Unit 22 – Diet and Cancer 1

Cancer

Group of >100 different diseases

Characterized by uncontrolled cell growth

Individual cancers differ by:

- where they develop

- how quickly they grow

- type of treatment

- impact on nutritional status

2nd leading cause of death in the US

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Cancer Progression 3

Estimated Cancer Prevalence 2007

Brain/CNS Breast

Endometrial/Uterine Colon/Rectum

Cervix

Esophagus Hodgkin Disease

Kidney

Larynx Leukemia

Liver and bile duct Lung

Melanoma of Skin Multiple Myeloma

Lymphoma Oral Cavity and Pharynx

Ovary Pancreas

Prostate Stomach

Testis Thyroid

Urinary Bladder

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What Causes Cancer?

80-90% of cancers are initiated by environmental factors that alter DNA

Most factors are modifiable

Causes of Cancer

Aflatoxins – toxin made my Aspergillus fungi

Ethanol - alcoholic beverages

Coal-tars

Herbal remedies containing plant species of the genus Aristolochia

Salted fish (Chinese-style)

Soot

Tobacco, smokeless

Wood dust

Arsenic

Asbestos

Chromium hexavalent cpds

Hepatitis B and C virus

Human papilloma viruses: some genital-mucosal types

Mustard gas

Solar radiation

Sunlamps or sunbeds

X-radiation and gamma radiation

Nitrates

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What Causes Cancer?

Diet accounts for approx. 40% of cancer risk

- Westernized dietary intake and lifestyle increase risk

of many types of cancer

Genetic factors account for approx. 5-42% of risk

for some cancers

- Prostate, breast, and pancreatic cancers

Nutrition and Cancer

Prevention 1/3 of all cancers are

related to dietary factors

Intake/utilization

impairment of nutrients

Absorption/metabolism

impairment

Cancer

and/or

treatment

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Nutrition in Cancer Prevention

Eat a variety of fruits and veggies

- 5-9 servings per day

Antioxidants and anti-inflammatory

compounds may protect DNA from

damage

Damaged DNA may direct abnormal cell

multiplication

Nutrition in Cancer Prevention

Limit red meats and processed

meats

High intakes of saturated fats from

meat and dairy products increase

cancer risk

Plant proteins provide unsaturated

fats plus vitamins, minerals, fiber,

and phytochemicals

Nutrition in Cancer Prevention

Excess body weight and physical inactivity

↑ risk of esophageal, colon/rectal, postmenopausal

breast, endometrial, and renal cancers

Increases hormones that promote cancer cell growth

Promotes insulin resistance and hyperinsulinism

Promotes low levels of inflammation which can

promote cancer cell growth and development

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Nutrition in Cancer Prevention

Link between excess body weight,

exercise, and cancer risk so strong that:

Recommended BMI range:

between 21 and 23

Limit energy-dense foods:

(particularly processed foods high in

sugar and fat, and low in fiber)

Physical activity:

at least 30 minutes every day

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American Institute for Cancer Research

Recommendations

Avoid sugary drinks

Limit foods high in salt

Limit alcohol to 1-2 drinks per day (if any at all)

Don’t use supplements to protect against cancer

Breastfeed up to 6 months

Do not smoke or chew tobacco

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Impact of Cancer on Nutrition

Site Potential Effects

Brain/CNS Eating disabilities, chewing/swallowing difficulty

Head and Neck Chewing/swallowing difficulty

Esophagus Dysphagia related to obstruction, GERD

Stomach Early satiety, N&V, impaired motility,

obstruction – may require EN or PN

Bowel Maldigestion/malabsorption,

obstruction – may require EN or PN

Liver Diarrhea

Pancreas Maldigestion/malabsorption, DM

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Impact of Cancer on Nutrition

Metabolic Changes

alter use of fuels (CHO, pro, fat)

promote loss of weight and lean body mass

Glucose intolerance / insulin resistance

Increased energy expenditure

Increased protein turnover

Reduced muscle protein synthesis

Accelerated fat breakdown

Kcal and nutrients redirected to supporting growth of tumor vs. fueling the body

Increased inflammatory/immune response increase metabolism

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Impact of Cancer on Nutrition

Anorexia

Contributing factor to weight loss and malnutrition

Potential causes:

- pain, depression, anxiety, fatigue, early satiety, N&V

Treatments contribute:

- taste alterations, loss of taste, sore mouth, dry mouth,

thick saliva, esophagitis, fatigue

Optimizing intake:

- texture/temp modification, scheduled eating, meds to

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Impact of Cancer on Nutrition

Cachexia:

wasting syndrome marked by weakness,

progressive loss of body weight, fat, and muscle

Present in approx. 80% cancer related deaths

Hard to reverse

Nutrition aimed at preserving muscle and fat stores - improves quality of life - does not guarantee increased length of survival

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Nutrition Therapy During Treatment

Improve tolerance to treatment

Enhance immune function

Aid in recovery

Improve quality of life

Enhance well-being

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Nutrition Therapy during Treatment

Calories

- Nonambulatory/sedentary

25-30 kcal/kg body weight

- Hypermetabolic/weight gain

30-35 kcal/kg body weight

- Hypermetabolic, severely stressed, malabsorption

35 kcal/kg body weight

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Nutrition Therapy during Treatment

Protein

- Nonambulatory/sedentary

1.0-1.2 g/kg body weight

- Hypermetabolic/weight gain

1.2-1.5 g/kg body weight

- Hypermetabolic, severely stressed, malabsorption

1.5-2.5 g/kg body weight

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Tips to increase kcals and protein

Add cheese - to toast, crackers, sandwiches, baked potatoes, veggies, soups, and noodles

Add peanut butter - to toast, bread, English muffins, fruit - blended into chocolate or vanilla milkshake

Add nuts and seeds: - sprinkled over cereals, fruit, desserts, veggies, salads, and pasta

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Altered Taste/Smell

Taste/smell impairment occurs in more than ¾ PTs

Can interfere with enjoyment of eating

↓ tolerance of bitter foods

↑ tolerance of sweet foods

Can significantly reduce intake

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Strategies to Reduce Food-borne

Illness Risk – Neutropenic Diet

Proper hand washing

Cook meat to “well-done”

No raw eggs, even in dressings, “over-easy” eggs

No sushi, raw seafood, raw meats, unpasteurized milk

Wash fruits/veggies thoroughly

Thaw food in fridge-not on counter or in sink

Refrigerate leftovers immediately and discard after 3d

Avoid salad bars and buffets when eating out

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Low-Bacterial / Low-Microbial Diet

Order is up to the discretion of the physician

Foods not allowed:

- fresh fruits and vegetables

- nuts and dried fruits

- foods from multi-serving containers

- deli meats and undercooked meats

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For More Information

www.cancer.org

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