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FNN 301 > Week 9 Oncology > Flashcards

Week 9 Oncology Flashcards

1
Q

How many Canadians are diagnosed with Cancer during this 3 hour lecture?

A

66

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2
Q

What is the leading cause of death in Canada?

A

Cancer (followed by heart disease)

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3
Q

how many Canadians will develop cancer during their lifetime?

A

40% - 2 in 5

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4
Q

How costly is cancer in canada?

A

$4.4 billion
Cancer is the 7th most costly illness in Cnada

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5
Q

1 in ____ men will develop cancer
1 in ____ women will develop cancer

A

1 in 2.2. for men (45%)
1 in 2.4 for women (42%)

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6
Q

what are the most common cancers in men? women?

A

men:
- lung
- colorectal
- prostate

women:
- lung
- colorectal
- breast

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7
Q

what are 2 common characteristics of all cancers?

A
  1. uncontrolled cellular proliferation
  2. ability of cells to metastasize or migrate from IG site to distant site
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8
Q

what are the 10 risk factors for cancer?

A
  1. age
  2. tobacco
  3. sun exposure
  4. carcinogen exposure
  5. family history
  6. bacteria
  7. alcohol
  8. dietary factors
  9. lack of physical activity
  10. excess weight
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9
Q

what are 5 direct causes of cancer?

A
  1. genetics
  2. error in cell division
  3. carcinogens
  4. radiation
  5. UV
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10
Q

what are 6 nutrition risk factors for cancer?

A
  1. lots of red meat (sausage, bacon, and then pork, beef, lamb)
  2. smoking, salting, pickling
  3. high temp cooking
  4. high total fat intake
  5. low fruit and veggie intake
  6. high alcohol consumption
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11
Q

what are 4 nutrition protective factors for cancer?

A
  1. fruits and veggies
  2. whole grains
  3. fibre
  4. vitamin D - ALL spfs block vitamin D
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12
Q

what are the 2 types of cancer genes?

A
  1. oncogenes (control cell division)
  2. tumor suppressor genes (cause apoptosis)
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13
Q

Cancers are characterized by 3 things:

A
  1. unregulated cell growth
  2. tissue invasion
  3. metastasis
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14
Q

How would you define cancer?

A
  • 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
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15
Q

According to the WHO, which food group (and 3 foods in it) cause cancer

A

processed meats:

  • sausages/hotdogs
  • bacon
  • salami
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16
Q

According to the WHO, which food group (and 3 foods in it) probably cause cancer

A

red meats

  • pork
  • beef
  • lamb
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17
Q

How many Canadian deaths are due to behavioural and dietary risk factors?

A

1/3

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18
Q

the original cancer, with the original specific area, is called the:

A

primary cancer

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19
Q

Cancer screening tests include 3 general types of tests:

A
  1. lab tests
  2. imaging tests
  3. biopsy tests
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20
Q

calcitonin and CA-125 are ____

A

tumor markers - substances produced by cancer cells or by other cells in response to cancer

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21
Q

What are 7 examples of possible imaging scans for cancer?

A
  1. CT scan
  2. MRI
  3. nuclear scan
  4. bone scan
  5. ultrasound
  6. x-ray
  7. PET scan
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22
Q

What type of imaging scan uses radioactive material attached to glucose

A

Pet scan

radioactive material travels through the body, collecting in cells that us a lot of energy (cancer cells)

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23
Q

____ works because radioactive material travels to the area where there is more energy concentration becauce cancer cells produce the most energy

A

PET Scan

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24
Q

In most cases, a ____ test is required to diagnose cancer

A

biopsy test

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25
Q

In a biopsy test, how do you obtain a sample of the tissue? there are 3 ways

A
  1. needle
  2. endoscopy
  3. surgery
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26
Q

Tumors are classified and assigned a stage using 1 of 2 methods

A
  1. the tumor node metastases staging system (TNM)
  2. overall staging group
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27
Q

What are the 7 main treatment modalities for cancer?

