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Diet and Health Guidelines to Lower
Risk of Cancer
Presented by
Janice Hermann, PhD, RD/LD
OCES Adult and Older Adult Nutr...
Cancer
Cancer second leading cause of death in the

United States
Cancer not a single disorder
Many types
Different ch...
Cancer Development
Genes work together to regulate cell division

and ensure new cells are replicas of parent
cells
Proc...
Cancer Development
Cancer develops from mutations in genes

regulating cell division

Mutations inhibit genes that ordin...
Cancer Development
An abnormal mass of cells is called a tumor
Benign
Tumors that stop growing without intervention or ...
How Cancer Develops
As a malignant tumor grows, blood vessels

form to supply the tumor with nutrients
Eventually, the t...
Cancer Development
Cancer Development
Genetic Factors
Immune Factors
Environmental Factors
Physical Activity
Dietary Factors
Cancer Ini...
Cancer Development
Genetic factors
All cancers have a genetic component in that a
mutation causes abnormal cell growth
...
Cancer Development
Immune factors
A healthy immune system recognizes foreign cells
and destroys them
Theorized an ineff...
Cancer Development
Environmental Factors
Environmental factors known to cause cancer:
Exposure to radiation and sunligh...
Cancer Development
Physical Activity
Lack of physical activity may play a role in the

development of some types of canc...
Cancer Development
Dietary Factors
Estimates are 1/3 of cancers attributed to

nutrition
Cancer Initiators

Some dieta...
Diet and Cancer Studies
Epidemiological studies try to identify relationships

between the diet of population groups and
...
Dietary Factors: Cancer Initiators
Pesticides
Some pesticides may be carcinogenic at extremely

high doses, however, the...
Dietary Factors: Cancer Initiators
Alcohol
Alcohol associated with increased risk of mouth,

esophageal and breast cance...
Dietary Factors: Cancer Initiators
Alcohol
If alcohol intake causes liver cirrhosis, there is an

increased risk of live...
Dietary Factors: Cancer Initiators
Food preparation methods
Cooking meat, poultry, and fish at high

temperatures and sm...
Dietary Factors: Cancer Initiators
Food preparation methods
Large amounts of salt-cured and salt-pickled foods
have been...
Dietary Factors: Cancer Promoters
High fat diets
High dietary total fat and saturated fat may be

related to increased r...
Dietary Factors: Cancer Promoters
High fat diets
May increase cancer risk by increasing:
Obesity
Bile acid production
...
Dietary Factors: Cancer Promoters
High calorie intake
In most epidemiologic studies, a positive

association has been se...
Dietary Factors: Cancer Promoters
Obesity may increase risk of colon,

endometrial and breast cancer
Increased risk may ...
Dietary Factors: Cancer Promoters
Protein
Excessive muscle meat sources of protein have
been related to increased risk o...
Dietary Factors: Cancer Promoters
Protein
In general tumor development is:
Suppressed by diets that contain protein bel...
Dietary Factors: Protective Factors
Fruits, vegetables, whole grains and legumes
Epidemiological studies show a link bet...
Dietary Factors: Protective Factors
Fruits, vegetables whole grains and legumes:

Fiber

Fiber-rich diets may protect ag...
Dietary Factors: Protective Factors
Fruits, vegetables, whole grains and legumes:

Antioxidants

Fruits, vegetables, who...
Dietary Factors: Protective Factors
Fruits, vegetables, whole grains and legumes:

Phytochemicals

Fruits, vegetables, w...
Dietary Factors: Protective Factors
Fruits, vegetables, whole grains, and legumes
Because it is not known which specific...
Dietary Factors: Protective Factors
Calcium
Calcium may have a role in lowering colon cancer;

however, more research is...
Cancer Development
Evidence suggests millions of cases of cancer

could be prevented by changes in:
Diet
Weight control...
Consequences of Cancer
Nonspecific effects of cancer include:
Anorexia and reduced food intake
Metabolic alterations
T...
Consequences of Cancer
Anorexia and Reduced Food Intake
Major contributors to wasting
With cancer body may not be able ...
Consequences of Cancer
Anorexia and Reduced Food Intake
Factors contributing to anorexia and reduced food
intake:
Chron...
Consequences of Cancer
Anorexia and Reduced Food Intake
Factors contributing to anorexia and reduced food

intake:
Pain...
Consequences of Cancer
Anorexia and Reduced Food Intake
Factors contributing to anorexia and reduced food

intake (cont....
Consequences of Cancer
Anorexia and Reduced Food Intake
Factors contributing to anorexia and reduced food

intake (cont....
Consequences of Cancer
Metabolic Alterations
Metabolic changes can also exacerbate wasting
Increased protein turnover, ...
Consequences of Cancer
Tissue Wasting
Weight loss often evident at time cancer diagnosed
Factors contributing to wastin...
Cancer Treatments
Primary medical treatments for cancer are:
Surgery
Chemotherapy
Radiation Therapy

