1. Cancer:a number of diseases that arise due to genetic alterations in cells that lead to unchecked growth (tumorigenesis). Dietary and immune factors are thought to influence risk of cancer. Tumors can be MALIGNANT (spread aggressively to other parts of the body) or BENIGN (non- growing tumors that do not threaten life).

4. Cancer Terminology Cancers are classified by their tissue of origin. Examples: Carcinomas:originate in epithelial tissues. Adenomas:originate in glandular tissues. Sarcomas:originate in soft tissues (e.g., muscle, bone, or connective tissues) Melanomas:originate from pigmented cells in the skin. Lymphomas:originate from lymph tissues. Leukemias:arise from white blood cells. Gliomas:arise from cells in the nervous system.

5. Genetic Alterations That Lead to Colorectal Cancer Effect of Dietary Constituents?

6. Figure 1: A theoretical framework ued to describe the process of carcinogenesis. InitiationPromotion Progression Metastasis Mutations Inflammation Rapid Cell Growth/ Tumor Growth/ Mutations Inflammation Rapid Cell Growth/ Tumor Growth/ in Tumor Inhibition of Dissemination in Tumor Inhibition of Dissemination Suppressor/ Apoptosis Suppressor/ Apoptosis Oncogenes Oncogenes Source: L.W. Wattenberg. Cancer Research (1993) 53:5890. NORMAL CELL INITIATED CELL CLONAL GROWTH

7. Nutritional Consequences of Cancer Dependent upon: 1.Stage of Cancer (e.g., Duke’s) 2.Location of Cancer 3.Treatment Modality (e.g., radiation, chemotherapy, surgery, etc.) Cancer patients MAY or MAY NOT be hypermetabolic.

8. Cancer Cachexia:PEM associated with cancer. Loss of Appetiteweight loss Depletion of lean body mass Depletion of serum proteins

9. Cancer Cachexia is caused by altered metabolism due to cytokines produced BY THE TUMOR. These cytokines cause anorexia and help to shunt fuel to the tumor.

10. Causes of Inadequate Nutrient Intake 1.Early satiety and nausea. 2.Fatigue. 3.Pain. 4.Psychological stress. 5.GI Obstructions.

11. Causes of Nutrient Losses in Cancer Malabsorption Diarrhea Vomiting Inadequate Digestion

12. Where Does Diet Fit in Cancer Treatment? Primary Cancer Treatments? Radiation, Chemotherapy, Surgery These treatments pose significant threats to health and nutritional status. New Therapies-- Monoclonal antibodies against the Her/Neu receptor (Herceptin) AntiAngiogenesis therapies: neomycin, angiostatin, endostatin Immunotherapy

13. Adequate nutrition is supportive therapy only. Diet cannot cure cancer but adequate nutritional status can help patients survive difficult treatments. You’ll hear many accounts of dietary success in cancer treatment. Some are likely to be true. Cancer Treatment Centers of America uses diet as adjunctive therapy for all types of cancer.

14. Rationale behind Treatment Strategies: Radiation: Interferes with cell’s ability to divide. Since many cancer cell-types grow faster than normal cells, this treatment SHOULD preferentially kill cancer cells. Fastest growing tissues are the ones hit hardest by radiation treatment: GI epithelium, bone marrow, hair, skin

15. Primary Side Effects of Radiation Treatment Fatigue, Anorexia, Nausea, Vomiting, Diarrhea Mouth Ulcers Lack of Saliva Production Chewing/ Damage to teeth and mandible Swallowing Difficult Radiation Enteritis= malabsorption, blood loss fluid/electrolyte imbalances