1. Section 3 Medical Nutrition Therapy

2. Chapter 21 Diet and Cancer

3. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company3 Objectives  Discuss how nutrition can be related to the development or the prevention of cancer  State the effects of cancer on the nutritional status of the host  Describe nutritional problems resulting from the medical treatment of cancer  Describe nutritional therapy for cancer clients

4. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company4 Cancer Cancer is the second leading cause of death in the United States. It is a disease characterized by abnormal cell growth and can occur in any organ. Cancerous tumors are malignant, affecting the structure and consequently the function of organs.

5. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company5 Cancer The mortality rate for cancer clients is high, but cancer does not always cause death. Oncology is the study of cancer. An Oncologist is a physician who specializes in cancer.

6. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company6 Causes of Cancer Precise etiology of cancer unknown. Heredity, viruses, environmental carcinogens, and possibly emotional stress may contribute to its development. Cancer is not inherited, but some families appear to have a genetic predisposition for it.

7. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company7 Causes of Cancer Environmental carcinogens include radiation (x-rays, sun, nuclear wastes), certain chemicals (ingested in food, water or touched by skin) and certain substances that are breathed in (tobacco smoke and asbestos). Carcinogens cause cancer after repeated exposure.

8. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company8 Causes of Cancer Viruses linked to cancer: Epstein Barr, hepatitis B, and herpes simplex II. Epstein Barr: nasopharyngeal cancer, T- cell lymphoma, Hodgkin’s disease and gastric carcinoma Hepatitis B: liver cancer Herpes Simplex II: cervical and uterine cancer

9. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company9 Classifications of Cancer Majority of all cancers fall under these headings: carcinomas, sarcomas, lymphomas, and leukemias. Skin cancer is becoming more prevalent. There are three types of skin cancer: basal cell, squamous cell, and melanoma.

10. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company10 Relationships of Food and Cancer Both good and bad relationships between food and cancer exist. Carcinogens include nitrates in cured and smoked foods such as bacon and ham. Regular ingestion associated with stomach and esophagus cancer.

11. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company11 Relationships of Food and Cancer High-fat diets associated with uterine, breast, prostate, and colon cancers. Excessive caloric intake associated with gallbladder and endometrial cancer. Smoking and drinking alcohol associated with lung, mouth, pharynx, and esophagus cancer.

12. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company12 Relationships of Food and Cancer Diets high in fiber help protect against colorectal cancer. Diets rich in vitamin C may protect against stomach and esophagus cancer. Diets high in vitamin A may protect against lung, bladder, and larynx cancer.

13. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company13 Relationships of Food and Cancer Flavonoids, phenols, and indoles are phytochemicals. These are substances that occur naturally in plant foods and are thought to be anticarcinogenic. Eat five or more servings of fruits and vegetables each day.

14. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company14 Relationships of Food and Cancer Legumes such as soybeans, dried beans, and lentils contain vitamins, minerals, protein, and fiber and may protect against cancer. High intakes of soy foods are associated with a decreased risk of breast and colon cancer.

15. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company15 Relationships of Food and Cancer An immune system that has been damaged—possibly through malnutrition—may be a contributing factor in the development of cancer. Excessive protein and fat intake, however, may be a factor in the development of cancer of the colon.

16. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company16 The Effects of Cancer Unexplained weight loss, weakness, anorexia. Loss of muscle tissue and hypoalbuminemia. Sense of taste and of smell becomes abnormal.

17. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company17 The Effects of Cancer Satiated earlier than normal. Abnormal insulin production with hyperglycemia. Hypercalcemia, renal stones, impaired kidney function Cachexia: severe malnutrition and body wasting.

18. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company18 Treatment of Cancer Surgical removal, radiation, chemotherapy, or a combination of these methods used to treat cancer. Side effects of these treatments can affect nutrition. These include xerostomia (dry mouth) and dysphagia (difficulty in swallowing).

19. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company19 Treatment of Cancer Tooth decay and loss of teeth sometimes occurs. Radiation and chemotherapy may depress appetite. Anorexia (loss of appetite), nausea, vomiting, and diarrhea can lead to fluid and electrolyte imbalances.

20. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company20 Nutritional Care Kcal needs of the cancer client are greater than before the illness. Clients on high-protein and high-kcal diets tolerate the side effects of therapy and higher doses of drugs better than those who cannot eat normally.

21. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company21 Nutritional Care Clients can form aversions to food making anorexia worse. To help with aversions: Hold chemotherapy 2 to 3 hours before and after meals Include favorite foods served attractively in familiar ways

22. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company22 Nutritional Care If chewing is a problem, use a soft diet. For diarrhea, use a low-residue diet. High-protein, high-kcal diets and plenty of fluids recommended for clients undergoing radiation or chemotherapy. 45 to 50 kcal per kg of body weight per day.

23. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company23 Nutritional Care Carbohydrates and fat will be needed to provide energy and spare protein for tissue building and the immune system. 1.0 to 1.2g of protein per kg of body weight a day. Malnourished clients may need from 1.3 to 2.0g of protein per kg of body weight a day.

24. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company24 Nutritional Care Vitamins and minerals are essential. During chemotherapy and radiation therapy the recommendation is to eliminate vitamin A and vitamin E in supplemental form and in the diet. Intake of these vitamins may prevent cancer cells from self-destructing and work against cancer therapy.

25. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company25 Nutritional Care Encourage food that will increase appetite. Foods brought from home Cold foods may be more appealing than hot foods Milk, cheese, eggs, and fish may be more appealing than meat (can taste bitter) Add sugar if foods are not sweet tasting

26. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company26 Nutritional Care Salad dressings, gravies, sauces, and syrups appropriately served on foods can be helpful for dry mouth. Several small meals may be better tolerated than three large meals. Use drugs to control nausea and pain. Nutritional supplements may be needed.

27. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company27 A client with cancer may feel that comments to encourage eating are depressing reminders of the cancer and the situation. How can the health care professional be helpful to the client?

28. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company28 At appropriate time, explain why it is important that the client eat. Encourage the client to eat foods the client enjoys. Recommend the client avoid eating at the time of day nausea is likely to occur. Refrain from food that gives off odors that contribute to nausea.

29. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company29 Conclusion Cancer is a disease characterized by abnormal cell growth. Energy needs increase because of the hypermetabolic state and the tumor’s need for energy nutrients. Surgery, radiation, and chemotherapy can cause side effects that affect nutrition.

30. Chapter 21Copyright © 2003 Delmar Learning, a Thomson Learning company30 Conclusion Improving the nutritional state is difficult because of the illness and anorexia. Parenteral or enteral nutrition may be necessary. Health care professional can help the client improve nutrition.