Aim is to remove...
Cancer Treatments
Surgery
Performed to remove tumors
Can affect nutritional status
Acute metabolic stress caused by su...
Cancer Treatments
Chemotherapy
Used to inhibit tumor growth
Interfere or prevent cell division
Affect rapidly growing ...
Cancer Treatments
Radiation Therapy
Bombarding cancer cells with radiation induces

formation of reactive oxygen species...
Cancer Treatments
Bone Marrow Transplants
Replace bone marrow destroyed by

chemotherapy or radiation
Primary treatment...
Cancer Treatments
Medications to combat anorexia and wasting
Medications sometimes prescribed to

stimulate the appetite...
Cancer Treatments
Alternative therapies
60 to 80% of cancer patients combine

complementary and alternative medicine (CA...
Cancer Treatments
Alternative therapies
Dietary supplements and herbal remedies among

most frequently used CAM
Many su...
Nutritional Therapy
Objectives of medical nutrition therapy are to:
Minimize tissue wasting and weight loss
Protein and...
Nutrition Therapy
Nutrition therapy depends on the type and

severity of cancer, side effects of treatment
and patient’s ...
Nutrition Therapy
Enteral (tube) and parenteral (intravenous) nutrition

support

Tube feedings and intravenous nutritio...
Nutrition Therapy
Nutrition support for bone marrow transplants
People undergoing a bone marrow transplant routinely

re...
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  • Cancer is the second leading cause of death in the United States.
    Cancer not a single disorder. There are:
    Many types
    Different characteristics
    Occur in different body locations
    Take different courses
    Require different treatments
  • Genes in the body work together to regulate cell division and ensure new cells are replicas of parent cells.
    This process allows:
    Body to grow
    Replace dead cells
    Repair damaged cells
  • Cancer develops from mutations in genes regulating cell division resulting in mutations that inhibit genes that ordinarily monitor and correct errors. Affected cells lose ability to stop cell division. This results in an abnormal mass of cells.
  • An abnormal mass of cells is called a tumor. A benign tumor is one that stop growing without intervention or can be surgically removed. Most benign tumors pose no threat to health. A malignant tumor is one that multiplies out of control. A malignant tumor can threaten surrounding tissues and health.
  • As a malignant tumor grows, blood vessels form to supply the tumor with nutrients. Eventually, the tumor invades more and more healthy tissue and may metastasize (spread to other areas of the body).
    Malignant cancers are described by:
    Location
    Size
    Extent of growth
    If spread to surrounding lymph nodes
    If spread to distant sites in the body
  • There are many factors that can influence cancer development:
    Genetic Factors
    Immune Factors
    Environmental Factors
    Physical Activity
    Dietary Factors. Dietary factors may initiate, promote or inhibit the growth of cancer cells.
  • Genetic factors
    All cancers have a genetic component in that a mutation causes abnormal cell growth. Some cancers have a genetically inherited component as well. For example, someone with a family history of color cancer has a greater risk of developing colon cancer than someone without a genetic predisposition; however, this does not mean that they will develop colon cancer.
  • Immune factors
    A healthy immune system recognizes foreign cells and destroys them. Theorized an ineffective immune system may not recognize tumor cells as foreign, thus allowing unchecked cell growth.
    Aging affects immune function, and incidence of cancer increases with age. Diseases that weaken the immune system can increase cancer risk.
  • Environmental Factors
    Some environmental factors are known to cause cancer:
    Exposure to radiation and sunlight
    Water and air pollution
    Smoking
  • Physical Activity
    Lack of physical activity may play a role in the development of some types of cancer.
    For example people whose lifestyles include regular, vigorous physical activity have the lowest risk of colon cancer.
    Physical activity may also protect against breast cancer by reducing body weight and by other mechanisms unrelated to body weight.
  • Dietary Factors
    Estimates are 1/3 of cancers attributed to nutrition. Dietary factors may initiate, promote or inhibit the growth of cancer cells. Different dietary factors affects different types of cancer.
     
