CANCER

AN OVERVIEW AND DIETARY MANAGEMENT
By V.VYTHEESHWARAN

Cancer
• Cancer is the 2nd most common cause of death in the US after heart disease. • Cancer kills 1 out of every 4 Americans. • The risk of developing cancer can be reduced by changes in a person’s lifestyle.

What is Cancer?
• Normal body cells grow, divide and die in an orderly fashion. • Cancer cells are different because they do not die, just continue to divide and grow. • Cancer cells form as a result of damaged DNA.

What is Cancer?
• These damaged genes can be passed on, which accounts for inherited cancers. • In other cases, the DNA is damaged by an outside source such as smoking. • Cancer usually forms a tumor.

What is Cancer
There are two types of tumors: Malignant and Benign • Malignant tumors spread to other areas in the body. These are the dangerous ones. • Benign tumors stay in one place.

Types of Cancer
• Sarcoma-rise from connective tissue such as muscle or bone and are more common in younger people. • Carcinomas-which occur in epithelial tissue and are more common in older people. It includes lung, breast, prostate, and colon.

Types of Cancer
• Leukemia- cancers of the blood or blood forming organs. • Lymphomas- affect the lymphatic system. The lymphatic system is a group of vessels and nodes that act as the body’s filter. It prevents bacteria and foreign invaders from entering the bloodstream.

Causes of Cancer
80% are considered sporadic- meaning the cause is unknown. There are several risk factors that increase the chance of cancer: • Age- risk increases >50. • Diet- high fat, high cholesterol diets increase risk.

Causes of Cancer
• Obesity- no clear link but research indicates it is a factor • Cigarettes- increases lung cancer, other tobacco products such as pipes and chewing tobacco increase cancers of the mouth. • Long term exposure to chemicalsasbestos, radon and benzene.

Causes of Cancer
• Exposure to high levels of radiation • Harmful ultraviolet rays from the sun. • Some viruses- Hepatitis B, C, HPV, Epsteinn-Barr. • Immune system diseases • Heredity

Objectives
• Recognize the special nutritional needs of cancer survivors during active cancer treatment • Advise cancer survivors about nutrition and physical activity during the recovery phase and beyond • Resolve controversial nutritional issues facing cancer survivors

Challenges of Cancer Survivors
• Highly motivated to seek information about diet and lifestyle changes. • Often receive conflicting dietary advice. • Claims abound on the use of dietary alternatives. • Currently there are many gaps and inconsistencies in the scientific evidence.

NUTRITIONAL DEFICIENCIES
There are several factors that may contribute to the type and degree of nutrient deficiencies:

• The primary organ where the malignancy occurs. • The severity of the cancer at the time of diagnosis. • The symptoms experienced by the person with cancer. • The type and frequency of the cancer treatment being used and the side effects associated with that treatment (surgery, radiation, or chemotherapy). • The effect of the malignancy or disease on food and nutrient ingestion, tolerance, and utilization.

Body Weight Changes
• Intentional weight loss during cancer treatment is not recommended • Some cancer survivors may gain weight during and after treatments • During treatment, a healthy eating plan that meets but does not exceed caloric needs (along with physical activity) is advisable • Healthy weight loss is best initiated after the recovery phase • Obesity is associated with increased risk and poorer prognosis of breast and colon cancers

The Phases of Cancer Survival
• Phase 1: Active Treatment • Phase 2: Recovery from Treatment • Phase 3: Preventing Cancer Recurrence, Second Primary Cancers. • Phase 4: Living with Advanced Cancer – Dietary management

Phase 1: Nutritional Issues During Active Treatment
• Energy balance is the most important goal • ENERGY INTAKE • ENERGY EXPENDITURE • NUTRITIONAL SUPPLEMENTS

ENERGY INTAKE
– The need for caloric intake is usually increased during cancer treatments – Nausea, vomiting, taste changes, loss of appetite, bowel changes all interfere wit our usual eating patterns. – Food choices at this time should be easy to chew, swallow, digest and absorb and should also be appealing. – Adjust usual food choices and usual food patterns.

ENERGY EXPENDITURE
– cancer treatment can cause fatigue – light regular physical activity during treatment should be encouraged to improve appetite, stimulate digestion, prevent constipation. – Helps to maintain energy level and muscle mass and provide relaxation or stress reduction

 Nutritional products such as Boost, Ensure etc… can be helpful on a temporary basis to assist with intake of calories and nutrients.  Other supplements is quite controversial. For example, it is counterproductive for patients to take vitamin supplements that contain high levels of folic acid or to eat foods fortified with high amount of folic acid, when on Methotrexate. (metho interferes with folate metabolism).

NUTRITIONAL SUPPLEMENTS

NUTRITIONAL SUPPLEMENTS
 Antioxidants(Vitamins C, E and phytochemicals or antioxidant minerals), may reduce the effectiveness of RT or CX. May help protect normal cells from treatment collateral damage  No good answer or evidence at this time there fore it would be prudent to advise patients not to exceed the upper intake limits for vitamins and to avoid other nutritional supplements that contain antioxidant compounds.

