PPT ON CANCER.pptx

Teaching Associate CCS College VNMKV Parbhani

 Cancer is a disease in which some of the body’s cells grow
uncontrollably and spread to other parts of the body.
 Cancer can start almost anywhere in the human body.
 It is made up of trillions of cells.
 Normally, human cells grow and multiply (through a process
called cell division) to form new cells as the body needs them.
 When cells grow old or become damaged, they die and new cells
take their place.
 Sometimes this orderly process breaks down and abnormal or
damaged cells grow and multiply when they should not.
 These cells may form tumors, which are lumps of tissue.
 Tumors can be cancerous (malignant) or not cancerous (benign).

 Cancerous tumors spread into or over, nearby tissues and can
travel to distant places in the body to form new tumors
(a process called metastasis).
 Cancerous tumors may also be called malignant tumors.
Many cancers form solid tumors, but cancers of the blood,
such as leukemias, generally do not.
 Benign tumors do not spread into or over, nearby tissues.
 When removed, benign tumors usually don’t grow back,
whereas cancerous tumors sometimes do.
 Benign tumors can sometimes be quite large, however. Some
can cause serious symptoms or be life threatening, such as
benign tumors in the brain.

o The genetic changes that contribute to cancer tend to affect
three main types of genes—
o proto-oncogenes
o tumor suppressor genes
o DNA repair genes.
o These changes are sometimes called “drivers” of cancer.
o Proto-oncogenes are involved in normal cell growth and
division. However, when these genes are altered in certain ways
or are more active than normal, they may become cancer-
causing genes (oncogenes), allowing cells to grow and survive
when they should not.

 Tumor suppressor genes are also involved in controlling cell
growth and division. Cells with certain alterations in tumor
suppressor genes may divide in an uncontrolled manner.
 DNA repair genes are involved in fixing damaged DNA.
 Cells with mutations in these genes tend to develop additional
mutations in other genes and changes in their chromosomes,
such as duplications and deletions of chromosome parts.
Together, these mutations may cause the cells to become
cancerous.

A carcinoma begins in the skin or the
tissue that covers the surface of internal
organs and glands.
Carcinomas usually form solid tumors.
They are the most common type of
cancer.
Examples of carcinomas include
Prostate Cancer,
Breast Cancer,
Lung Cancer,
Colorectal Cancer.

A sarcoma begins in the tissues
that support and connect the body.
A type of cancer that begins in
bone or in the soft tissues of the
body.
A sarcoma can develop in fat,
muscles, nerves, tendons, joints,
blood vessels, lymph vessels,
cartilage, or bone.

3) Leukemias
• Leukemia is a cancer of the blood.
• Leukemia begins when healthy blood cells change and grow
uncontrollably.
• The 4 main types of leukemia are :

4) Lymphomas
Lymphoma is a cancer that
begins in the lymphatic system.
The lymphatic system is a
network of vessels and glands
that help fight infection.
There are 2 main types of
lymphomas:
Hodgkin lymphoma and
non-Hodgkin lymphoma

Different cancers have different risk factors.
• There is a strong heredity tendency to cancer.
• Most cancers required not one mutation but two or more
mutations before cancer occurs.
• In those families that are particularly predisposed to cancer the
genes are already mutated in the inherited genome.
• Breast, ovarian and colon cancers are mostly familial.

Ionizing radiation:
X-rays, gamma rays and particle radiations from
radio-active substances, even UV rays can
predispose to cancer by rupturing DNA strands,
thus causing mutation.
Chemical Substances:
Chemical substances that causes mutation are
called carcinogens.
Benzene and asbestos are considered as
carcinogens.
The carcinogens that causes no. of deaths are
those in cigarette smoke.

• Tobacco is the most clearly identified cause of
cancer. in India, million of deaths per year caused
due to use of tobacco.
• Cancers associated with tobacco- lungs, mouth,
oesophagus and bladder.
• According to NCRP (National Cancer Registry
Programme) of the ICMR, nearly 3rd of the cancer
incidents in country are attributable to the use of
tobacco.
• Consuming pan with tobacco causes -
Leukoplakia (thick, white patches on the inside surfaces of your mouth)
Erythroplakia (a red area that is either flat or raised)
(pre-cancerious injury occurs among 70% of tobacco users).

