
- stem cell therapy
- surgery
Depends on tumor location, size, and health of person
what are the 2 types of surgery used to treat cancer?
- open surgery
- minimally invasive surgery
What are the 6 different routes to administer chemotherapy?
- oral
- IV
- injection
- intraperitoneal
- intra-arterial
- topical
What is adjuvant chemotherapy?
chemo administered after surgery to remove any chance cells that were missed
what is neoadjuvant chemotherapy?
cheo administered to shrink the tumor so it can be more easily treated by radiation or surgery
Why does chemo have so many side effects?
toxicity due to rapidly dividing cells
What are 9 common medical side effects of chemo?
- neutropenia - low neutrophil count
- thrombocytopenia - low blood platelet count
- anemia
- diarrhea
- mucositis - inflammation of digestive tract
- alopecia - hair loss
- cardiotoxicity - adverse effects on structure and function
- neurotoxicity
- nephrotoxicity
what are common nutrition side effects of chemo?
- anorexia
- nausea
- mucosititis - all through digestive tract
- diarrhea
- constipation
- weight loss
- ageusia - no taste
- hypogeusia - little taste
- dysgeusia - distorted taste
- xerostomia - dry mouth, lack of saliva
- lactose intolerance
- thrush
Cistaplin and Dacarbazine are the only 2 chemo drugs that
have taste alterations (metallic taste
____ leads to alteration in cellular and nuclear DNA from eletrcomagnetic rays and charged particles
radiation
What are 6 of the most common side effects of all of the chemo agents?
- nausea and vomiting
- diarrhea
- xerostomia
- stomatitis
- anorexia
- taste alterations
Which cells are most susceptible to radiation?
continuously proliferating cells
is toxicity or radiation localized or generalized?
it is localized to the region that is being irradiated
what are the 2 types of radiation?
- internal beam (seeds placed in the body)
- external beam (comes from a machine)
How does radiation work?
it damages the cancer cell’s dna
What are the main nutrition side effects of radiation?
- fatigue
- anorexia
3.. nausea - oropharyngeal
- taste alterations
- mucositis
- dysphasia - painful swallowing
- xerostomia (dry mouth
- esophagitis
- abdomen/pelvis -
- steatorrhea - fat in stool
Malnutrition is VERY common in oncology, and impact ____ % of cancer patients. it is the biggest cause of cancer death
30-70%
OR
40-80%
what is the biggest cause of cancer death?
malnutrition
what is the primary goal of oncology nutrition therapy?
what are the secondary and tertiary goals?
primary goal: prevent malnutrition
secondary goal: optimize nutritional status during treatment
what % of cancer deaths are attributed to malnutrition rather than tumor/malignancy itself?
10-20%
Cancer is associated with rapid and extensive weight loss. Muscle loss or sarcopenia is seen in ____ %
15-50%
by age 80, what % of your muscle is gone?
30%
What is cancer cachexia?
it is a type of malnutrition
it is a muscle wasting disease of cancer
can occur with our without fat loss - you are losing muscle without losign fat
chances can be irreversible with traditional nutrition
what are the 5 mechanisms in volved in cancer cachexia?
- systematic inflammation - the main hallmark for cancer cachexia) - production of acute phase proteins
- anorexia
- decreased physical activity
- decreased secretion of host anabolic hormones
- altered protein, lipid and carb metabolism
What are 4 different types of cancer malnutrition?
- cancer cachexia
- tumor mediated malnutrition
- starvation-related malnutrition
- sarcopenia
What happens in tumor related malnutrition?
- tumor signals CNS signals anorexia
- inflammation leads to muscle wasting, liver metabolism changes, and fat use and depletion
what is starvation-related malnutrition?
chronic starvation WITHOUT inflammation
characterized by REDUCED ENERGY INTAKE, OR malabsorption when intake is normal
Can be fully reversed with proper nutrition
How do you diagnose inadequate nutritional intake? there are 2 ways:
- patient cant eat for a week
- intake is <60% of requirements
_____ is the degenerative loss of skeletal muscle mass, quality, and strength
sarcopenia
sarcopenia can occur at the same time as obesity
sarcopenia happens no matter what, but it is accellerated when we are sick
sarcopenia is associated with:
- increased incidence of chemo toxicity
- shorter time to tumor progression
- physical disability
- poor surgical outcomes
- decreased survival
What are 3 nutritional assessments used in malnutrition?
