1. Medical Nutrition Therapy for Cancer Prevention, Treatment, and Recovery Chapter 40

2. © 2004, 2002 Elsevier Inc. All rights reserved. Cancer n When cells divide and reproduce abnormally and have the potential to spread throughout the body, crowding out normal cells and tissues n One third of the cancer deaths in the United States each year can be attributed to nutrition and other lifestyle factors. n When cells divide and reproduce abnormally and have the potential to spread throughout the body, crowding out normal cells and tissues n One third of the cancer deaths in the United States each year can be attributed to nutrition and other lifestyle factors.

3. © 2004, 2002 Elsevier Inc. All rights reserved. Carcinogenesis n Initiation-exposure to carcinogen- initiators begin altering cellular DNA, remains dormant until activated by promoting agent n Promotion-initiated cells activated by promoting agents to multiply n Progression- tumor cells accumulate & grow independently, capacity for invasion & metastasis n Initiation-exposure to carcinogen- initiators begin altering cellular DNA, remains dormant until activated by promoting agent n Promotion-initiated cells activated by promoting agents to multiply n Progression- tumor cells accumulate & grow independently, capacity for invasion & metastasis

4. © 2004, 2002 Elsevier Inc. All rights reserved. Cancer—Cause Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

5. © 2004, 2002 Elsevier Inc. All rights reserved. Cancer—Pathophysiology Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

6. © 2004, 2002 Elsevier Inc. All rights reserved. Cancer—Medical and Nutritional Management Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

7. © 2004, 2002 Elsevier Inc. All rights reserved. Tumor Node Metastases (TNM) Staging System n T- size of original (primary) tumor n N- node involvement (spread to nearby lymph nodes) n M- presence of distant metastases n T- size of original (primary) tumor n N- node involvement (spread to nearby lymph nodes) n M- presence of distant metastases

8. © 2004, 2002 Elsevier Inc. All rights reserved. Treatment n Primary- definitive, indicates that it will be the only therapy ie: surgical removal of a small tumor n Adjuvant- usually treatment “in addition to” initial treatment ie: using chemo after surgery as part of treatment regimen n Combination- use of 2 or more therapeutic agents/processes for treatment n Salvage- additional treatment used in hope of cure to prolong life, in pt with recurrence of CA after initial treatment n Primary- definitive, indicates that it will be the only therapy ie: surgical removal of a small tumor n Adjuvant- usually treatment “in addition to” initial treatment ie: using chemo after surgery as part of treatment regimen n Combination- use of 2 or more therapeutic agents/processes for treatment n Salvage- additional treatment used in hope of cure to prolong life, in pt with recurrence of CA after initial treatment

9. © 2004, 2002 Elsevier Inc. All rights reserved. Prevention Factors n Energy balance and exercise n Fat n Protein n Fiber n Fruits and vegetables n Chemoprevention n Energy balance and exercise n Fat n Protein n Fiber n Fruits and vegetables n Chemoprevention

10. © 2004, 2002 Elsevier Inc. All rights reserved. Prevention Factors—cont’d n Alcohol n Coffee and tea n Artificial sweeteners n Nitrates, nitrites, and nitrosamines n Method of food preparation n Alcohol n Coffee and tea n Artificial sweeteners n Nitrates, nitrites, and nitrosamines n Method of food preparation

11. © 2004, 2002 Elsevier Inc. All rights reserved. Fruits and Vegetables n Appear to have a protective effect against cancer n Thought to be due to the phytoestrogen and phytochemical content of the plant- based diet n Appear to have a protective effect against cancer n Thought to be due to the phytoestrogen and phytochemical content of the plant- based diet

12. © 2004, 2002 Elsevier Inc. All rights reserved. Fat n Research, although controversial, has shown evidence that high-fat diets are linked to an increased risk of cancer of the breast, colon, lung, and prostate

13. © 2004, 2002 Elsevier Inc. All rights reserved. American Cancer Society’s Dietary Recommendations for Cancer Prevention 1. Eat a variety of healthful foods, with an emphasis on plant sources. 2. Adopt a physically active lifestyle. 3. Achieve and maintain a healthy body weight throughout life. 4. Limit consumption of alcoholic beverages. 1. Eat a variety of healthful foods, with an emphasis on plant sources. 2. Adopt a physically active lifestyle. 3. Achieve and maintain a healthy body weight throughout life. 4. Limit consumption of alcoholic beverages.