    Cancer Initiators. Some dietary factors may initiate cancer development
    Cancer Promoters. Other dietary factors may promote cancer development once it has started
    Protective Factors. Still other dietary factors may protect against cancer development
  • Diet and Cancer Studies
    Epidemiological studies try to identify relationships between the diet of population groups and incidence of specific cancers. Diet complexity makes identifying relationships difficult because:
    Thousands of chemicals in a diet
    Diets contain initiators, promoters and protective factors
    Changing one factor in the diet may change others, making identifying individual factors difficult
    Many cancers have a long latency period, thus diet at initiation or promotion may not be the same as at diagnosis
  • Dietary Factors: Cancer Initiators
    Pesticides
    Some pesticides may be carcinogenic at extremely high doses, however, they are safe at the levels permitted on fruits and vegetables. The benefits of eating fruits and vegetables are far greater than any potential risk.
    Food additives
    Those approved by the FDA for use in foods are not carcinogenic.
  • Dietary Factors: Cancer Initiators
    Alcohol
    Alcohol is associated with increased risk of mouth, esophageal and breast cancer.
    Mouth and esophageal cancer are especially increased if alcohol is combined with smoking.
     The relationship between alcohol and breast cancer may be due to alcohol-induced increases of estrogen levels, reduction of folic acid levels or direct effect of alcohol or its metabolites on breast tissue.
  • Dietary Factors: Cancer Initiators
    Alcohol
    If alcohol intake causes liver cirrhosis, there is an increased risk of liver cancer.
    Malnutrition associated with alcoholism is also likely to be important in the increased risk for certain cancers.
    Thus, potential benefits of moderate alcohol intake for cardiovascular disease must be weighed against potential risks.
  • Dietary Factors: Cancer Initiators
    Food Preparation Methods
    Cooking meat, poultry, and fish at high temperatures and smoking meat causes carcinogens to form on food surfaces which have been related to colon, breast and stomach cancer.
    High heat cooking methods such as grilling, broiling, and barbecuing. Polycyclic aromatic hydrocarbons and hetrocyclic amines are formed when high-heat cooking methods such as grilling, broiling, barbecuing, and smoking meats are used. These substances are formed during combustion of carbon fuel and pyrolysis of protein.
    Healthier cooking methods include roasting, broiling, poaching, steaming, stewing, braising and microwaving.
    Fruits and vegetables appear to provide a protective effect against this risk.
  • Dietary Factors: Cancer Initiators
    Food Preparation Methods
    Large amounts of salt-cured and salt-pickled foods have been related to stomach, colon and bladder cancers.
    Sodium and potassium nitrates used in salting, pickling, and curing processes. Nitrates can be converted into nitrite, which can interact with dietary compounds, such as amines and amides, to produce nitrosamines and nitrosamides, potential carcinogens.
    The risk is primarily for individuals who consume excessive amounts of these types of foods, and is not a major issue for most individuals.
    Diets with high amounts of fruits and vegetables contain vitamin C and phytochemicals can retard conversion of nitrites to nitrosamines.
  • Dietary Factors: Cancer Promoters
    High Fat Diet
    High dietary total fat and saturated fat may be related to increased risk of breast, colon, endometrial and prostate cancer. However, omega-3 fatty acids however, may be protective.
    Thus same dietary fat advice applies to cancer protection as to heart disease:
    Reduce total fat and saturated fat
    Increase omega-3 fatty acids
  • Dietary Factors: Cancer Promoters
    High Fat Diet
    High fats diets may increase cancer risk through increasing obesity, bile acid production, and estrogen levels. Because fat is calorie dense it is difficult to distinguish between the effects of dietary fat and total calories.
  • Dietary Factors: Cancer Promoters
    High Calorie Intake
    In most epidemiologic studies, a positive association has been seen with high calorie intake and promotion of breast, colon and endometrial cancer.
    The increase in cancer risk may be due to the excess calories themselves, weight gain due to excess calories, or high fat intake that often supplies excess calories and contributes to weight gain.
  • Dietary Factors: Cancer Promoters
    Obesity
    Obesity may increase risk of colon, endometrial and breast cancer. The increased risk may be due to:
    Extra weight
    Adipose tissue production of estrogen
    Extra calories
    High fat intake that often supplies excess calories and contributes to weight gain
    Protective effect of physical activity related to breast and colon cancer may be due in part to helping to control obesity.
  • Dietary Factors: Cancer Promoters
    Protein
    Excessive muscle meat sources of protein have been related to increased risk of colon and prostate cancer. Not know if increased risk due to:
    Protein level
    Fat content
    Fat type
    Increased calories from fat
    Other factor such as being low in fiber, antioxidants and phytochemicals
    The amount of muscle meat protein recommended by USDA Daily Food Plan is not excessive.
    Further research needed
  • Dietary Factors: Cancer Promoters
    Protein
    In general tumor development is:
    Suppressed by diets that contain protein below that required for optimal growth
    Enhanced by protein levels two to three times the amount required
  • Dietary Factors: Protective Factors
    Fruits, vegetables whole grains and legumes
    Epidemiological studies show a link between diets with plenty of fruits, vegetables, whole grains and legumes and reduced incidence oral cavity, esophagus, stomach, colon and lung cancer.