• Regular use of such products could also causes genetic deformities.
• Cancers of head and neck correlate strongly with – use of tobacco and alcohol.
• Beedi smoking from younger age - higher risk of gastric cancer.
• Risk increases with no. of beedies smoke and its duration.
• The carcinogenic effect of red meat is mainly from the chemical residues in meat
passed on through – the food preservatives rather than from natural meat.

 Interaction of genes with food components can affect carcinogen
metabolism, regulation of hormones, DNA repair, apoptosis ( the death of
cells which occurs as a normal and controlled part of an organism’s
growth/development), cell differentiation, cell growth cycle and
inflammatory response.
 Foods may cause cancer by being direct carcinogen or carcinogen may be
produced by cooking.
 Sometimes microorganisms may produce carcinogens in stored foods.
 Food stuff may act as a substrate for the formation of carcinogen in the body
of food stuff may alter the bacterial flora of the bowel thereby producing
carcinogen.

Meat:
 Meat intake has been positively associated with risk of
Digestive Tract Cancers
Breast Cancer
Renal Cell Carcinoma.
 Intake of red meat (beef, lamb and pork) processed meat (ham, salamn
and bacon) - colon cancer.
 In non-vegetarians - Cancer of prostate.
 Frequent beef consumers - bladder cancer.
 High intake of fish sauce – gastric cancer.
 Intake of red meat cooked by – broiling or barbecuing methods –
positively related to risk of non-Hodgkin’s lymphoma (cancer of
lymphatic system, which is a part of the body’s immune system).
 Cooking meat, poultry and fish at a high temp. causes carcinogens to
form on food surfaces.

Energy Balance:
o The relationship between body weight, body mass index or relative body
weight and site-specific cancer has been widely investigated.
o In most epidemiologic studies, a positive association has been seen with
– breast, endometrium, gall bladder and kidney cancers.
o Breast cancer – associated with weight gain, increased waist/hip ratio in
menopausal women (especially those who do not use hormone
replacement therapy).
o Colon cancer – physical inactivity, high energy intake and large body
mass is associated in both men and women.
Sugars:
o Consumption of simple sugars
(monosaccharides and disaccharides) –
colorectal cancers (related to colon and rectum).

Fat:
 Fat plays significant role in etiology (cause) of cancer.
 High intake of fat is positive associated with – breast, colon,
pancreatic and prostate cancer incidence.
 Diets high in animal fat and n-6 fatty acid intake increases risk of
– colorectal and breast cancers.
 Intake of saturated fat positively related to risk of non-Hodgkin’s
lymphoma.
Protein:
 Increased meat intake has associated with an increased risk of –
colon cancer and possibly with advanced prostate cancer.

Vitamins and minerals:
o Low blood carotenoid levels – lung cancer.
o Low dietary Vit. C – oro pharyngeal, stomach and esophageal cancer.
o Low dietary Vit. E – lung, cervix, colorectal cancer.
o Low folic acid and Vit. A, C – cervical dysplasia and cervical cancer.
o Low Folate – increases homocysteine levels – colon cancer.
o Selenium and zinc also increases risk of cancer.
o Cohort Studies on breast cancer survivors showed that most women
had low serum concentrations of 25(OH)D.
o 25(OH)D – (it is the primary biomarker used to assess Vit-D status).
o According to studies - low intake of fruits and vegetables have
greater chances of getting cancer.

Alcohol:
 Alcohol have casual role in carcinogenesis, especially for
cancers of mouth, throat, breast, pharynx and oesophagus.
 It increases effect on those tissues directly exposed to it during
consumption and tends to act coordinately with tobacco.
 Alcoholism often damages the liver and lead the development
of liver cancer.
 Alcohol, especially beer consumption, has been associated
with an increased risk for colorectal cancer.
Alfatoxins:
 The fungi which grows on cereals and groundnuts can cause
liver cancer.

Nitrates:
o It present in variety of foods, but main dietary source – vegetables
and drinking water.
o Sodium and potassium nitrates are used in processed of – salting,
pickling, curing foods, also added to hot dogs and meat to get pink
colour.
o Nitrosamines are present in tobacco and tobacco smoke.
o Nitrosamines related to nitrates which are potent carcinogens and
causes naso-pharyngeal, stomach and colorectal cancers.
B-carotene supplements:
o Research shown that when lung cancer patients are supplemented
with B-carotene, severity of disease increases.