A
  1. chemotherapy
  2. radiation
  3. immunotherapy
  4. target therapy
  5. hormone therapy
  6. stem cell therapy
  7. surgery

Depends on tumor location, size, and health of person

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28
Q

what are the 2 types of surgery used to treat cancer?

A
  1. open surgery
  2. minimally invasive surgery
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29
Q

What are the 6 different routes to administer chemotherapy?

A
  1. oral
  2. IV
  3. injection
  4. intraperitoneal
  5. intra-arterial
  6. topical
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30
Q

What is adjuvant chemotherapy?

A

chemo administered after surgery to remove any chance cells that were missed

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31
Q

what is neoadjuvant chemotherapy?

A

cheo administered to shrink the tumor so it can be more easily treated by radiation or surgery

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32
Q

Why does chemo have so many side effects?

A

toxicity due to rapidly dividing cells

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33
Q

What are 9 common medical side effects of chemo?

A
  1. neutropenia - low neutrophil count
  2. thrombocytopenia - low blood platelet count
  3. anemia
  4. diarrhea
  5. mucositis - inflammation of digestive tract
  6. alopecia - hair loss
  7. cardiotoxicity - adverse effects on structure and function
  8. neurotoxicity
  9. nephrotoxicity
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34
Q

what are common nutrition side effects of chemo?

A
  1. anorexia
  2. nausea
  3. mucosititis - all through digestive tract
  4. diarrhea
  5. constipation
  6. weight loss
  7. ageusia - no taste
  8. hypogeusia - little taste
  9. dysgeusia - distorted taste
  10. xerostomia - dry mouth, lack of saliva
  11. lactose intolerance
  12. thrush
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35
Q

Cistaplin and Dacarbazine are the only 2 chemo drugs that

A

have taste alterations (metallic taste

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36
Q

____ leads to alteration in cellular and nuclear DNA from eletrcomagnetic rays and charged particles

A

radiation

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37
Q

What are 6 of the most common side effects of all of the chemo agents?

A
  1. nausea and vomiting
  2. diarrhea
  3. xerostomia
  4. stomatitis
  5. anorexia
  6. taste alterations
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38
Q

Which cells are most susceptible to radiation?

A

continuously proliferating cells

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39
Q

is toxicity or radiation localized or generalized?

A

it is localized to the region that is being irradiated

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40
Q

what are the 2 types of radiation?

A
  1. internal beam (seeds placed in the body)
  2. external beam (comes from a machine)
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41
Q

How does radiation work?

A

it damages the cancer cell’s dna

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42
Q

What are the main nutrition side effects of radiation?

A
  1. fatigue
  2. anorexia
    3.. nausea
  3. oropharyngeal
    - taste alterations
    - mucositis
    - dysphasia - painful swallowing
    - xerostomia (dry mouth
    - esophagitis
    - abdomen/pelvis -
    - steatorrhea - fat in stool
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43
Q

Malnutrition is VERY common in oncology, and impact ____ % of cancer patients. it is the biggest cause of cancer death

A

30-70%

OR

40-80%

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44
Q

what is the biggest cause of cancer death?

A

malnutrition

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45
Q

what is the primary goal of oncology nutrition therapy?

what are the secondary and tertiary goals?

A

primary goal: prevent malnutrition

secondary goal: optimize nutritional status during treatment

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46
Q

what % of cancer deaths are attributed to malnutrition rather than tumor/malignancy itself?

A

10-20%

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47
Q

Cancer is associated with rapid and extensive weight loss. Muscle loss or sarcopenia is seen in ____ %

A

15-50%

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48
Q

by age 80, what % of your muscle is gone?

A

30%

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49
Q

What is cancer cachexia?

A

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

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50
Q

what are the 5 mechanisms in volved in cancer cachexia?

A
  1. systematic inflammation - the main hallmark for cancer cachexia) - production of acute phase proteins
  2. anorexia
  3. decreased physical activity
  4. decreased secretion of host anabolic hormones
  5. altered protein, lipid and carb metabolism
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51
Q

What are 4 different types of cancer malnutrition?