- canadian nutrition screening tool (CNST)
- energy and protein requirements are established individually
- fluid needs can be calculated using the same formulas used for patients without renal disease
What are some items to check in a physical assessment and biochemistry for malnutrition?
- weight measures
- muscle wasting (SGA)
- cbc
- iron status
- a1c levels
- glucose
- vitamin D - only in the presence of malnutrition
why arent serum protein markers reliable for identifying malnutrition?
they are not specific or sensitive
many variables affect it, like inflammation! when someone has cancer they have a lot of inflammation,
what marker is often used for malnutrition?
a single effective lab indicator identifying malnutrition is lacking, but albumin is used often
what is used more in canada to check for malnutrition? albumin or prealbumin?
albium
BUT, prealbumin is being used more. its still a marker of inflammation, but you check it with c-reactive protein
protein intake has very little effect on total albumin pool on a daily basis.
this is because very little newly synthesized albumin shows up in the albumin pool
_____ might be falsely high in dehydration, due to decreased plasma volume
albumin (decreased plasma volume)
What is the half life of albumin?
14-20 days
long half life
that is why its more of a marker for chronic nutrition
what is the primary function of albumin?
it is a carrier protein
it maintains oncotic pressure
What factors increase serum albumin levels?
dehydration
marasmus
blood transfusions
exogenous albumin
What factors decrease serum albumin?
overhydratoin
hepatic failure
burns
inflamation
nephrotic syndroem
both albumin and prealbumin are _____ proteins and _____
visceral proteins
negative acute phase reactants
what is the advantage of prealbumin compared to albumin?
it has a shorter half life (2-3 days instead of 14-20 days)
therefore changes more rapidly with acute changes in nutrient intake
____ is elevated in Acute Kidney Injury
prealbumin
______ is unaffected by hydration status
prealbiumin
what is the most widely used indicator for the presence of inflammation?
C-reactive proteins
its levels are higher with both acute and chronic inflammation
What factors increase serum prealbumin levels?
severe renal failure
corticosteroid use
oral contraceptives
what factors decrease prealbumin levels?
post-surgery
liver-disease
infection
dialysis
hyperthyroidism
How much energy do typical cancer patients need?
How much energy do cancer patients who need to gain weight, need?
normal = 25-30 kcal/kg/day
gain weight = 30-40 kcal/kg/day
(obese patients = 21-25 kcal)
what type of cancer patients need more calories?
larger tumor
metastatic malignancies
radiation
chemo
surgery
head and neck
what type of cancer patients need less calories?
65+ yrs old
non-metastatic breast prostate cancer
brain cnacer
how many kcal per day do brain cancer, non-metastatic breast cancer, and prostate cancer need
21-25 kcal/day
resting energy expenditure can increase, decrease, or remain unchanged in cancer patients
how much protein do cancer patients need, compared to non-cancer patients?
normal people - 0.8 g/kg-1 g/kg of protein
Cancer patients - 1-1.2 g/kg of protein
we do not restrict fat in cancer patients. healthy fat consumption is encouraged because it is calorie dense and helps with poor appetite
still have to manage diabetes pre, during, and post cancer treatment
_____ is recommended in those with inadequate orla nutrition despite nutritional interventions
enternal nutrition
how do you calculate fluid needs for oncology patients without renal concerns?