Estrogens:
 These have been given extensively for the relief of post-menopausal
symptoms and for the prevention of osteoporosis.
 A major doubt concerns the role of estrogens in the production of cancer
of the breast and endometrial cancers.
Viruses:
 Viruses may act as a co-factors in the development of some malignant
diseases.
 Epidemiological studies have suggested a possible role for
 Hepatitis-B virus in human primary liver cancer.
 Human papilloma-virus (is the most common sexually transmitted
infection)
 Epstein Barr virus (associated with certain cancers)
 These are considered oncogenic (causing development of tumor or
tumors).

Stress:
• It may damage to the thymus gland and the immune system and
hormonal effects mediated through the hypothalamus, pituitary
and adrenal cortex.
• This ‘Cascade of Physiologic events’ may provide the neurologic
symptoms that converts anxiety to malignancy (tumor).
• Stress influence the integrity of the immune system, food behavior
and the nutrition status.
Metabolic Syndrome:
• It is associated with a higher risk of -
Colorectal pancreatic cancers – males
Breast cancers – females.

Age:
 The risk of developing colorectal cancers increases with age.
 The incidence is 6 times greater in persons who are aged 65 years than
between 40-60 years.
 It reflects that accumulation of critical genetic mutation over a time that
ultimately reach a point of highest development in neoplastic
transformation.
 The other factors includes – exposure to exogenous mutation, altered
host immune function, inherited genetic syndromes and disorders.
Physical stress:
 Regular, vigorous physical activity have the lowest risk of colon cancer in
both men and women.
 It also protect from breast cancer by reducing body weight and the other
mechanisms unrelated of body weight.

 A healthy immune system recognizes foreign cells and destroy them.
 Ineffective immune system may not recognize tumor cells as foreign
cells, thus allowing the uncontrollable growth.
 Ageing affects immune function.
 When immune system suppressed increases risk of cancer.
 The patients who take immune suppressents (these are drugs that lower
the body’s ability to reject a transplanted organ) are higher risk of
developing cancer.
• Cancer is a complex multifactorial disease state.
• There are more than 200 different types of cancers, each with its own etiology and
symptoms.

• Malignant diseases manifest themselves in a variety of ways resulting in
general symptoms like fever, loss of appetite, fatigue or restlessness.
Specific cancers give rise to symptoms different for each one.
Danger signals of cancer
• Sore that does not heal.
• change in the colour of wart or mole.
• Chronic indigestion or difficulty in swallowing or early satiety.
• A lump or thickening in the breast or any part of the body.
• Abnormal bleeding or discharge from any body opening.
• Change in normal bowel habits.
• Persistent hoarseness of voice.

SYMPTOMS
TYPE OF CANCER SYMPTOMS
Oral cancer Ulcers, white or red patches inside the oral cavity or difficulty
in swallowing or opening the mouth wide, thickening of the
tongue.
Lung/Throat cancer Persistent cough, chest pain, blood in sputum, shortness of
breathe, weight loss or loss of appetite, hoarseness, repeated
bouts of pneumonia or bronchitis, difficulty in swallowing.
Stomach cancer Early satiety, indigestion or heartburn, pain in the abdomen,
bloating of stomach after meals, loss of appetite, weakness,
tiredness, diarrhea or constipation, blood in vomit.
Colon cancer Diarrhoea, constipation or any other changes in bowel habits,
frequent gas pains, blood in faeces.

TYPE OF CANCER SYMPTOMS
Breast Cancer A lump in the breast or under-arm area, change in shape, size or
colour of the breast, discharge from nipple, dimpled, puckered
or scaly surface of the breast (like an orange peel).
Cervical/
Uterine Cancer
Unusual vaginal bleeding, pain in the pelvic area, foul smelling
or unusual discharge.
Kidney
Cancer
Blood in urine, frequent fevers, weight loss or loss of appetite,
tiredness, pain in the side, anaemia or high blood pressure.
bladder Cancer The need to urinate frequently, painful urination, blood in urine.
Prostate Cancer Urination problems.
Melanoma (skin)
Cancer
Change in size, shape or colour of mole or wart.

1) Abnormalities in Metabolism:
• The extreme weight loss and weakness is caused by abnormalities in
glucose metabolism, in which cancer patients cannot produce glucose
efficiently from carbohydrates and instead feed off their own tissue
protein and convert it to glucose instead.
• Gluconeogenesis increases (metabolic pathway that results in the
generation of glucose from certain non-carbohydrate carbon substrates),
further Straining the supply of body proteins.
• Many patients develop insulin resistance.
• Drugs can be used to correct this metabolic error.
• Glucose intolerance occurs in cancer patients due to increased insulin
resistance and due to inadequate insulin release.

