NUTRITION AND CANCER

DEFINITION OF CANCER
Refers to uncontrolled growth of abnormal cells which may occur in various body sites, and therefore not a single disease. It is a condition where cells behave abnormally, grow out of control,

CAUSES OF CANCER CELL DEVELOPMENT

The basic cause of cancers is a fundamental loss of the natural control over normal cell production.

These may be brought about by:

1. Heredity 2. Tobacco smoking 3. Diet (e.g. excess caloric intake, red meat consumption, alcohol) 4. Excess weight 5. Unprotected exposure to sunlight

6. Toxins (e.g. benzene, diesel exhaust, hair dye, pesticides, wood dust, arsenic, etc.) 7. Lack of physical activity 8. Radiation

THE DIET CANCER CONNECTION

1. Foods contain substances that are potentially carcinogenic. They may be natural components of food, formed during storage and processing (including cooking), intentionally added (e.g. food additives), or accidental contaminants.

2. Foods also contain substances that protect against cancer. These include Vitamin A, C, and E, carotenoids, selenium, dietary fiber and phytochemicals.

TABLE I: Dietary Risk Factors in Cancer Etiology

DIETARY RISK SITES THAT MAY BE FACTORS AFFECTED 1. Total energy 1. Breast (especially (independent of fat intake) among post - menopausal women). 2. Total Fat 2, Breast, colon, prostate, pancreas, ovary. 3. Animal Fat, Saturated 3. Breast, prostate, ovary Fat

5. Cholesterol 6. Fried Foods

7. Protein, especially animal protein 8. Meat 9. Alcohol

5. Colon 6. Breast, colon, prostate , endometrium , ovary 7. Prostate 8. Pancreas 9. Colon, esophagus, larynx, liver, oral cavity ( month and throat)

10. Salt, salt - picked food 11. Nitrite-cured meat 12. Charcoal-broiled / smoked fatty foods 13. Moldy food

10. Stomach 11. Stomach 12. Stomach 13. Liver

EFFECTS OF CANCER WITH NUTRITIONAL IMPLICATIONS

NUTRITIONAL CARE OF PATIENTS WITH CANCER

A .Stages of Cancer Therapy and Nutritional Objective

STAGES DIETARY MANAGEMENT 1. Curative Is when treatment is aggressive or Stage radical (e.g. radiotherapy, chemotherapy, and surgery) The aim is to eliminate the disease and cure the patient. The overall goal is the prolongation of life and survival. Dietary management is aimed at the treatment-related side effects of the medical / surgical therapy as well as the effects of the disease itself.

STAGES 2. Pallative Stage

DIETARY MANAGEMENT Diet therapy at this stage is less restrictive. A major consideration is the patients informed preference for the level of nutrition support acceptable to him.

STAGES 3.Terminal Stage

DIETARY MANAGEMENT Is when death appears imminent (within weeks or hours), management is aimed solely at comfort. The continuation of aggressive nutrition support at this time becomes an ethical question. The wishes of the patient and his relatives may be followed.

B. Dietary Management of Cancer

Cancer patients are usually in hypercatabolic state. Hence, nutritional support such as the enteral or parenteral feeding is indicated. 2. The following are some dietary management strategies for the feeding problems of cancer patients :

1.

Goals of Dietary Management

1. Improve or maintain patients optimal nutritional status and body weight. Maintain patients strength during therapy and reduce secondary side effects of therapy

 3. Prevent or reverse patients immunosuppression 4. Provide short term and long term measure to ensure survival.

A. Anorexia
Small, frequent feedings are preferable to large meals. Often, the mere sight of large portions of food can induce nausea and anorexia. Have snacks and fruit juices at the patients bedside for him to take whenever hungry. Consider the patients food preferences. Choose calorie - dense foods and beverages

 Use wine as appetite stimulant. Encourage dining with friends or family in pleasant surroundings.

B. Nausea and Vomiting

Clear liquids, salty foods and fruits like watermelon are occasionally tolerated. Too sweet and greasy foods may initiate or increase discomfort. Strong odors, particularly that of food cooking, are sometimes objectionable. Drinking or eating rapidly, or sudden movement may stimulate vomiting. Drink liquids an hour before or after eating to keep from filling-up quickly during meals.

 Eat high-carbohydrate foods such as crackers and toast if troubled by nausea upon first wake up in the morning. Eat slowly and chew food thoroughly. Rest after eating. Activity can slow down digestion and may cause discomfort

C. Hypogeusia ( diminished taste perception )

In the absence of oral or esophageal lesions, give flavorful ( e.g. spicy ) foods Serve attractively prepared food.

D. Hypergeusia ( heightened taste perception )

Serve bland foods. Serve cold foods minimal odors. or foods with

E. Dysgeusia (Taste Blindness)

If there is aversion to several of the most popular protein foods, look for alternatives that are more palatable, and also good sources of protein such as milk, ice cream, bland cheese, cottage cheese and peanut butter. Small, frequent feedings. Give liquid high protein diet supplement.