14. © 2004, 2002 Elsevier Inc. All rights reserved. Pharmacological Agents for Anorexia-Cachexia Syndrome and Weight Loss Management n Appetite stimulants n Metabolic agents and cytokine blockers n Prokinetic drugs n Anabolic agents n Appetite stimulants n Metabolic agents and cytokine blockers n Prokinetic drugs n Anabolic agents

15. © 2004, 2002 Elsevier Inc. All rights reserved. Factors That Affect Appetite Reference: American Institute for Cancer Research: Food, nutrition, and the prevention of cancer: a global perspective, Washington, DC, 1997, AICR.

16. © 2004, 2002 Elsevier Inc. All rights reserved. Nutritional Implications of Cancer Therapy n Chemotherapy —Taste abnormalities, diarrhea, constipation n Radiation therapy —Fatigue, loss of appetite, skin changes n Surgery —Fatigue, pain, loss of appetite n Immunotherapy —Flulike symptoms, decreased food intake n Chemotherapy —Taste abnormalities, diarrhea, constipation n Radiation therapy —Fatigue, loss of appetite, skin changes n Surgery —Fatigue, pain, loss of appetite n Immunotherapy —Flulike symptoms, decreased food intake

17. © 2004, 2002 Elsevier Inc. All rights reserved. Nutritional Implications of Cancer Therapy—cont’d n Bone marrow transplant —Nausea, vomiting, diarrhea, mucositis, xerostomia, dysgeusia n Severe oral muscositis n Graft versus host disease (GVHD) n Veno-occlusive disease (VOD) n Bone marrow transplant —Nausea, vomiting, diarrhea, mucositis, xerostomia, dysgeusia n Severe oral muscositis n Graft versus host disease (GVHD) n Veno-occlusive disease (VOD)

18. © 2004, 2002 Elsevier Inc. All rights reserved. Marrow Transplantation—Cause Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

19. © 2004, 2002 Elsevier Inc. All rights reserved. Marrow Transplantation—Pathophysiology Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

20. © 2004, 2002 Elsevier Inc. All rights reserved. Marrow Transplantation— Medical and Nutritional Management Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

21. © 2004, 2002 Elsevier Inc. All rights reserved. Severe Oral Mucositis Following Marrow Transplantation

22. © 2004, 2002 Elsevier Inc. All rights reserved. Guidelines for Oral Feeding During Antitumor Therapy

23. © 2004, 2002 Elsevier Inc. All rights reserved. Guidelines for Oral Feeding During Antitumor Therapy —cont’d

24. © 2004, 2002 Elsevier Inc. All rights reserved. Commonly Used Complementary and Alternative Therapies n Macrobiotic diet n Vegetarian diet n Gerson therapy n Kelley/Gonzales regimen n Juice therapies n Macrobiotic diet n Vegetarian diet n Gerson therapy n Kelley/Gonzales regimen n Juice therapies n Shark cartilage n DHEA n Enzymes n Oxymedicine n Coenzyme Q10

25. © 2004, 2002 Elsevier Inc. All rights reserved. Commonly Used Complementary and Alternative Therapies—cont’d n Black cohosh n Echinacea n Flaxseed n Ginger n Iscador n Black cohosh n Echinacea n Flaxseed n Ginger n Iscador n Milk thistle n PC-SPECS n Saw palmetto n Soy and soy foods n Teas

26. © 2004, 2002 Elsevier Inc. All rights reserved. Nutrition in the Etiology of Cancer n Epidemiologic research has evaluated the role of diet in the etiology of cancer in different population groups. n Diets contain inhibitors and enhancers of carcinogenesis. n Laboratory studies have served as models to test the effect of food and nutrition on cancer development. n Epidemiologic research has evaluated the role of diet in the etiology of cancer in different population groups. n Diets contain inhibitors and enhancers of carcinogenesis. n Laboratory studies have served as models to test the effect of food and nutrition on cancer development.