• There is increased lipolysis (the breakdown of fats and other lipids by
hydrolysis to release fatty acids), free fatty acids and glycerol turnover and
decreased lipogenesis (the metabolic formation of fat) and hyperlipidemia
(high concentration of fats or lipids in the blood).
• Fat oxidation rates are higher Tumours derive protein at the expense of
the host.
• The rates of whole body catabolic rate exceeds that of synthetic rate,
depletion of body protein occurs. Albumin is depleted in cancer.
• Branched chain amino acid infusions can decrease protein catabolism in
cancer patients.
• These metabolic abnormalities may be the cause for the failure to gain
lean body mass or maintain healthy body weight inspite of receiving
adequate energy and nutrients.

2) Anorexia:
o Anorexia is frequently accompanied by depression or discomfort from normal
eating.
o This contributes further to a limited nutrient intake at the very time the
disease process causes an increased metabolic rate and nutrient demand.
o Often this imbalance of decreased intake and increased demand creates a
negative nitrogen balance, an indication of body tissue wasting.
o Such a vicious cycle can lead to 'cancer cachexia‘
( wasting syndrome characterized by weight loss, anorexia, asthenia and anemia).
o This occurs in as many as 80 per cent of people with cancer.
o Loss of appetite can occur due to systemic effect of malignant tumour per se.
o It may often be intensified by fatigue, pain, fear, depression, sepsis (the body's
extreme response to an infection) or can develop as a consequence of such
treatments as surgery, radiation, chemotherapy and other drug treatments.
o Anorexia leads to weight loss and malnutrition.

3) Wasting:
 Many factors appear to play a role in the wasting associated
with cancer.
 Cytokines (are small proteins they signal the immune system to do its job),
released by both tumour cells and immune cells involved in the
inflammatory response induce a hyper- metabolic, catabolic
state.
 The combined effects of a poor appetite, accelerated and
abnormal metabolism and diversion of nutrients to support
tumour growth result in a lower supply of energy and nutrients
at instances when demands are high.

4) Malabsorption:
• The associated overgrowth of bacteria in the upper small bowel
may result in steatorrhoea (The presence of excess fat in feces)
and vitamin B12 deficiency.
• Direct interaction of bacteria with certain nutrients result in
abnormalities of the intestinal epithelium which of cause
malabsorption.
• Protein-losing enteropathy (ongoing damage or irritation and
swelling to the small intestine) can occur not only in intestinal
lymphoma and gastric carcinoma but now is known to occur with
tumours arising outside the alimentary tract (malignant
melanoma- type of skin cancer that develops from the pigment-
producing cells known as melanocytes).

• If the malignancy involves the pancreas, the pancreatic
duct or the common bile duct, normal secretory function
of digestive enzymes and related materials such as bile
salts is subsequently limited.
• Biliary obstruction can also produce a deficiency of
prothrombin (protein produced by liver), leading to blood
clotting problems and a deficiency of bile flow.
• This inturn interferes with normal digestion and
absorption and lead to further decreased calcium
absorption and metabolism with subsequent
osteomalacia ( a marked softening of your bones, most
often caused by severe vitamin D deficiency).

• Protein and electrolyte absorption as well as that of other nutrients
may also be diminished by solid tumor infiltration of the small
intestine or dissemination to lymphnodes (each of a number of
small swellings in the lymphatic system where lymph is filtered and
lymphocytes are formed).
• Abdominal tumours may also cause either gastrolic or jejunocolic
fistulas.
• This results in a bypass of the small intestine and contributes to the
subsequent malabsorption.
• Diarrhoea and steatorrhoea (The presence of excess fat in feces) as
well as protein loss follow.
• Extensive protein may also be lost in exudates associated with
various gastrointestinal enteropathies.

5) Fluid-Electrolyte Imbalances :
 Gastrointestinal lesions leading to general malabsorption can
also contribute to fluid and electrolyte losses.
 Continuous vomiting and diarrhoea not only bring loss of
water but also cause loss of minerals and water-soluble
vitamins.
 Villous adenoma (A type of tissue that grows in the colon and
other places in the gastrointestinal tract and sometimes in
other parts of the body) and adenocarcinomas (type of cancer,
It develops in the glands that line your organs) of the colon can
contribute to severe electrolyte imbalance.