    These foods contain essential nutrients and other important substances that may help lower the risk of cancer, as well as being low in fat. Some of the compounds in these foods that may help lower cancer risk:
    Dietary fiber
    Vitamin C
    Vitamin E
    Phytochemicals
    Low fat
  • Dietary Factors: Protective Factors
    Fruits, vegetables whole grains and legumes: Fiber
    Fiber-rich diets may protect against colon cancer. There are two types of fiber, water-soluble fiber and water-insoluble fiber. Both insoluble and soluble fibers may protect against colorectal cancer.
    Bile acids are released into the intestine to help with fat digestion. In the intestine bile can be converted into potential cancer causing substances. Soluble fibers can bind bile acids and increase their excretion.
    Insoluble fibers absorb water making a larger, softer stool which can dilute potential cancer causing substances. A larger, softer stool moves through intestine faster so colon exposed to cancer causing substance for less time.
    Foods high in fiber are typically lower in fat, which may also help protect against colon cancer by reducing bile acid production.
    In addition high fiber foods including fruits, vegetables, whole grains and legumes provide many other nutrients that can lower risk including antioxidants; selenium, Vitamin C, vitamin E and beta-carotene and phyotochemicals. This is another important reason to increase fiber from food sources, rather than supplements, because food sources provide both types of fiber.
  • Dietary Factors: Protective Factors
    Fruits, vegetables whole grains and legumes: Antioxidants
    Fruits, vegetables, whole grains and legumes also contain antioxidant nutrients; vitamin C, vitamin E and selenium that may protect against cancer.
    Antioxidants stop free radical oxidation which may help to prevent cell and tissue damage that can promote cancer. It’s also possible these nutrients have many other effects in the body which lower cancer risk.
  • Dietary Factors: Protective Factors
    Fruits, vegetables whole grains and legumes: Phytochemicals
    Fruits, vegetables, whole grains and legumes also contain phytochemicals that may protect against cancer.
    Some phytochemcials function as antioxidants, protecting against harmful cell damage from oxidation. Others lower cancer risk in different ways such as activating enzymes that destroy carcinogens.
  • Dietary Factors: Protective Factors
    Fruits, vegetables whole grains and legumes
    Because it is unclear which specific substances in fruits, vegetables whole grains and legumes help to lower cancer risk, at the present time the best recommendation is to eat a variety of these foods.
    Even though these nutrients can be purchased as supplements, the best way to get them is through food sources. It is not known whether these nutrients by themselves, or as they occur in food, or other nutrients in these foods is the beneficial factor. In addition to these nutrients fruits, vegetables, whole grains, and legumes contain hundreds of different compounds called phytochemicals. Research into the role of phytochemicals in reducing cancer risk is just beginning.
  • Dietary Factors: Protective Factors
    Calcium
    Calcium may have a role in lowering colorectal cancer; however it is too early to be sure. In the meantime, it is known that adequate calcium throughout the lifespan is important for growth and bone development.
  • There is a relationship between diet and cancer. In fact one-third of cancer deaths are estimated to be attributed to nutrition and other lifestyle factors, and another third is related to cigarette smoking and tobacco use.
    Evidence suggests millions of cases of cancer could be prevented by changes in:
    Diet
    Weight control
    Physical activity
    Smoking
  • Consequences of Cancer
    Nonspecific effects of cancer include:
    Anorexia and reduced food intake
    Metabolic alterations
    Tissue wasting and weight loss
    Loss of appetite, tissue wasting, weight loss and fatigue typify cancer cachexia, which occurs in as many as 80% of people with cancer.
  • Consequences of Cancer
    Anorexia and Reduced Food Intake
    Anorexia and reduced food intake are major contributors to wasting.
    With cancer the body may not be able to respond to reduced nutrient intake and nutrient stores are rapidly depleted. Without adequate energy and nutrients, the body is poorly equipped to:
    Maintain immune defenses
    Support organ function
    Absorb nutrients
    Repair damaged tissues
  • Consequences of Cancer
    Some factors that may contribute to anorexia and reduced food intake include:
    Chronic nausea and early satiety. People with cancer frequently experience nausea and a premature feeling of fullness after eating small amounts of food.
    Fatigue. People with cancer often tire easily and lack the energy to prepare and eat meals. If cachexia develops, these tasks become even more difficult to handle.
  • Consequences of Cancer
    Some factors that may contribute to anorexia and reduced food intake include (cont.):
    Pain. People in pain may have little interest in eating, particularly if eating makes pain worse.
    Mental stress. A cancer diagnosis can cause distress, anxiety, and depression, all of which may reduce appetite. Facing and undergoing cancer treatments causes additional psychological stress.
  • Consequences of Cancer
    Some factors that may contribute to anorexia and reduced food intake include (cont.):
    Effects of cancer therapies. Therapies for cancer (including medications, chemotherapy radiation therapy, surgery, and bone marrow transplants) can affect food intake by causing nausea, vomiting, altered taste perceptions, food aversions, inflammation of the mouth and esophagus, dry mouth, mouth sores, difficulty swallowing, intestinal cramping
  • Consequences of Cancer
    Some factors that may contribute to anorexia and reduced food intake include (cont.):
