Download Oncology

Chapter 10
Cancer: Nutrition
Prevention and Treatment
What Is Cancer?
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Cancer is the uncontrolled growth of abnormal
cells that form a mass of tissue known as a tumor
A malignant tumor impairs body function and
takes nourishment away from normal tissue
Oncology is the study of cancer; an oncologist is a
medical doctor who specializes in the treatment of
cancer
Most cancer research is epidemiologic—based on
observed associations in given populations, rather
than cause-and-effect research
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Physiologic Precursors of Cancer
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Chronic inflammation as induced by obesity, diet,
inactivity
Free radicals inducing chromosomal changes (DNA)
Angiogenesis (the creation of blood vessels)
Hyperinsulinemia promoting insulin-like growth
factor; insulin resistance and hyperinsulinemia found
with:
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Gynecologic cancers
Digestive tract cancers
Bladder and prostatic cancers
Leukemia
Non-Hodgkin’s lymphoma (Pisani, 2008; Pischon et al., 2008; Renehan et al.,
2008; Suba and Ujpal, 2006)
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Etiology
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Genetics—associated with correlates of
the metabolic syndrome
Associated with:
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High intake of saturated fat, polyunsaturated
fat Excess CHO (sugar), low fiber
Low intake of plant-based foods/antioxidants
Excess salt
Low intake omega-3 fatty acids (fatty fish)
Possible excess iron intake (high iron levels
associated inflammation)
Low vitamin D status
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Non-Diet Risk Factors
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Associated with low level of physical activity
Smoking/chewing tobacco
Alcohol intake, especially excessive
Exposure to UV light
Exposure to carcinogens in the environment
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Particles and chemicals in the air
Nitrates in processed meats
Inorganic arsenic in water supplies
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American Institute for
Cancer Research
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30% to 40% reduction in cancer risk with—
Diet rich in a variety of plant-based foods,
especially fruits and vegetables;
magnesium-rich foods (“beans and
greens”) lower inflammation; flavanoids
(phytochemicals) associated with reduced
risk
Maintenance of a healthy weight and
physical activity
Alcohol consumed in moderation
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American Institute for
Cancer Research (continued)
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Diet low in fat (i.e., saturated and
polyunsaturated fats) and salt
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Monounsaturated and omega-3 fats have
neutral/ protective effect
Foods prepared and stored safely
No tobacco in any form
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Other Preventive Measures
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Emphasize nuts as a natural source of
monounsaturated fats and vitamin E
Use aluminum foil under meat on the
barbecue grill. Avoid exposing the meat to
the smoke of meat drippings on hot coals
(to avoid production of nitrosamines)
Include supplement of vitamin D to reduce
risk of colorectal and skin cancer and other
forms
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Bladder Cancer
(Fourth leading type for men in U.S.—ninth
worldwide)
 Associated with cigarette smoking and chronic UTIs
(Murta-Nascimento et al., 2007)
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Associated with obesity (Koebnick et al., 2008)
To lower risk with diet:
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Increase intake of fruits and vegetables
Increase intake of B vitamins and retinol—dark-green leafy
and deep orange color (Garcia-Closas et al., 2007)
Increase cruciferous vegetables—broccoli, cauliflower,
Brussels sprouts, cabbage (Zhao et al., 2007)
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Breast Cancer
(Second leading cause of cancer death among women in the
U.S.)
 Central obesity associated (Tehard and Clavel-Chapelon, 2006)
 To lower risk:
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Normalize hyperinsulinemia (Goodwin et al., 2008); follow TLC diet
and increased exercise, especially for overweight women
(Bardia et al., 2006)
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Avoid excess fat—saturated, in particular (Thiebaut et al., 2007);
emphasize monounsaturated fat—olive oil (Menendez et al., 2007) and
fatty fish (Sun et al., 2005; Yee et al., 2005)
 Increase fruits and vegetables, especially folate sources (Ericson
et al., 2007; Fung et al., 2005)
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Avoid alcohol, or if included in moderation, increase intake of
folate to help offset risk (Stolzenberg-Solomon et al., 2006; Tjonneland et al.,
2006)
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Colorectal Cancer
(Major cause of death and illness in adults
Over age 50)
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Hyperinsulinemia associated, along with central obesity,
excess alcohol, smoking, and low intake of folate and the
amino acid methionine (Campos et al., 2005; Kim et al., 2007)
All individuals on insulin therapy for type 2 diabetes should
be screened initially and every 5 years (Berster and Goke, 2008)
To lower risk:
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Follow TLC diet to reduce reliance on insulin use/production
 Limit salt intake (Marques-Vidal et al., 2006)
 Include vitamin D supplementation; 1000 IU associated with
50% reduced risk (Grant et al., 2007)
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Endometrial and Ovarian Cancer
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Obesity and hyperinsulinemia linked along
with inflammation and excess estrogen
levels (Goswami et al., 2007; Gunter et al., 2008)
To reduce risk:
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Increase folate intake (Xu et al., 2007)
Increase carotenoids (Czeczuga-Semeniuk and Wolczynski, 2005)
Avoid excess coffee intake (Silvera et al., 2007)
Avoid acrylamide—found in starchy foods
prepared at high temperatures (i.e., fried
foods) (Hogervorst et al., 2007)
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Esophageal Cancer: On the Rise
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Precursor: Barrett’s esophagus (premalignant lesion
and strictures of the lower esophageal section related
to ulceration and reflux). Zinc deficiency may
contribute (Guy et al., 2007)
Obesity and high sugar intake implicated (Thompson et al.,
2008)
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To lower risk:
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Increase intake of omega-3 fats—fatty fish or supplements
(Mehta et al., 2008)
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Avoid alcohol and smoking (La Vechhia et al., 2008)
Slow down pace of eating and decrease salt (Yang et al., 2005)—
may be due, in part, to increased saliva production with
increased chewing
Include antioxidant sources—vitamins C, E (Dong et al., 2008)
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Lung Cancer:
Part Environmental, Part Diet
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To minimize risk:
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Increase intake of magnesium to promote DNA
repair capacity (Mahabir et al., 2008)
 Increase intake of cruciferous
vegetables—may be due to magnesium
content or other phytochemicals (Wang et al., 2004)
 Increase omega-3 and reduce omega-6 fatty
acids (Xia et al., 2005)
 Increase fruits (Kubik et al., 2008)
 Increase dietary intake of boron (Mahabir et al., 2008) and
copper, zinc, iron (Mahabir et al., 2007)
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Prostate Cancer
(Most common form and leading cause of death
among men in the U.S.)