A
  1. cancer cachexia
  2. tumor mediated malnutrition
  3. starvation-related malnutrition
  4. sarcopenia
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52
Q

What happens in tumor related malnutrition?

A
  • tumor signals CNS signals anorexia
  • inflammation leads to muscle wasting, liver metabolism changes, and fat use and depletion
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53
Q

what is starvation-related malnutrition?

A

chronic starvation WITHOUT inflammation

characterized by REDUCED ENERGY INTAKE, OR malabsorption when intake is normal

Can be fully reversed with proper nutrition

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54
Q

How do you diagnose inadequate nutritional intake? there are 2 ways:

A
  1. patient cant eat for a week
  2. intake is <60% of requirements
55
Q

_____ is the degenerative loss of skeletal muscle mass, quality, and strength

A

sarcopenia

sarcopenia can occur at the same time as obesity

sarcopenia happens no matter what, but it is accellerated when we are sick

56
Q

sarcopenia is associated with:

A
  1. increased incidence of chemo toxicity
  2. shorter time to tumor progression
  3. physical disability
  4. poor surgical outcomes
  5. decreased survival
57
Q

What are 3 nutritional assessments used in malnutrition?

A
  1. canadian nutrition screening tool (CNST)
  2. energy and protein requirements are established individually
  3. fluid needs can be calculated using the same formulas used for patients without renal disease
58
Q

What are some items to check in a physical assessment and biochemistry for malnutrition?

A
  1. weight measures
  2. muscle wasting (SGA)
  3. cbc
  4. iron status
  5. a1c levels
  6. glucose
  7. vitamin D - only in the presence of malnutrition
59
Q

why arent serum protein markers reliable for identifying malnutrition?

A

they are not specific or sensitive

many variables affect it, like inflammation! when someone has cancer they have a lot of inflammation,

60
Q

what marker is often used for malnutrition?

A

a single effective lab indicator identifying malnutrition is lacking, but albumin is used often

61
Q

what is used more in canada to check for malnutrition? albumin or prealbumin?

A

albium

BUT, prealbumin is being used more. its still a marker of inflammation, but you check it with c-reactive protein

62
Q

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

A
63
Q

_____ might be falsely high in dehydration, due to decreased plasma volume

A

albumin (decreased plasma volume)

64
Q

What is the half life of albumin?

A

14-20 days
long half life

that is why its more of a marker for chronic nutrition

65
Q

what is the primary function of albumin?

A

it is a carrier protein

it maintains oncotic pressure

66
Q

What factors increase serum albumin levels?

A

dehydration
marasmus
blood transfusions
exogenous albumin

67
Q

What factors decrease serum albumin?

A

overhydratoin
hepatic failure
burns
inflamation
nephrotic syndroem

68
Q

both albumin and prealbumin are _____ proteins and _____

A

visceral proteins
negative acute phase reactants

69
Q

what is the advantage of prealbumin compared to albumin?

A

it has a shorter half life (2-3 days instead of 14-20 days)

therefore changes more rapidly with acute changes in nutrient intake

70
Q

____ is elevated in Acute Kidney Injury

A

prealbumin

71
Q

______ is unaffected by hydration status

A

prealbiumin

72
Q

what is the most widely used indicator for the presence of inflammation?

A

C-reactive proteins

its levels are higher with both acute and chronic inflammation

73
Q

What factors increase serum prealbumin levels?

A

severe renal failure
corticosteroid use
oral contraceptives

74
Q

what factors decrease prealbumin levels?

A

post-surgery
liver-disease
infection
dialysis
hyperthyroidism

75
Q

How much energy do typical cancer patients need?

How much energy do cancer patients who need to gain weight, need?

A

normal = 25-30 kcal/kg/day

gain weight = 30-40 kcal/kg/day

(obese patients = 21-25 kcal)

76
Q

what type of cancer patients need more calories?

A

larger tumor
metastatic malignancies
radiation
chemo
surgery
head and neck

77
Q

what type of cancer patients need less calories?