    Obstructions. A tumor may partially or completely obstruct a portion of the GI tract, causing complications such as nausea and vomiting, early satiety, delayed gastric emptying, and bacterial overgrowth. Some patients with obstructions are unable to tolerate oral diets.
  • Consequences of Cancer
    Metabolic Alterations
    Metabolic changes can also exacerbate wasting. Examples of metabolic changes with cancer include:
    Increased protein turnover, but reduced muscle protein synthesis
    Increased gluconeogenesis, further straining supply of body proteins
    Increased triglyceride breakdown, but decreased fat synthesis
    Many develop insulin resistance
    Metabolic alterations help explain why people with cancer fail to regain lean body mass or maintain healthy body weights even when receiving adequate energy and nutrients.
  • Consequences of Cancer
    Tissue Wasting
    Weight loss often evident at time cancer diagnosed.
    Factors contributing to wasting:
    Anorexia and reduced food intake
    Metabolic alterations
    Cytokines released by both tumor and immune cells induces a hypermetabolic, catabolic state
    Diversion of nutrients to support tumor growth result in lower energy and nutrients available to healthy tissues
    Severe tissue wasting, often seen in the later stages of cancer, may be ultimate cause of death.
  • Cancer Treatments
    Primary medical treatments for cancer are:
    Surgery
    Chemotherapy
    Radiation Therapy
    The aim of treatment is to remove cancer cells, prevent further tumor growth, and alleviate symptoms.
    However, medical treatments can effect nutritional status.
  • Cancer Treatments
    Surgery
    Surgery is often performed to remove tumors.
    Surgery can affect nutritional status:
    Acute metabolic stress caused by surgery raises protein and energy needs and can exacerbate wasting.
    Surgery may also contribute to pain, fatigue, anorexia and reduced food intake.
    Blood loss further contribute to nutrient losses.
  • Cancer Treatments
    Chemotherapy
    Used to inhibit tumor growth by interfering or preventing cell division. These treatments affect rapidly growing cancer cells.
    Unfortunately, most of these drugs can effect normal cells (especially rapidly dividing cells, such as those in the GI tract, skin and bone marrow) and can effect nutritional status due to:
    Anorexia
    Malabsorption
    Diarrhea
  • Cancer Treatments
    Radiation Therapy
    Bombarding cancer cells with radiation induces formation of reactive oxygen species, such as superoxide and hydroxyl radicals, which can damage cellular DNA and cause cell death.
    Radiation can effect normal cells and can effect nutritional status:
    Radiation to head and neck may damage salivary glands and taste buds, causing dry mouth and altered taste.
    Radiation to lower abdomen can cause radiation enteritis, inflammation of the small intestine, causing nausea, vomiting, diarrhea, and malabsorption.
  • Cancer Treatments
    Bone Marrow Transplants
    Replace bone marrow destroyed by chemotherapy or radiation is a primary treatment for leukemia.
    Bone marrow transplants can substantially effect nutritional status:
    After bone marrow is destroyed, immune function is suppressed, increasing the risk of foodborne illness
    Effects of transplant include anorexia, dry mouth, inflamed mucous membranes, altered taste, and diarrhea
    Patients often unable to consume adequate food and may require nutritional support
  • Cancer Treatments
    There are medications to combat anorexia and wasting. Medications sometimes prescribed to stimulate the appetite and promote weight gain.
  • Cancer Treatments
    Alternative Therapies
    60 to 80% of cancer patients combine complementary and alternative medicine (CAM) approaches with standard treatment.
    Many people do not discuss their use of complementary and alternative medicine approaches with their physicians
  • Cancer Treatments
    Alternative Therapies
    Dietary supplements and herbal remedies among most frequently used complementary and alternative medicine (CAM) approaches.
    Many supplements can be used without risk; however, others may have adverse effects or interfere with conventional treatments:
    St. John’s wort can reduce effectiveness of some anticancer drugs
    Antioxidant supplementation may interfere with chemotherapy and radiation treatment
  • Nutrition Therapy
    Objectives of medical nutrition therapy are to:
    Minimize tissue wasting and weight loss
    Protein and energy needs are considerable to prevent tissue wasting and weight loss.
    Correct nutritional deficiencies
    Help people maintain their strength and immune function
    Provide a diet that can be tolerated and enjoyed despite the complications of illness
  • Nutrition Therapy
    Nutrition therapy depends on the type and severity of cancer, side effects of treatment and patient’s nutritional status. In addition, factors may interfere with eating.
  • Nutrition Therapy
    Enteral (tube) and parenteral (intravenous) nutrition support
    Tube feedings and intravenous nutrition not routinely recommended for adequately nourished or mildly malnourished people with cancer who are able to eat.
    However, these approaches help to maintain nutrition status when anorexia persists or when a patient is severely malnourished and is about to undergo aggressive cancer therapy.
    Each case needs to be decided individually.
  • Nutrition Therapy
    Nutrition support for bone marrow transplants
    People undergoing a bone marrow transplant routinely receive total parenteral nutrition (TPN) before and after the transplant because the GI tract is severely compromised by the preparatory procedure.
    When GI function return, the patient begins to receive foods orally along with TPN, whenever possible. As oral intake improves, TPN is gradually tapered off.
  • Transcript of "Cancer"