F. Chewing and swallowing difficulty

Adjust diet to patients tolerance. Give thick consistency fluids or semi-solid foods. Avoid sticky foods Consider tube feeding.

G. Xerostomia (dry mouth)

Soft bland foods, especially cool or cold foods with high fluid content. Serve solid foods with gravies, sauces, melted butter, broths, mayonnaise, yoghurt or salad dressing. Dunk bread and other baked foods in milk , tea or coffee for easy swallowing. If solid food is not tolerated, try pureed diet or full liquid diet. Give salivary stimulant like citric acid containing beverages. Lemon drops or gums.

 Try moist and liquid foods such as soups and stews. They may be easier to chew and swallow. Eat soft, cold foods such as ice cream, fruit juice bars, water melon, and grapes. They may feel and taste better than other foods. Drink through straw to make swallowing easier.

H. Thick viscous saliva

Give clear liquid like tea, popsicles and slushes. Saline rinses before eating may help.

I. Esophagitis
Avoid secretagogues like alcohol, caffeine, spicy and salty foods. Give cold, clear liquids or semisolids initially.

J. Oral and esophageal pain due to lesions

Avoid highly seasoned, acidic, extremely hot and extremely cold foods that cause irritation. Consuming foods at room temperature may be soothing. Give a mechanical soft diet (high calorie, high protein fluids, pudding, finely chopped or pureed food) that are requires minimum chewing. Avoid hard, dry, crisp, or rough-textured foods. Soak dry foods in liquid such as gravy, sauces, coffee, tea or milk.

K. Heart burn
Bland diet Small frequent feedings Do not lie down for two to three hours after meals. Keep head and chest elevated with pillows or put a six-inch bed block under the head of the bed. Avoid chemical irritants such as hot, spicy foods, coffee, liquour, smoking and stress.

L. Indigestion
Small frequent feedings, Avoid overeating and foods that may cause indigestion

M. Bloating
Eat frequent small meals Avoid fatty, fried and greasy foods, gas-forming vegetables (broccoli, cabbage, cauliflower, corn, cucumber, beans, green peppers, sauerkraut and turnips), carbonated beverages, chewing gum and milk. Emphasize sweet or starchy foods and low-fat protein foods. Sit up and walk around after meals.

N. Diarrhea
Determine the cause: > If treatable, bowel rest and total parenteral nutrition maybe indicated until diarrhea subsides so that oral enteral feeding can be given. > If there is bacterial overgrowth due to prolonged antibiotic therapy, supplementation with lactobacillus acidophulus cultures through fermented dairy products (e.g. Yakult or Yogurt) maybe helpful.

 If cause is highly resistant to treatment, a nutrition therapy goal would be to promote patient comfort through: > Medications to minimize symptoms > Small frequent meals served at room temperature > Intravenous fluids, to maintain fluidelectrolyte balance > Fiber containing supplements > Total parenteral nutrition ( TPN ) if bowel resist will relieve symptoms.

O. Malabsorption
Start with a polymeric formula or a lactose-free formula, orally or enterally. If signs of malabsorption persist, consider giving an elemental diet or TPN. For fat absorption: > Omit fat in the diet. Medium chain triglycerides are usually tolerated. For vitamin and mineral malabsorption: > Give supplements. For lactose intolerance: > Omit regular milk. Soybean milk or lowlactose formula may be used for children and adults requiring a high protein diet.

P. Weight loss, Muscle loss

Give high protein, high calorie diet

Q. Neurologic complications
These include impairment of motor functions, confusion, dementia and neuropathy. The following strategies may be helpful: > Simplify meal tray; use special utensils, if available. > Modify food consistency if there is difficulty of swallowing. > In advanced cases of neurologic involvement, the patient may need feeding assistance, or consider tube feeding.

R. Dehydration
Take frequent feedings of liquids or foods that become liquid in the stomach, such as fruits with a high fluid content; jello, ice cream, sherbet, fruit ices and popsicles.

 HIV infects T cells and monocytogenes/macrophanges , B lympocytes, and other cells ensuing severe immune functions Considered as a wasting syndrome characterized as emaciation and weight loss

 Can spread through exchange of body fluids during sexual intercourse, by exposure to infected blood or sharing contaminated needles.

Nutrition Intervention
To preserve lean body mass To provide adequate amounts of all nutrients To minimize gastrointestinal symptoms Improve quality of life To provide supportive and and nonjudgemental care to patient.

 ENERGY - may require about 35 to 45kcal per gram usual weight. PROTEIN 2 to 2.5 gram protein per kg are needed. FAT Increase the use of omega 3 fatty acids and decrease sources of saturated fat in the diet.

 VITAMINS AND MINERALS Altered metabolism of Vitamin A, E, C and B12, folate, zinc and selenium. ORAL AND ENTERAL NUTRITION SUPPORT shown to promote body mass repletion, improve mental function and shorten hospitalization time.