20-40 ml/kg
OR
1 ml fluid per 1kcal of estimated needs
altered fluid balance is common in oncology
which supplements are recommended for cancer patients?
supplements with 100% DRI
- multivitamin - if not eating a variety of foods, malnourished, or history of weight loss
- Vitamin D3 - important for immune function, decreases ability of tumour to form blood vessels. Need 1000 IU-2000 IU vitamin D3 daily
high does vitamin D3 is good - leads to 31% reduced relative risk for disease progression - FISH OIL (omega 3)
- iron
- B12
How much vitamin D3 should cancer patients take per day`
1000-2000 IU
why is vitamin D3 supplements important for oncology?
important role for immune function
decreases ability of tumour to form blood vessels
preserves and increases lean body mass
improves muscle mass
why is omega 3 fatty acid important for cancer patients?
improves appetite
oral intake
lean body mass
overall body weight
there is promising evidence for improved tumour response when taken during treatment
improves 1 year survival rate
how much fish oil should cancer patients take per day
2 g/day
high doses of this vitamin are DETRIMENTAL for cancer patients. why?
vitamin C
because they protect both the cancer cells and the healthy cells
does evidence support removing meat from the diet for cancer patients?
no
in pancreatic cancer, patients have pancreatic enzyme insufficiency, where they malabsorb all macronutrients and fat soluble vitamins
signs include
bloating
foul gas
steatorrhea
diarrhea
what is xerostomia?
dry mouth
what is esophagitis
iflammation of the esophagus
what are some nutrition therapy tips for the treatment of anorexia in oncology?
- eat small, frequent meals
- maximize intake when appetite is normal
- limit fluid with meals to avoid feeling full
- keep favourite foods available
- mild exercise, as tolerated
- eat meals in a pleasant environment
- find a liquid nutritional supplement that is appealing - drink only 2-4 oz at a time
what are some nutrition therapy tips for the treatment of nausea in oncology?
- eat small frequent meals
- eat food at room temp or cold (hot foods give strong odors)
- separate liquid and solid foods by 1 hour
- stay up right for 1-2 hours after eating
5.eat bland, soft foods on treatment days
- anti-nausea medication
what are some nutrition therapy tips for the treatment of early satiety in oncology?
drinks should contain nutrients - drink them in between meals
avoid raw vegetables/high fibre foods
eat frequent, small meals
dont lay down after meal
what is oral mucositis?
What are 5 factors that contribute to the development of oral mucositis?
- acute inflammation of the oral mucosal membrane
- painful, hard to swallow, can lead to infection
Contributing factors:
1. head and neck cancer
2. radiation therapy
3. chemotherapy
4. chemoradiotherapy
5. hematopoietic stem cell transplant
what are 7 nutrition tips for oral mucositis and esophagitis
- drink 2-3L of COLD fluids
- have diet high in protein, vitamin B, vitamin C
- use soft, moist, bland foods
- avoid extreme temps
- avoid dry or coarse foods
- avoid alcohol based washes
- rinse mouth with a warm saline solution after meals and at bedtime
what are some nutrition tips for xerostomia (dry mouth)?
- take several sips of water before swallowing
- cleanse mouth 2-4 hours
- drink 2-3 L of fluid daily
- suck sugarless candy
- use vaseline to keep lips moist
- avoid citrus fruit and dry foods
- use saliva substitutes
What is dysphagia?
What 6 items that contribute to the development of dysphagia?
difficulty swallowing foods/fluids
- oral cancer
- pharyngeal cancer
- esophageal cancer
- radiation therapy
- chemotherapy
- surgery
what are some nutrition tips for people with dysphagia?
- change food texture and consistency
- get an assessment from a speech language pathologist
- eat upright
- eat only when alert
- supervised eating
wet sounding voice during or after eating or drinking likely means you are aspirating
What factors contribute to nausea and vomiting?
- GI tract cancer
- brain cancer
- tumour causing bowel obstruction
- radiation therapy
- chemotherapy
- immunotherapy
what are some nutrition tips to treat nausea in oncology?
- drink 2-3 L
- small frequent meals served COOL
- restrict fluids at meals
- dont lie doewn after
- if it hasnt resolved within 24 hours, call 911
What is diarrhea?
What factors contribute to it?
It is the abnormal increase in stool frequency, volume, and liquidity.
Contributing factors include:
1. colon cancer
2. lymphoma
3. pancreatic cancer
4. graft versus host disease
5. radiation therapy
6. chemotherapy
7. immunotherapy
8. surgery
what are nutrition tips for managing diarrhea?