    1. 1. Diet and Health Guidelines to Lower Risk of Cancer Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist Oklahoma Cooperative Extension Service 02/22/14
    2. 2. Cancer Cancer second leading cause of death in the United States Cancer not a single disorder Many types Different characteristics Occur in different body locations Take different courses Require different treatments
    3. 3. Cancer Development Genes work together to regulate cell division and ensure new cells are replicas of parent cells Process allows: Body to grow Replace dead cells Repair damaged cells
    4. 4. Cancer Development Cancer develops from mutations in genes regulating cell division Mutations inhibit genes that ordinarily monitor and correct errors Affected cells lose ability to stop cell division Result is an abnormal mass of cells
    5. 5. Cancer Development An abnormal mass of cells is called a tumor Benign Tumors that stop growing without intervention or can be surgically removed Most often pose no threat to health Malignant Tumors that multiply out of control Threaten surrounding tissues and health
    6. 6. How Cancer Develops As a malignant tumor grows, blood vessels form to supply the tumor with nutrients Eventually, the tumor invades more and more healthy tissue and may metastasize Malignant cancers are described by: Location Size Extent of growth If spread to surrounding lymph nodes If spread to distant sites in the body
    7. 7. Cancer Development
    8. 8. Cancer Development Genetic Factors Immune Factors Environmental Factors Physical Activity Dietary Factors Cancer Initiators Cancer Promoters Protective Factors
    9. 9. Cancer Development Genetic factors All cancers have a genetic component in that a mutation causes abnormal cell growth Some cancers have a genetically inherited component as well Example: someone with a family history of color cancer has a greater risk of developing colon cancer than someone without a genetic predisposition; however, this does not mean that they will develop colon cancer
    10. 10. Cancer Development Immune factors A healthy immune system recognizes foreign cells and destroys them Theorized an ineffective immune system may not recognize tumor cells as foreign, thus allowing unchecked cell growth Aging affects immune function, and incidence of cancer increases with age Diseases that weaken the immune system can increase cancer risk
    11. 11. Cancer Development Environmental Factors Environmental factors known to cause cancer: Exposure to radiation and sunlight Water and air pollution Smoking
    12. 12. Cancer Development Physical Activity Lack of physical activity may play a role in the development of some types of cancer People whose lifestyles include regular, vigorous physical activity have the lowest risk of colon cancer Physical activity may also protect against breast cancer by reducing body weight and by other mechanisms unrelated to body weight
    13. 13. Cancer Development Dietary Factors Estimates are 1/3 of cancers attributed to nutrition Cancer Initiators Some dietary factors may initiate cancer development Cancer Promoters Other dietary factors may promote cancer development once it has started Protective Factors Still other dietary factors may protect against cancer development
    14. 14. Diet and Cancer Studies Epidemiological studies try to identify relationships between the diet of population groups and incidence of specific cancers Diet complexity makes identifying relationships difficult Thousands of chemicals in a diet Diets contain initiators, promoters and protective factors Changing one factor in the diet may change others, making identifying individual factors difficult Many cancers have a long latency period, thus diet at initiation or promotion may not be the same as at diagnosis
    15. 15. Dietary Factors: Cancer Initiators Pesticides Some pesticides may be carcinogenic at extremely high doses, however, they are safe at the levels permitted on fruits and vegetables The benefits of eating fruits and vegetables are far greater than any potential risk Food additives Those approved for use in foods are not carcinogenic
    16. 16. Dietary Factors: Cancer Initiators Alcohol Alcohol associated with increased risk of mouth, esophageal and breast cancer Mouth and esophageal cancer are especially increased if alcohol is combined with smoking
    17. 17. Dietary Factors: Cancer Initiators Alcohol If alcohol intake causes liver cirrhosis, there is an increased risk of liver cancer Malnutrition associated with alcoholism is also likely to be important in the increased risk for certain cancers Thus, potential benefits of moderate alcohol intake for cardiovascular disease must be weighed against potential risks
    18. 18. Dietary Factors: Cancer Initiators Food preparation methods Cooking meat, poultry, and fish at high temperatures and smoking meat causes carcinogens to form on food surfaces which have been related to colon, breast and stomach cancer High heat cooking methods such as grilling, broiling, and barbecuing Healthier cooking methods include roasting, broiling, poaching, steaming, stewing, braising and microwaving Fruits and vegetables appear to provide a protective effect
    19. 19. Dietary Factors: Cancer Initiators Food preparation methods Large amounts of salt-cured and salt-pickled foods have been related to stomach, colon and bladder cancers Sodium and potassium nitrates used in salting, pickling, and curing processes Nitrates can be converted into nitrite, which can form potential carcinogens nitrosamines Diets with high amounts of fruits and vegetables contain vitamin C and phytochemicals can retard conversion of nitrites to nitrosamines
    20. 20. Dietary Factors: Cancer Promoters High fat diets High dietary total fat and saturated fat may be related to increased risk of breast, colon, endometrial and prostate cancer Omega-3 fatty acids however, may be protective Thus same dietary fat advice applies to cancer protection as to heart disease Reduce total fat and saturated fat Increase omega-3 fatty acids