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Screened with PSA levels
High risk factors include African heritage, family hx, low
intake of tomato products, smoking, taller height, high BMI,
low physical activity (Giovannucci et al., 2007); male breast cancer
linked (Lee and Jones, 2008)
To reduce risk:
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Follow TLC diet to lower insulin levels
Vitamin E—nuts (Wright et al., 2007)
Supplement with vitamin D
Increase tomato product intake
Increase zinc intake (van Wijngaarden et al., 2007)
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Thyroid Cancer
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Increased risk among persons living near
or downwind (Europe) of 1986 Chernobyl
nuclear power plant accident in Russia
and Ukraine region
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Such individuals (especially the children)
should receive lifetime screening due to high
rate of secondary cancers such as leukemia
(Kumagai et al., 2007 ; Balanov, 2007)
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Such individuals should avoid iodine deficiency
with iodine supplementation to reduce risk of
thyroid cancer, leukemia, and breast cancer
(Kesminiene and Cardis, 2007)
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Impact of Cancer on Food Choices
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Taste changes (dysgeusia):
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Reduced threshold for bitter tastes
(meat aversion is common)
Increased threshold for sweetness
(high-sugar foods more acceptable)
Increased threshold for salt and sour flavors
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Effect of Cancer and Treatment
on Nutritional Status
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Altered metabolism with hypermetabolic state
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Requires some form of nutrition support (enteral or
parenteral)
Nausea and vomiting from chemotherapy or
toxins generated from cancer cells
Dysphagia (impaired swallowing), dry mouth (with
greatly increased risk of dental decay), and sore
mouth/esophagitis from radiation or surgery of the
neck area
Diarrhea from radiation or surgery in the
abdominal area. If villi are damaged, digestive
enzymes are diminished and diarrhea occurs
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Low-lactose milk products or alternatives advised
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Nutrition Goals for
Cancer Treatment
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Maintain body weight—sweet foods may
be best accepted
Include adequate protein for goal of
normal albumin
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Alternatives to meat:
• Eggs
• Cheese/yogurt/milkshakes
• Peanut butter or nuts
• Bean-based soups
Ensure adequate fluid intake
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Other Nutrition Goals
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Replace minerals/electrolytes lost from
vomiting/diarrhea
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Use commercial products
Include bean-based soups (potassium,
magnesium, and sodium)
Citrus fruits (potassium)
Other soups (sodium)
Whole grains (magnesium and potassium)
Maintain as good a nutritional status as
possible with a variety of foods or reliance
on commercial liquid supplements
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Monitor Altered Nutritional
Needs for Cancer Survivors
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Increased risk for CVD and diabetes due to weight
gain, osteoporosis with estrogen/androgen
deficiency, secondary tumors
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With gastric surgery, pellagra may develop
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DXA scans to r/o osteoporosis
Promote increased exercise for bone health, weight goals
Promote MyPyramid/Dietary Guidelines for CA prevention
Monitor s/s: dermatitis, diarrhea, delirium/dementia,
possible neurologic changes and prevent/tx with vitamin B3
Intestinal resections increase risk for variety of
nutrient deficiencies
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With Cancer Remission
for Prevention of Recurrence
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Promote lifelong positive nutrition
behaviors
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Encourage high-fiber diet and emphasis on
monounsaturated fats
Encourage moderate kilocalorie intake to
manage weight and avoidance of excess salt
Encourage high-quality diet per the MyPyramid
Food Guidance System
Promote positive lifestyle
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Encourage regular physical activity
Encourage avoidance of excess alcohol
Encourage avoidance of tobacco
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