- 2.4-3 L of water (more water)
- more soluble fibre foods (peeled apples, bananas, potatoes, applesauce, white rice, oatmeal)
- less insoluble fibre (leafy greens, nuts, seeds, hugh sugar foods, high fat dairy)
- small frequent meals
- avoid sugar alcohol containing foods
BLOOD IN STOOL REQUIRES IMMEDIATE ATTENTION
ayurvedic medicine, homeopathy, and naturopathy are examples of:
whole medical systems
botanicals, dietary supplements, vitamins etc are examples of
biologically based therapies
biofields, sound, light are examples of
energy therapies
What is a superfood?
a marketing term with no set criteria or scientific basis
most have few studies and their results are inconclusive
Beans, asparagus, and green leafy vegetables are high in
folate
eggs, milk, meat are high in
b12
onions, apples, soybeans are high in
flavonoids
oatmeal, tofu, beans, meats are high in
iron
fish, pumpkin seeds, legumes, are high in
zinc
squash, sweet potato, carrots are high in
carotenoids
citrus fruits, peppers, broccoli, are high in
vitamin c
when is juicing a good option?
Why is juicing not recommeded for cancer patients?
when low fibre diets are needed
it is low protein
high sugar
might be too high in vitamin C
if i have cancer do i need to take supplements?
which vitamins are NOT recommended?
no!
large doses of vitamins A, C, E and selenium are not recommended. they can decrease treatment effect because chemo causes oxidative stress thats why it works
if taking a vitamin, mineral, or supplement, make sure it has:
NPN #
or
DIN #
what are 3 ways to reduce risk of pesticide exposure?
- buy local
- buy in season foods
- peel and wash fruits and veggies
there is no clear evidence that organic foods help reduce cancer risk more than non-organic counterparts
why do people claim that the alkaline diet can treat cancer?
cancer cells thrive in acidic environments, so if we eat alkaline diet, we will change the pH of your cells so cancer can’t survive.
the truth is our bodies are good are regulating ph
alkaline diet excludes many protein sources
drinking alkaline water can’t change the pH of the whole body
blood ph is controlled between 7.35-7.45
REMEMBER, A CHANGE IN URINE STATUS DOESNT INDICATE A CHANGE IN OVERALL BODY PH
fruits, vegetables and seeds are alkaline
what is the deal with sugar and cancer?
sugar intake has not been shown to directly increase risk or progress of cancer
but sugar and sweet beverages add substantial calories to the diet, thus promoting weight gain, which can adversely affect cancer outcomes
increased sugar leads to increased insulin levels – influences cancer cell growth - increases risk of other chronic diseases
many tipes of cancer cells have ++ insulin receptors, making them respond more than normal cells to insulin’s abiliy to promote growth
there is pre-clinical and early clinical evidence that this diet can influence cancer progression
ketogenic diet
what are the risk factors for ketogenic diet in cancer?
weight loss
micronutrient malnutrition
dehydration
patients needs lots if education and trainingn
in a ketogenic diet, what % of kcal in diet is fat, protein,c arbs?
90% fat
10-15% protein
5-10% carbs
body switches from burning glucose to burning fat for energy
why is ketogenic diet good for cancer
when body doesnt have carbs it uses ketones as energy source. but ketone bodies are not used by cancer cells for energy
research shows that hyperglycemia may contribute to:
- cancer cell proliferation
- apoptosis inhibition
- metastasis
- perineural invasion
- chemotherapy resistance
- reduced treatment tolerance
how much meat puts you at risk for cancer
you can safely consume 18 oz of red meat per week (3 oz at a time).
increased consumption leads to cancer.
processed, grilled, smoked meats should be avoided
grilling can form ______ at high cooking temps, leading to cancer
heterocyclic amines
is vegetarianism good for cancer?
it is good for prostate and colon cancer
according to the american cancer society, what are the recommendations for preventing cancer?
- move
- be a healthy weight
- eat less
- limit red meat
- dont drink alcohol
- dont rely on supplements
