Cancer is a degenerative disease that can be prevented and managed by following proper nutritional considerations however the prognosis highly depends on the stage of diagnosis.

1. CANCER
By: Akansha Bhatnagar

2. • Cancer is a condition where cells in a specific part of the body grow and
reproduce uncontrollably.
• The cancerous cells can invade and destroy surrounding healthy tissue, including
organs.
• Cancer begins in one part of the body before spreading to other areas (metastasis:
growth of malignant tissues that spreads to surrounding tissues or organs)
CANCER

3. CAUSES OF CANCER
Cancer arises from the transformation of normal cells into tumor cells in a multistage process that
generally progresses from a pre-cancerous lesion to a malignant tumor. Causes of cancer includes:
• Inherited genetic defects (for example, BRCA1 and BRCA2 mutations, oncogenes)
• Infections
• Environmental factors (for example, air pollution)
• Poor lifestyle choices -- such as smoking and heavy alcohol use -- can also damage DNA and
lead to cancer
• Ageing is another fundamental factor for the development of cancer. The overall risk
accumulation is combined with the tendency for cellular repair mechanisms to be less effective
as a person grows older.

4. CARCINOGENS
Carcinogens are the agents that interact with the genetic factors of a person and lead to
genetic mutations and causes cancer, the types of carcinogens include:
• physical carcinogens, such as ultraviolet and ionizing radiation;
• chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a
food contaminant), and arsenic (a drinking water contaminant).
• biological carcinogens, such as infections from certain viruses, bacteria, or parasite.

5. STAGES OF CARCINOGENESIS
1. INITIATION: It involves transformation of cells produced by the interaction of
carcinogens (chemicals, radiation or viruses) with the cellular DNA. Transformation
Occurs rapidly but cells can remain dormant for a variable period until they are
activated by promoting agent.
2. PROMOTION: cells multiply and escapes apoptosis and a neoplasm is established.
3. PROGRESSION: tumor cells aggregate and grow into a fully malignant neoplasm or
tumor.

6. cell
Grows and divides
Radiation,
chemicals,
viruses
Cell loses apoptosis
I
N
I
T
I
A
T
I
O
N
Uncontrolled division of cells
Neoplasm/tumor
develops
P
R
O
M
O
T
I
O
N
benign malignant cancer
PROGRESSION

7. SPECIFIC TYPES OF CANCER (WCRF)
Bladder cancer
Drinking water with increased arsenic may cause bladder cancer.
Breast cancer
• It is the most common cancer in women worldwide.
• Ionizing radiation exposure from medical treatment such as X-rays, particularly during puberty,
increases the risk of breast cancer, even at low doses.
• Hormone therapy (containing estrogen with or without progesterone) increases risk of breast
cancer and the risk is greater with combined estrogen plus progesterone preparations. Oral
contraceptives containing both estrogen and progesterone also cause a small increased risk of
breast cancer in young women.
• Endometrial cancer
• Body fatness increases the risk of endometrial cancer.

8. Kidney cancer
• Smoking is a cause of kidney cancer. Both current and former smokers have an increased risk
of renal cell cancer compared to people who have never smoked. Analgesics containing
phenacetin are a cause of cancer of the renal pelvis. Polycystic kidney disease predisposes
people to kidney cancer and hypertension is associated with higher risk of kidney cancer.
Liver cancer
• Hepatitis B and hepatitis C viruses are causes of liver cancer. The former appears to act
directly by damaging cells and their DNA. The latter shows an indirect effect, mediated by
cirrhosis. Greater body fatness, consumption of alcoholic drinks, and higher exposure to
aflatoxins and consumption of aflatoxin-contaminated foods are causes of liver cancer.
Lung cancer
• Smoking is the principal cause of lung cancer; there is also convincing evidence that arsenic
in drinking water increase the risk of lung cancer.
• Consuming fruits, and also foods containing carotenoids, probably protect against this cancer.
Pancreatic cancer
• Body fatness increases the risk of pancreatic cancer.

9. Esophageal cancer
• There are two types of esophageal cancer – adenocarcinoma and squamous cell carcinoma.
Adenocarcinoma develops at the junction of the esophagus and stomach, and squamous cell
carcinoma occurs in the cells lining the upper part of the esophagus.
• Smoking is an important risk factor for esophageal cancer as well as chewing betel quid.
Stomach cancer
• The bacterium Helicobacter pylori is an important cause of stomach cancer, particularly non-
cardia cancer. Epstein-Barr virus, which is carcinogenic to humans, has also been linked to
stomach cancer in some studies.
• Tobacco use is a cause of stomach cancer.
Colorectal cancer
• Consuming processed meat and alcoholic drinks, body fatness increase the risk of colorectal
cancer. There was also convincing evidence that physical activity is protective against colon
cancer specifically.
• Wholegrains, foods containing dietary fiber, dairy products and calcium supplements probably
protect and consuming red meat probably increases the risk of colorectal cancer.