A

65+ yrs old
non-metastatic breast prostate cancer
brain cnacer

78
Q

how many kcal per day do brain cancer, non-metastatic breast cancer, and prostate cancer need

A

21-25 kcal/day

79
Q

resting energy expenditure can increase, decrease, or remain unchanged in cancer patients

A
80
Q

how much protein do cancer patients need, compared to non-cancer patients?

A

normal people - 0.8 g/kg-1 g/kg of protein

Cancer patients - 1-1.2 g/kg of protein

81
Q

we do not restrict fat in cancer patients. healthy fat consumption is encouraged because it is calorie dense and helps with poor appetite

A
82
Q

still have to manage diabetes pre, during, and post cancer treatment

A
83
Q

_____ is recommended in those with inadequate orla nutrition despite nutritional interventions

A

enternal nutrition

84
Q

how do you calculate fluid needs for oncology patients without renal concerns?

A

20-40 ml/kg

OR

1 ml fluid per 1kcal of estimated needs

85
Q

altered fluid balance is common in oncology

A
86
Q

which supplements are recommended for cancer patients?

A

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
87
Q

How much vitamin D3 should cancer patients take per day`

A

1000-2000 IU

88
Q

why is vitamin D3 supplements important for oncology?

A

important role for immune function

decreases ability of tumour to form blood vessels

preserves and increases lean body mass

improves muscle mass

89
Q

why is omega 3 fatty acid important for cancer patients?

A

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

90
Q

how much fish oil should cancer patients take per day

A

2 g/day

91
Q

high doses of this vitamin are DETRIMENTAL for cancer patients. why?

A

vitamin C

because they protect both the cancer cells and the healthy cells

92
Q

does evidence support removing meat from the diet for cancer patients?

A

no

93
Q

in pancreatic cancer, patients have pancreatic enzyme insufficiency, where they malabsorb all macronutrients and fat soluble vitamins

A

signs include

bloating
foul gas
steatorrhea
diarrhea

94
Q

what is xerostomia?

A

dry mouth

95
Q

what is esophagitis

A

iflammation of the esophagus

96
Q

what are some nutrition therapy tips for the treatment of anorexia in oncology?

A
  • 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
97
Q

what are some nutrition therapy tips for the treatment of nausea in oncology?

A
  1. eat small frequent meals
  2. eat food at room temp or cold (hot foods give strong odors)
  3. separate liquid and solid foods by 1 hour
  4. stay up right for 1-2 hours after eating

5.eat bland, soft foods on treatment days

  1. anti-nausea medication
98
Q

what are some nutrition therapy tips for the treatment of early satiety in oncology?

A

drinks should contain nutrients - drink them in between meals

avoid raw vegetables/high fibre foods

eat frequent, small meals

dont lay down after meal

99
Q

what is oral mucositis?

What are 5 factors that contribute to the development of oral mucositis?

A
  • 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

100
Q

what are 7 nutrition tips for oral mucositis and esophagitis

A
  1. drink 2-3L of COLD fluids
  2. have diet high in protein, vitamin B, vitamin C
  3. use soft, moist, bland foods
  4. avoid extreme temps
  5. avoid dry or coarse foods
  6. avoid alcohol based washes
  7. rinse mouth with a warm saline solution after meals and at bedtime
101
Q

what are some nutrition tips for xerostomia (dry mouth)?

A
  1. take several sips of water before swallowing
  2. cleanse mouth 2-4 hours
  3. drink 2-3 L of fluid daily
  4. suck sugarless candy
  5. use vaseline to keep lips moist
  6. avoid citrus fruit and dry foods
  7. use saliva substitutes
102
Q

What is dysphagia?

What 6 items that contribute to the development of dysphagia?

A

difficulty swallowing foods/fluids

  1. oral cancer
  2. pharyngeal cancer
  3. esophageal cancer
  4. radiation therapy
  5. chemotherapy
  6. surgery
103
Q

what are some nutrition tips for people with dysphagia?

A
  1. change food texture and consistency
  2. get an assessment from a speech language pathologist
  3. eat upright
  4. eat only when alert
  5. supervised eating

wet sounding voice during or after eating or drinking likely means you are aspirating

104
Q

What factors contribute to nausea and vomiting?