6) Anaemia
 The underlying problem of anaemia may be compounded by a
number of factors, including anorexia with curtailment of
dietary nutrients necessary for haemoglobin synthesis, iron,
protein, folic acid, vitamin B, and vitamin C as well as
malabsorption of these materials.
 Additional contributory factors may be increased hemolysis
(breakdown or destruction of red blood cells so that the
contained oxygen-carrying pigment hemoglobin is freed into the
surrounding medium), bleeding of ulcerated lesions or presence
of gastrointestinal fistulas (an abnormal connection between
two body parts, such as an organ or blood vessel and another
structure).

7) Taste and Appetite Changes:
 These may be due to psychosomatic factors, fear, pain
and side-effects of medications.
 Diet prescribed should be according to the preferences
and likes of the patient.
 Chemotherapy or head and neck radiation may cause
taste blindness and inability distinguish the basic tastes
of salt, sweet, sour or bitter with consequent food
aversions.
 Since the aversion is often toward basic protein foods, a
high-protein liquid supplement may needed while
preparation of foods.

8) Learned Food Aversions:
 Psychologic factors undoubtedly play a role in appetite.
 The fear and uncertainty engendered by the diagnosis od cancer
and its uncertain outcome and the stress of diagnostic procedures
are exacerbated by the physiologic and metabolic effects of various
antitumor intervention.
 Those stress can cause learned food aversion.
 This behaviour is the unconscious association of the consumption
of a particular food with a concurrent or subsequent unpleasant
reaction such as nausea and vomiting.
 The result is subsequent avoidance of that food.
 In cancer patients, unpleasant reactions may occur in association
with anti-tumour therapy such as a chemotherapeutic drug or
ionising radiation.

9) Osteomalacia:
 Certain tumours reduce plasma calcitriol [a synthetic version of Vitamin
D3 used to treat calcium deficiency with hypoparathyroidism (decreased
functioning of the parathyroid glands) and metabolic bone disease in people
with chronic kidney failure] concentration in conjunction with
hypophosphatemia (a blood has a low level of phosphorous), thereby inducing
an oncogenic osteomalacia (softening of your bones, most often caused by
severe vitamin D deficiency)
 Gastrointestinal malabsorption of calcium and phosphate has been observed.
 Resection of the tumour corrects the bone disease.
 Most neoplasms, however, obstruct slowly and progressively resulting in
anorexia, dysphagia, nausea, vomiting, pain, diarrhoea or anaemia, leading to
weight loss and weakness.
 Fluid and electrolyte and acid-base balance result from persistent vomiting or
diarrhoea or as a consequence of dehydration and/or malnutrition.

10) Hypercalcaemia:
 It is one of the most common metabolic complications
of cancer.
 Approximately 20 to 40 per cent of patients with breast,
squamous(thin, flat cells that look like fish scales),
bladder and renal carcinoma develop hypercalcemia
(the calcium level in your blood is above normal) at
some point of their disease.
• All the methods of treating cancer involves killing cancerous cells.
• In this process, some healthy cells are also damaged.
• That is what causes the side effects of cancer treatment.

1) Problems Related To Surgical Treatment:
 For any surgical process and its healing process nutritional
requirements are beyond its regular nutritional needs.
 GIT surgery poses special problems in normal ingestion, digestion
and absorption of food nutrients.
 Head and neck surgery/restrictions in the oropharyngeal area (the
part of the throat at the back of the mouth behind the oral cavity)
are sometimes necessitated by cancer.
 Food intake is greatly affected in such cases and a creative variety
of food forms and semiliquid textures as well as modes of feeding
must be devised.

 Mechanical problems of food ingestion required long term tube
feeding.
 Gastrectomy (medical procedure where all or part of stomach is
surgically removed) may causes ‘dumping’ problems and it
required frequent, small, low CHO feedings.
 Vagotomy (a surgical operation in which one or more branches
of vagus nerve are cut, typically to reduce the rate of gastric
secretion) contributes to gastric stasis(delayed gastric emptying
in the absence of mechanical obstruction).
 Pancreatectomy (surgery to remove all or part of the pancreas)
contributes to loss of digestive enzymes, induced insulin
dependent DM and general weight loss.

2) Problems related to radiotherapy:
 Radiation to the oropharyngeal area (the part of the throat at the
back of the mouth behind the oral cavity) often produces:-
a) Mucositis (mouth or gut is sore and inflamed)
b) Dysphagia (difficulty swallowing foods or liquids,
arising from the throat or easophagus, ranging from
mild difficult to complete and painful blockage).
• c) A loss of taste sensation with increasing anorexia,
nausea, diarrhea and consequent decreased appetite.