    21. 21. Dietary Factors: Cancer Promoters High fat diets May increase cancer risk by increasing: Obesity Bile acid production Estrogen levels Because fat is calorie dense it is difficult to distinguish between the effects of high dietary fat, and total calories
    22. 22. Dietary Factors: Cancer Promoters High calorie intake In most epidemiologic studies, a positive association has been seen with high calorie intake and promotion of breast, colon and endometrial cancer Increased risk may be due to: Excess calories themselves Weight gain due to excess calories High fat intake that often supplies excess calories
    23. 23. Dietary Factors: Cancer Promoters Obesity may increase risk of colon, endometrial and breast cancer Increased risk may be due to: Extra weight Adipose tissue production of estrogen Extra calories High fat intake that often supplies excess calories and contributes to weight gain Protective effect of physical activity related to breast and colon cancer may be due in part to helping to control obesity
    24. 24. Dietary Factors: Cancer Promoters Protein Excessive muscle meat sources of protein have been related to increased risk of colon and prostate cancer Not know if increased risk due to: Protein level Fat content Fat type Increased calories from fat Other factor such as being low in fiber, antioxidants and phytochemicals Further research needed
    25. 25. Dietary Factors: Cancer Promoters Protein In general tumor development is: Suppressed by diets that contain protein below that required for optimal growth Enhanced by protein levels two to three times the amount required
    26. 26. Dietary Factors: Protective Factors Fruits, vegetables, whole grains and legumes Epidemiological studies show a link between diets with plenty of fruits, vegetables, whole grains and legumes and reduced incidence oral cavity, esophagus, stomach, colon and lung cancer Compounds in these foods that may help lower cancer risk: Dietary fiber Vitamin C Vitamin E Phytochemicals Low fat
    27. 27. Dietary Factors: Protective Factors Fruits, vegetables whole grains and legumes: Fiber Fiber-rich diets may protect against colon cancer In the intestine bile can be converted into potential cancer causing substances. Soluble fibers can bind bile acids and increase their excretion Insoluble fibers absorb water making a larger, softer stool which can dilute potential cancer causing substances A larger, softer stool moves through intestine faster so colon exposed to cancer causing substance for less time Foods high in fiber are typically lower in fat, which may also help protect against colon cancer by reducing bile acid production
    28. 28. Dietary Factors: Protective Factors Fruits, vegetables, whole grains and legumes: Antioxidants Fruits, vegetables, whole grains and legumes also contain antioxidant nutrients that may protect against cancer Antioxidants stop free radical oxidation which may help to prevent cell and tissue damage that can promote cancer Possible these nutrients have many other effects in the body which lower cancer risk
    29. 29. Dietary Factors: Protective Factors Fruits, vegetables, whole grains and legumes: Phytochemicals Fruits, vegetables, whole grains and legumes also contain phytochemicals that may protect against cancer Some function antioxidants, protecting against harmful cell damage from oxidation Others lower cancer risk in different ways such as activating enzymes that destroy carcinogens
    30. 30. Dietary Factors: Protective Factors Fruits, vegetables, whole grains, and legumes Because it is not known which specific substances in fruits, vegetables, whole grains and legumes help to lower cancer and whether it is the substances themselves or their presence in food, the best recommendation is to eat a variety of these foods. Best to get these nutrients from foods not supplements.
    31. 31. Dietary Factors: Protective Factors Calcium Calcium may have a role in lowering colon cancer; however, more research is needed In the meantime, adequate calcium is known to be important for growth and bone development
    32. 32. Cancer Development Evidence suggests millions of cases of cancer could be prevented by changes in: Diet Weight control Physical activity Smoking
    33. 33. Consequences of Cancer Nonspecific effects of cancer include: Anorexia and reduced food intake Metabolic alterations Tissue wasting and weight loss Anorexia, tissue wasting, weight loss and fatigue typify cancer cachexia Occurs in as many as 80% of people with cancer
    34. 34. Consequences of Cancer Anorexia and Reduced Food Intake Major contributors to wasting With cancer body may not be able to respond to reduced nutrient intake and nutrient stores are rapidly depleted Without adequate energy and nutrients, the body is poorly equipped to: Maintain immune defenses Support organ function Absorb nutrients Repair damaged tissues
    35. 35. Consequences of Cancer Anorexia and Reduced Food Intake Factors contributing to anorexia and reduced food intake: Chronic nausea and early satiety  People with cancer frequently experience nausea and a premature feeling of fullness after eating small amounts of food Fatigue  People with cancer often tire easily and lack the energy to prepare and eat meals  If cachexia develops, these tasks become even more difficult to handle
    36. 36. Consequences of Cancer Anorexia and Reduced Food Intake Factors contributing to anorexia and reduced food intake: Pain  People in pain may have little interest in eating, particularly if eating makes pain worse Mental stress  A cancer diagnosis can cause distress, anxiety, and depression, all of which may reduce appetite  Facing and undergoing cancer treatments causes additional psychological stress