A
  1. GI tract cancer
  2. brain cancer
  3. tumour causing bowel obstruction
  4. radiation therapy
  5. chemotherapy
  6. immunotherapy
105
Q

what are some nutrition tips to treat nausea in oncology?

A
  1. drink 2-3 L
  2. small frequent meals served COOL
  3. restrict fluids at meals
  4. dont lie doewn after
  5. if it hasnt resolved within 24 hours, call 911
106
Q

What is diarrhea?

What factors contribute to it?

A

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

107
Q

what are nutrition tips for managing diarrhea?

A
  1. 2.4-3 L of water (more water)
  2. more soluble fibre foods (peeled apples, bananas, potatoes, applesauce, white rice, oatmeal)
  3. less insoluble fibre (leafy greens, nuts, seeds, hugh sugar foods, high fat dairy)
  4. small frequent meals
  5. avoid sugar alcohol containing foods

BLOOD IN STOOL REQUIRES IMMEDIATE ATTENTION

108
Q

ayurvedic medicine, homeopathy, and naturopathy are examples of:

A

whole medical systems

109
Q

botanicals, dietary supplements, vitamins etc are examples of

A

biologically based therapies

110
Q

biofields, sound, light are examples of

A

energy therapies

111
Q

What is a superfood?

A

a marketing term with no set criteria or scientific basis

most have few studies and their results are inconclusive

112
Q

Beans, asparagus, and green leafy vegetables are high in

A

folate

113
Q

eggs, milk, meat are high in

A

b12

114
Q

onions, apples, soybeans are high in

A

flavonoids

115
Q

oatmeal, tofu, beans, meats are high in

A

iron

116
Q

fish, pumpkin seeds, legumes, are high in

A

zinc

117
Q

squash, sweet potato, carrots are high in

A

carotenoids

118
Q

citrus fruits, peppers, broccoli, are high in

A

vitamin c

119
Q

when is juicing a good option?

Why is juicing not recommeded for cancer patients?

A

when low fibre diets are needed

it is low protein
high sugar
might be too high in vitamin C

120
Q

if i have cancer do i need to take supplements?

which vitamins are NOT recommended?

A

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

121
Q

if taking a vitamin, mineral, or supplement, make sure it has:

A

NPN #
or

DIN #

122
Q

what are 3 ways to reduce risk of pesticide exposure?

A
  1. buy local
  2. buy in season foods
  3. peel and wash fruits and veggies
123
Q

there is no clear evidence that organic foods help reduce cancer risk more than non-organic counterparts

A
124
Q

why do people claim that the alkaline diet can treat cancer?

A

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

125
Q

what is the deal with sugar and cancer?

A

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

126
Q

there is pre-clinical and early clinical evidence that this diet can influence cancer progression

A

ketogenic diet

127
Q

what are the risk factors for ketogenic diet in cancer?

A

weight loss
micronutrient malnutrition
dehydration

patients needs lots if education and trainingn

128
Q

in a ketogenic diet, what % of kcal in diet is fat, protein,c arbs?

A

90% fat

10-15% protein

5-10% carbs

body switches from burning glucose to burning fat for energy

129
Q

why is ketogenic diet good for cancer

A

when body doesnt have carbs it uses ketones as energy source. but ketone bodies are not used by cancer cells for energy

130
Q

research shows that hyperglycemia may contribute to:

A
  1. cancer cell proliferation
  2. apoptosis inhibition
  3. metastasis
  4. perineural invasion
  5. chemotherapy resistance
  6. reduced treatment tolerance
131
Q

how much meat puts you at risk for cancer

A

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

132
Q

grilling can form ______ at high cooking temps, leading to cancer

A

heterocyclic amines

133
Q

is vegetarianism good for cancer?

A

it is good for prostate and colon cancer

134
Q

according to the american cancer society, what are the recommendations for preventing cancer?

A
  1. move
  2. be a healthy weight
  3. eat less
  4. limit red meat
  5. dont drink alcohol
  6. dont rely on supplements

FNN 301 (10 decks)

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