10. GLOBAL CANCER STATISTICS
According to WHO report, cancer is a leading cause of death worldwide, accounting
for 8.8 million deaths in 2015. The most common causes of cancer death are cancers
of:
• Lung (1.69 million deaths)
• Liver (7,88, 000 deaths)
• Colorectal (7,74 ,000 deaths)
• Stomach (7,54, 000 deaths)
• Breast (5,71, 000 deaths)

11. NATIONAL CANCER STATISTICS
• Estimated number of people living with the disease: around 2.5 million
• Every year, new cancer patients registered: Over 7 lakh
• Cancer-related deaths: 5,56,400
• Cancers of oral cavity and lungs in males and cervix and breast in females
account for over 50% of all cancer deaths in India.
MALES
ORAL CAVITY
LUNG
STOMACH
COLORECTUM
PHARYNX
FEMALES
BREAST
CERVIX
COLORECTUM
OVARY
ORAL CAVITY
GENDER SPECIFIC COMMON
CANCERS IN INDIA

12. RISK FACTORS
• Tobacco use, alcohol use, unhealthy diet (high consumption of red
meats, saturated fats, highly salted and pickled foods), and physical
inactivity are major cancer risk factors worldwide.
• Some chronic infections are risk factors for cancer and have major
relevance in low- and middle-income countries. Approximately
15% of cancers diagnosed in 2012 were attributed to carcinogenic
infections, including Helicobacter pylori, Human papillomavirus
(HPV), Hepatitis B virus, Hepatitis C virus, and Epstein-Barr virus.
• Hepatitis B and C virus and some types of HPV increase the risk for
liver and cervical cancer, respectively. Infection with HIV
substantially increases the risk of cancers such as cervical cancer.
• There is a possible increased cancer risk posed by the formation of
polycyclic aromatic hydrocarbons and heterocyclic amines when
high heat cooking methods such as grilling, barbecuing and
smoking of meats are used due to combustion of carbon fuel and
pyrolysis of protein.

13. DIAGNOSIS OF CANCER
• Physical examination
• Blood tests : (biomarker analysis )
• Cytology study and tumor biopsy
• Imaging (x-rays, CT scan, MRI, PET)
• TNM Staging :
T refers to the size and extent of the tumor.
N refers to the number of nearby lymph nodes that have cancer.
M refers to whether the cancer has metastasized. This means that the cancer
has spread from the primary tumor to other parts of the body.
Needle
Endoscope
Surgery

15. NUTRITION IMPACT OF CANCER THERAPIES
• CHEMOTHERAPY
Chemotherapy involves use of chemical agents or medications to treat cancer.
NUTRITION IMPACT SYMPTOMS OF
CHEMOTHERAPY :
Myelosuppression
Fatigue
Nausea
Vomiting
Mucositis
Changes in taste and smell
Xerostomia
Dysphagia
Changes in bowel function
Malignant tissue along with bone
marrow, hair follicles and mucosa of
alimentary canal are the most affected

16. Immunotherapy
In immunotherapy biologic agents are used as cytotoxic agents or as stimulators of
patient’s own natural defenses.
IMPACT SYMPTOMS OF IMMUNOTHERAPY:
Fever
Chills
Fatigue
Flulike symptoms
Decreased food intake

17. Radiation therapy
A highly localized dose of a radioactive implant is given either internally or
externally and hence the side effects are site specific.
Affects tumor and
surrounding areasRadiation therapy impact
symptoms to
Head and Neck : sore mouth ,
altered taste and smell, dysphagia,
odynophagia, mucositis,
xerostomia.
Thorax: heartburn, acute
esophagitis, dysphagia,
odynophagia.
Abdomen: gastritis, nausea, GI
damage, nutrient malabsorption.

18. Surgery
• Fatigue
• Pain
• Loss of appetite
• Changes in normal eating
Surgical method of cancer treatment involves resection or removal of any part of
alimentary tract.
IMPACT SYMPTOMS OF SURGERY
Major surgical resections for cancer may
necessitate the removal of adjacent normal
tissue with resultant loss of function.

19. Cancer Cachexia
Malnutrition is characterized by progressive
depletion of body reserves (body weight,
adipose tissue, skeletal muscle) when the
supply of nutrients is limited. In cachexia,
weight loss and depletion of body reserves
is greater than would be expected based on
the prevailing level of dietary intake, owing
to the presence of metabolic abnormalities,
which enhance catabolism.

20. NUTRITIONAL CARE
• Patients should be advised to consume sufficient energy
and protein to maintain their nutritional stores and to
achieve and maintain appropriate weight for height.
• Patients experiencing difficulty in eating and treatment
related side-effects, the use of multivitamin and mineral
supplement that provides no more than 100% of RDA is
considered safe.
• Early intervention is essential hence nutritional screening
(PG-SGA) and assessment for the risk of nutritional
problems should be done throughout the treatment and
recovery.
• Proper, individualized determination of routes of
nutritional care should be done : oral, enteral or
parenteral.
GOALS:
• To prevent and reverse
nutrient deficiencies.
• To preserve lean body
mass
• To minimize nutrition
related side effects.
• To maximize the quality of
life.

21. PALLIATIVE CARE FOR ADVANCE CANCER PATIENTS
Palliative care is active total care of an individual when curative measures
are no longer considered an option by either the medical team or patient.
GOAL
To provide an optimal quality of life for
the individual and family
NUTRITION
SHOULD BE
PROVIDED AS
TOLERATED OR
AS DESIRED
PLEASURABLE ASPECTS OF
EATING SHOULD BE
EMPHASIZED WITHOUT
THE CONCERN FOR
NUTRIENTS OR QUANTITY
MAINTAINING
STRENGTH AND ENERGY
AND MANAGE
NUTRITION IMPACT
SYMPTOMS
MANAGING
PSYCHOLOGICAL,
SPIRITUAL AND SOCIAL
ISSUES

22. PREVENTION
• Avoid tobacco consumption in any form.
• Eat plenty of fruits and vegetables.
• Be physically active and maintain a healthy weight.
• Drink alcohol only in moderation.
• Select foods low in salt and fat.
• Prepare and store food safely.

23. THANKYOU

24. REFERENCES
• http://cancerindia.org.in/common-cancers/
• https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-
statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf
• http://www.who.int/cancer/en/
• http://icmr.nic.in/cancer.pdf
• http://cancerindia.org.in/statistics/
• http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers
• Book: Krause’s Food Nutrition and Diet Therapy (11th ed.)
• Book: Modern Nutrition in Health and Disease by Ross et. al. (11th ed.)