    37. 37. Consequences of Cancer Anorexia and Reduced Food Intake Factors contributing to anorexia and reduced food intake (cont.): Effects of cancer therapies  Therapies for cancer (including medications, chemotherapy radiation therapy, surgery, and bone marrow transplants) can affect food intake by causing nausea, vomiting, altered taste perceptions, food aversions, inflammation of the mouth and esophagus, dry mouth, mouth sores, difficulty swallowing, intestinal cramping, diarrhea, and constipation
    38. 38. Consequences of Cancer Anorexia and Reduced Food Intake Factors contributing to anorexia and reduced food intake (cont.): Obstructions  A tumor may partially or completely obstruct a portion of the GI tract, causing complications such as nausea and vomiting, early satiety, delayed gastric emptying, and bacterial overgrowth  Some patients with obstructions are unable to tolerate oral diets
    39. 39. Consequences of Cancer Metabolic Alterations Metabolic changes can also exacerbate wasting Increased protein turnover, but reduced muscle protein synthesis Increased gluconeogenesis, further straining supply of body proteins Increased triglyceride breakdown, but decreased fat synthesis Many develop insulin resistance Metabolic alterations help explain why people with cancer fail to regain lean body mass or maintain healthy body weights even when receiving adequate energy and nutrients
    40. 40. Consequences of Cancer Tissue Wasting Weight loss often evident at time cancer diagnosed Factors contributing to wasting Anorexia and reduced food intake Metabolic alterations Cytokines released by both tumor and immune cells induces a hypermetabolic, catabolic state Diversion of nutrients to support tumor growth result in lower energy and nutrients available to healthy tissues Severe tissue wasting, often seen in the later stages of cancer, may be ultimate cause of death
    41. 41. Cancer Treatments Primary medical treatments for cancer are: Surgery Chemotherapy Radiation Therapy Aim is to remove cancer cells, prevent further tumor growth, and alleviate symptoms Medical treatments can effect nutritional status
    42. 42. Cancer Treatments Surgery Performed to remove tumors Can affect nutritional status Acute metabolic stress caused by surgery raises protein and energy needs and can exacerbate wasting  Surgery may also contribute to pain, fatigue, anorexia and reduced food intake Blood loss further contribute to nutrient losses
    43. 43. Cancer Treatments Chemotherapy Used to inhibit tumor growth Interfere or prevent cell division Affect rapidly growing cancer cells Unfortunately, most of these drugs can effect normal cells (especially rapidly dividing cells, such as those in the GI tract, skin and bone marrow) and can effect nutritional status due to: Anorexia Nausea Malabsorption Diarrhea
    44. 44. Cancer Treatments Radiation Therapy Bombarding cancer cells with radiation induces formation of reactive oxygen species, such as superoxide and hydroxyl radicals, which can damage cellular DNA and cause cell death Radiation can effect normal cells and can effect nutritional status Radiation to head and neck may damage salivary glands and taste buds, causing dry mouth and altered taste Radiation to lower abdomen can cause radiation enteritis, inflammation of the small intestine, causing nausea, vomiting, diarrhea, and malabsorption
    45. 45. Cancer Treatments Bone Marrow Transplants Replace bone marrow destroyed by chemotherapy or radiation Primary treatment for leukemia Can substantially effect nutritional status After bone marrow is destroyed, immune function is suppressed, increasing the risk of foodborne illness Effects of transplant include anorexia, dry mouth, inflamed mucous membranes, altered taste, and diarrhea Patients often unable to consume adequate food and may require nutritional support
    46. 46. Cancer Treatments Medications to combat anorexia and wasting Medications sometimes prescribed to stimulate the appetite and promote weight gain
    47. 47. Cancer Treatments Alternative therapies 60 to 80% of cancer patients combine complementary and alternative medicine (CAM) approaches with standard treatment Many people do not discuss their use of complementary and alternative medicine approaches with their physicians
    48. 48. Cancer Treatments Alternative therapies Dietary supplements and herbal remedies among most frequently used CAM Many supplements can be used without risk; however, others may have adverse effects or interfere with conventional treatments St. John’s wort can reduce effectiveness of some anticancer drugs Antioxidant supplementation may interfere with chemotherapy and radiation treatment
    49. 49. Nutritional Therapy Objectives of medical nutrition therapy are to: Minimize tissue wasting and weight loss Protein and energy needs are considerable to prevent tissue wasting and weight loss. Correct nutritional deficiencies Help people maintain their strength and immune function Provide a diet that can be tolerated and enjoyed despite the complications of illness
    50. 50. Nutrition Therapy Nutrition therapy depends on the type and severity of cancer, side effects of treatment and patient’s nutritional status In addition, factors may interfere with eating
    51. 51. Nutrition Therapy Enteral (tube) and parenteral (intravenous) nutrition support Tube feedings and intravenous nutrition not routinely recommended for adequately nourished or mildly malnourished people with cancer who are able to eat However, these approaches help to maintain nutrition status when anorexia persists or when a patient is severely malnourished and is about to undergo aggressive cancer therapy Each case is decided individually
    52. 52. Nutrition Therapy Nutrition support for bone marrow transplants People undergoing a bone marrow transplant routinely receive total parenteral nutrition (TPN) before and after the transplant because the GI tract is severely compromised by the preparatory procedure When GI function return, the patient begins to receive foods orally along with TPN, whenever possible As oral intake improves, TPN is gradually tapered off
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