Download Fundamentals of Nutrition

Section 3
Medical Nutrition Therapy
Chapter 21
Diet and Cancer
Objectives
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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
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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.
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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.
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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.
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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.
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Causes of Cancer
Viruses linked to cancer: Epstein Barr,
hepatitis B, and herpes simplex II.
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Epstein Barr: nasopharyngeal cancer, Tcell lymphoma, Hodgkin’s disease and
gastric carcinoma
Hepatitis B: liver cancer
Herpes Simplex II: cervical and uterine
cancer
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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The Effects of Cancer
Unexplained weight loss, weakness,
anorexia.
Loss of muscle tissue and
hypoalbuminemia.
Sense of taste and of smell becomes
abnormal.
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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.
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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).
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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.
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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.
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Nutritional Care
Clients can form aversions to food making
anorexia worse.
To help with aversions:
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Hold chemotherapy 2 to 3 hours before
and after meals
Include favorite foods served
attractively in familiar ways
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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.
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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.
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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.
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Nutritional Care
Encourage food that will increase appetite.
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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
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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.
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Stop and Share
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?
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Stop and Share
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.
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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.
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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.
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