2.  Cancer is a group of more than 100 different diseases.  Cancer occurs when cells become abnormal and keep dividing without control or order.  Most cancers are named for the type of cell or organ in which they begin.

3.  *B cells: Beta cells are specialized lymphocyates that produce immunoglobulins. They originate in the bone marrow cells and involve many cells in the body in the immune response.  T cells: T cells are specialized lymphocytes in the immune response which originate from stem cells in bone marrow and migrate when mature to the thymus gland.

4.  The specific type of cancer, and the disease process itself, has profound effects on the entire body system and cause primary nutritional deficiencies.

5.  1. Cancers occurring in the GI tract of adjacent tissue cause difficulty in ingestion and use of nutrients. 2. Intestinal malignancies contribute to hypokalemia.  3. *Anorexia, the most common symptom, is related to altered metabolism, type of treatment, or emotional distress.

6.  The most common detection and diagnostic tools for cancer are: 1. CT (or CAT) scans, MRI 2. Ultrasonography 3. Endoscopy 4. Biopsy

7.  Current cancer therapy takes 3 major forms: surgery, radiation, and chemotherapy. Sometimes they are used in combination. Nutritional support for all these therapies increases the successful rate of the treatments.

8.  1. Surgery Surgical procedures post special nutritional problems depending on the site. *For example, head and neck surgery or resections greatly affect intake, requiring different feeding methods, feeding intervals, and modifications in oral food preparation.

9.  2. Radiotherapy: Radio therapy significantly influences nutritional status, depending on the site of the treatment. For example, radiation to the head and neck or esophagus affects oral mucosa, salivary secretions, taste sensation, and sensitivity to temperature and texture of food.

10.  3. Chemotherapy Chemotherapy has the same effect on normal cells as they do on cancer cells. This becomes more apparent in changes in the bone marrow, hair follicles, and GI tract. For example, hair follicle effects are body hair loss and alopecia.

11.  General guidelines: *1. Energy: Carbohydrate should supply most of the energy intake with fat restricted to about 30% of total calories. 2. Protein: Provide additional amino acids and nitrogen for healing and tissue regeneration. * 3. Vitamins and minerals: Vitamin A and C are components of tissue structure.

12.  4. Water is second only to oxygen as the most important nutrient in the human body, and the maintenance of the fluid and electrolyte balance is especially crucial in cancer.  *5. Vitamins that are popular in megavitamin and mineral therapies are A, C, B12, and thiamin, and the minerals iron, zinc, and selenium.

13. *6. Both vitamin and mineral megadoses hamper immune function and can be toxic at high levels, increasing problems with skin, bone, and Central Nervous System, such as nausea, diarrhea, hair and nail loss, and depleted immune function independent of the toll of the disease itself. Both vitamin and minerals megadoses are not safe at high levels.

14.  *1. Malnutrition in a cancer patient is not inevitable. Most patients can be adequately nourished, if properly planned and executed nutrition therapy is provided. A severely malnourished patient may require a daily intake of 3000 to 4000 kcalories.  *2. Nutrition therapy must be proactive and aggressive.  3. Nutrition therapy is designed for specific physical and psychological needs and is highly individualized.

15. 4. Nutrition care plans are patient-centered. 5. Anticipate psychosocial situations that relate to appetite, various foods, drug effects, lifestyle, and beliefs of the client. *6. Provide the patients with information regarding symptoms they are experiencing, actions of their drug regimes, and mouth care tips they can do themselves.

16.  7. Make a thorough assessment of energy, protein, electrolytes, fluid, and micronutrient needs of the patient to use as a baseline for planning diet.  *8. Investigate the use of enteral and/or parenteral methods of feeding if they become necessary. Oral intake is preferred but may not be feasible in some cases.

17.  AIDS patients are at high risk for neoplasms. The oncology team is likely to also be involved in the treatment of patients with HIV infection.  Nutrition has a primary role in the process, progression, and treatment of HIV disease.  *There is no dormant phase in HIV infection. Once the virus enters the body, it settles into a pattern in the host cells, replaces the immune system cells, and continues to proliferate.

18.  * Food and nutrient interactions with the antiretroviral medications are common, making it difficult for a patient to adhere to the medical regime. However, improvement in nutritional status, especially lean body mass, improves well-being and quality of life, despite the level of HIV in the blood.

19.  * The stress response of the body to the immune system’s efforts to protect the body is a continuous process, resulting in loss of lean body mass, chronic inflammation, and hypermetabolism. The stress response is also marked by loss of appetite and reduced nutrient intake.

20.  * Small, frequent feedings high in quality protein are better tolerated than full meals.  Maximum nutrient intake enhances immune cell function and allowing the person to have a better quality life.  When the patient is no longer able to eat, enteral tube feedings or parenteral feeding may be used.

21.  Many patients will try any alternative that is offered to them, hoping for a miracle. Popular among the many such regimes offered is the use of megadoses of vitamin and mineral supplements. For instance, vitamin A, C, and B12 and the minerals zinc and selenium are said to stregthen the immune system and enable it to overcome the ravages of the disease.

22.  The opposite effect is more likely: 1. *Excess vitamin C often causes rebound scurvy when discontinued. 2. Vitamin A, zinc, and selenium are very toxic when taken in excess over long periods. 3. Excess supplements will suppress immune function instead of strengthening it. 4. *Laetrile is still around and still touted as a cure for AIDS, as it has been for cancer. Laetrile has never been proven to be beneficial in the treatment of chronic disease.

23.  Nutritional and metabolic changes characteristic of both cancer and AIDS individuals are directly related to: 1. The body’s response to the disease 2. Psychological and emotional responses 3. Surgical procedures 4. Treatment methods