It is characterized by uncontrolled growth and spread of abnormal cells, which continue to reproduce until they form a mass of tissue

known as a tumor.

Carcinogen- any substance that is an agent directly involved in the promotion of cancer or in the facilitation of its propagation.

Etiology

Associated with a high intake of saturated fat, polyunsaturated fat, and excess CHO (sugar)
Associated with excess weight gain Associated with other correlates of the metabolic syndrome Certain cancers appear to be related to hyperinsulinemia (e.g., some forms of breast, colon, liver, ovarian and uterine, pancreatic, prostate, and renal cancer) Possible excess iron intake (associated with inflammation)

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Non-Diet Risk Factors

Associated with low level of physical activity

Smoking/chewing tobacco Alcohol intake, especially excessive

Exposure to UV light
Chronic inflammation with high C-reactive protein (CRP)

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CARCINOGENESIS

Initiation takes place when a carcinogen like virus becomes activated in the body and binds to DNA.

Promotion is the growth of cancer cells.

Progression is the uncontrolled growth of cancer cells until malignant tumor develops.

Gliomas: CNS

Leading Cancer Sites MEN- prostate, colorectal, lung, skin WOMEN-breast, colorectal, lung, skin

American Institute for Cancer Research: 30% to 40% Reduction in Cancer Risk with:
Choose a diet rich in a variety of plant based foods Eat plenty of vegetables and fruits Maintain a healthy weight and be physically active Drink alcohol in moderation Select foods low in fat and salt Prepare and store foods safely Do not use tobacco in any form Vitamin D intake of 1000iu/day

HOW DO CANCER AND CANCER TREATMENT AFFECT THE NUTRITIONAL STATUS OF THE HOST? Anorexia from chemotherapy, pain, surgery, radiation or depression

Dysphagia, nausea, vomiting, diarrhea

Decreased nutrient intake

CANCER CACHEXIA
Tumor competition for nutrients

Cancer Treatments
SURGERY
Surgical resection of tumor For diagnosis, resection of solid tumor, prevention of metastasis and reduction of the size of tumor to alleviate pain

CHEMOTHERAPY
Use of drugs alone or in combination to cure or control cancer(Systemic effect) E.g. Alkylating agents, anti-metabolites, antibiotics

RADIATION
Uses ionizing radiation to kill cells by altering the DNA of the malignant cell

Nutritional Goals During Cancer Treatment

Short term goal- Prevent weight loss Long term goal- Achieving and maintaining normal weight Replacing nutritional losses from side effects of treatment e.g. Fluid and electrolyte losses from vomiting, diarrhea and malabsorption Providing adequate amounts of kilocalories, protein, carbohydrates, fat, vitamins and minerals

Nutrient Needs
Increasing CHON and calories(individualized)
High CHON diet of 1.5-2.0g/kg High calorie needs -by using gravies; Changing cooking methods to include more butter or good oils.
25-35cal/kg- weight maintenance 40-50 cal/kg- replenish body stores

E.g. Add skim milk powder to milk to make double strength milk; chill before serving.

 Minimizing side effects

Fatigue: Prepare easy meals such as scrambled eggs, toast and canned fruits. Eat a good breakfast; patients usually have more energy in the am. Use frozen or canned foods Drink commercial liquid supplements, milkshakes, or pasteurized eggnog.

 No appetite:
Include snacks; emphasize small, frequent meals Include high calorie drinks such as sherbet blended with juice Keep sugar based candy by bedside ( brush teeth first; rinse mouth with water regularly) * see page 495

Nausea and Vomiting:

Use antiemetic meds before meals( hr before eating) Avoid fatty foods Avoid concentrated sweets; salty foods are more tolerated Sip liquids slowly Avoid reclining directly after meals; use proposed pillows in bed Avoid foods with a strong odor * see page 495

 Stomatitis or Esophagitis:
Eat soft foods Add gravy, butter, or sauces to dry foods Avoid very salty, spiced, or acidic foods Use a straw for beverages Use artificial saliva as prescribed

Diarrhea:
Avoid lactose containing beverages and foods Use commercial drinks that are lactose free Avoid roughage; emphasize soluble fiber foods like oatmeal, cooked carrots, bananas, peeled apples Limit caffeine, hot or cold liquids and high fat foods *see page 495

 Constipation: Increase water and fiber intake Include walking if possible or leg lifts if bedridden Altered taste (dysgeusia): Try lemon juice or vinegar on vegetables Emphasize cold foods such as ice cream and pudding; keep cans of fruit in the refrigerator Experiment with spices and marinades for meat Add bacon bits for flavor

Methods of Feeding
Oral nutrition- preferred whenever possible Tube feedings/ enteral nutrition Total parenteral nutrition
Used when the digestive tract is not functioning Nutrients are administered intravascularly

Tube Feedings
a. Complete products- meal replacements that require digestion and absorption b. Chemically defined products- minimal or no digestion/ for pancreatic cancer patients c. Modular products- used in combination with other tube feeding products to enhance calorie or CHON intake d. Specialty products- vary in terms of specific amino acid, CHO and fat content/ for patients w/ hepatic or renal failure

Neutropenic Diet
A diet for people with weakened immune system.( >1000mm3 neutrophil) Helps protect them from bacteria and other harmful organisms found in some food and drinks. Guidelines: *see page 491-492 Avoiding undercooked meats, fish and eggs. Ensuring that raw fruits and vegetables are washed well and/or peeled. Eat or drink only pasteurized milk and dairy products Follows appropriate sanitation guidelines for food preparation and storage.

With Cancer Remission for Prevention of Recurrence

Promote lifelong positive nutrition behaviors

Encourage high-fiber diet and emphasis on monounsaturated fats Encourage moderate kcalorie intake to manage weight, as well as avoidance of excess salt Encourage high-quality diet per MyPyramid Food Guidance System

Promote positive lifestyle Encourage regular physical activity Encourage avoidance of excess alcohol Encourage avoidance of tobacco

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