Phase 2: Nutritional Issues After Treatment is Completed
• Most important goal Rebuild muscle strength and correct problems. • Adequate food intake • Physical activity
– Required to rebuild muscle strength. – Consultation required for elder patients.

Benefits of Moderate Regular Physical Activity for Cancer Survivors
• • • • • • reduce anxiety reduce depression improve mood boost self esteem reduce symptoms of fatigue, beneficial effects on heart rate, lean body mass and respiratory capacity

Diet and Cancer
The American Cancer Society recommends 4 rules of thumb for cancer prevention Choose most of the foods you eat from plant sources. 5 or more servings Limit intake of high fat foods, particularly from animal sources. Be physically active. Limit alcohol intake.

• • • •

Dietary Components Associated with Cancer

THE BAD GUYS!!!
Excesses of Certain substances such as: • Fat- the end products of metabolism have been found to be carcinogenic. • Alcohol- has been connected with liver, colorectal, and breast cancers.

Dietary Components Associated with Cancer

THE BAD GUYS!!!
• Pickled and Smoked Foods- related to cancers of the esophagus and stomach. that may increase the risk. • Cooking methods have also been found to have a role in cancer. Frying or charcoal-broiling meats at very high temperatures creates chemicals

Protective Dietary Components

THE HEROES
• Certain foods and nutrients have been shown to protect against certain types of cancers. • Vitamin C - has been shown to protect against cancer of stomach, esophagus, and oral cavity. • Antioxidants- these are certain protective substances found in fruits and vegetables.

Protective Dietary Components

THE HEROES
• Fruits and Veggies- contain vitamins, fiber and phytochemicals. • Vitamin E and selenium- both antioxidants that protect cells against breakdown. • Calcium- Calcium reduces cell turnover rates. • Water- drinking more than 5 glasses a day has been associated with a lower risk of cancer.

Diet and Cancer
• Fiber- Insoluble fiber is connected to decreased risk of colon cancer. • Beans, vegetables, whole grains and fruit are good sources. • Salt- some evidence links diets containing large amounts of foods preserved by pickling and salting to increased cancers of the stomach, nose and throat.

Diet and the Cancer Patient
• Nutrition is an important part of treatment. • Eating the right kinds of food before, during and after treatment can help the patient feel better and stay stronger. • Treatments can have an affect on appetite.

Diet and the Cancer Patient
• People with cancer have unique nutrition needs. • Eating enough food is usually not a problem. Treatment can have an adverse effect on appetite. • Nutrition suggestions often emphasize eating high calorie, high protein foods.

Diet and the Cancer Patient Side Effects
Treatments kill cancer cells but they also kill healthy cells. This can cause side effects such as: • Loss of appetite • sore mouth or throat • dry mouth • dental and gum problems • changes in taste or smell • Nausea • Diarrhea • Constipation • fatigue • depression.

Diet and the Cancer Patient
• It is very important to have good nutrition to minimize the side effects of cancer, prevent or reverse nutritional deficiencies, and to maximize the quality of life. • The best method of calorie intake is by mouth. Sometimes this is not possible.

Diet and the Cancer Patient
Other options of intake are: • Feeding Tube • TPN or total parental nutrition- this is nutrition directly through a vein.

FIVE FOR CANCER
Five things you should remember about preventing cancer. • Eat lots of fruits, vegetables, and whole grains. • Discover the pleasure of physical activity. • Stay tobacco free • Enjoy a low-fat diet • Protect yourself from the sun between 10:00 am and 4:00 pm.

COMMON DIET THERAPIES
• FULL FLUID DIET • SOFT DIET

FULL FLUID DIET
• Initial diet. • Administered alongside or immediately after therapy. • Predominant diet for oral, pharyngeal, oesophagal and GI tract cancer. • Administered at regular intervals (Every 2 hours).
FOOD VEGETARIAN NON-VEGETARIAN Corn flour Dhal flour Milk Meat Egg Fruit juice Butter Sugar 50 mg 30 mg 1000 ml ----800ml 2 Tbsps 100 mg 50 mg --800 ml 50mg One 850ml 2 Tbsps 100 mg

The above table shows amount of food to be consumed per day

SOFT DIET
• Secondary diet. • Administered following a period of full fluid diet. • Enriched with nutrients. • Supplementation of essential vitamins like folate and Vit C lost during drug therapy. • Meats can be avoided as far as possible as it results in the formation of nitrosamines in stomach. • This can be countered by administration of Vit C
FOOD Milled cereals Dhal Milk Meat, fish, sausages Egg Tender vegetables Potatoes Tender leafy vegetables Fruits (Apples & Oranges) Fats and Oils Sugar VEGETARIAN 300 mg 50 mg 1000 ml ----50 mg 100 mg 100 mg 100 mg 30 mg 80 mg NON-VEGETARIAN 300 mg 30 mg 600 ml 100 mg 30 mg 50 mg 100 mg 100 mg 100 mg 30 mg 80 mg

The above table shows amount of food to be consumed per day

Conclusion
• Cancer is a preventable disease in most cases. • Lead a healthy lifestyle. • Be aware of your body.

FOR MORE RESOURCES
• http://www.cancer.gov • http://www.cancer.org • http://muextension.missouri.edu

THANK YOU