 The liver is more resistant to damage from radiation in adults as
compared with children (children are more vulnerable).
Abdominal radiation may cause:
 Intestinal damage with tissue oedema (swelling) and congestion
(blockage)
 decreased peristalsis (series of muscle contractions) or
 Endarteritis (inflammation of the intima or lining coat of an
artery) in small blood vessels.
 In the intestinal wall there may be:
1) Fibrosis (excessive accumulation of scar tissue
in the intestinal wall) stenosis(narrowing)
2) Necrosis (death of tissue or cells through
disease or injury) or ulceration.

• If this condition continues over time, it may contributing to nutritional
problems by leading haemorrhage (the release of blood from a broken
blood vessel, either in/out-side of the body), obstruction,
fistulas (abnormal communication between two body surfaces eg.,
arteriovenous fistula-between artery and veins), diarrhea or
malabsorption.
• Tempting appetite must be developed through food appearance and
aroma as well as texture.
• High energy (1kcal/ml) and protein (50gms/lit) containing oral liquid
nutrition supplements are given.
• Adequate nutrition support during radiotherapy can decreases:
1. the impact of side effects,
2. minimize weight loss,
3. improve quality of life and
4. help patients recover from radiotherapy quickly.

3) Problems Related To Chemotherapy:
• The gastrointestinal symptoms caused by the effect of their toxic
drugs on the rapidly developing mucosal cells.
• The anaemia associated with bone marrow effects.
• The general systemic toxicity effect on appetite.
 The stomatitis (painful swelling and sores inside the mouth),
nausea, diarrhea and malabsorption contribute in many food
intolerances.
 Prolonged vomiting seriously affects fluid and electrolytes balance
especially in elderly persons and needs to be controlled.

 Anti-depressant drugs (used for pretreatment to relieve mental
depression) cause well-known pressor effects (rising/tending to
raise blood pressure) when used with tyramine rich foods
(a compound which occurs naturally in cheese and other food
which increases blood pressure) thus these foods should be
avoided when using such drugs.
 Malnutrition during treatment can lead to –
i. Increased risk of infections
ii. Treatment toxicity
iii. Increased health care costs
iv. Decreased response to treatment quality of life
v. Life expectancy.

o When cancer is diagnosed the weight loss and severe malnutrition is seen in
the later stage and it may be the cause of death in many cases.
o When lean body mass is significantly depleted, regardless of the cause,
death will follow.
o Without adequate energy and nutrients, the body is poorly equipped to
maintain immune defenses, support organ functions, absorb nutrients and
repair damage tissues.
1. To meet the increased metabolic demands of the disease and prevent
catabolism as much as possible.
2. To alleviate (make less severe) symptoms resulting from the disease and its
treatment through adaptation of food and feeding process.

 Total energy value of the diet must be increased-
• To prevent excessive weight loss.
• To meet increase metabolic demand.
• To counter catabolic (breakdown of complex molecules such as protein and
lipids and release of energy within the organism) or hyper metabolic states.
• To support anabolism is necessary (utilizes energy released by catabolism to
synthesize complex molecules)
 Out of this total kcal value, there must be sufficient CHO to spare protein
for vital tissue synthesis.
 For an adult patients with good nutritional status – about 2000kcal
 For an malnourished patient – 3000-4000 kcal depending on the degree of
malnutrition and body trauma
(is a serious injury to the body)

Calorie requirements are:
 Use of CHO or fat to achieve caloric levels is useful (type and amount
consistent with patient’s condition)
 Patients who are stressed, initiating cancer therapy or have history of DM
should be monitored for hyperglycaemia (elevation of blood sugar levels).
CALORIES CATEGORY
20-25 kcal/kg sedentary patients.
30 - 35 kcal/kg slightly hyper metabolic for weigh gain/anabolism.
40 – 45 kcal/kg hyper metabolic or severly stressed patients, significant
malabsorption.

Many breast cancer patients gain weight during
treatment.
Body composition changes during treatment – muscle
tissue is lost while fat is gained.
Physical activity is decreased and intake may be increased.
According to studies weight gain during breast cancer
treatment is associated with increased risk of recurrence
and death from breast cancer
Current strategy is to work on physical activity to maintain
muscle mass.
Healthy eating is encouraged.

o PEM is common in cancer patients.
o Additional protein is required to –
• Provide essential amino acids and nitrogen
necessary for tissue regeneration
• Healing and rehabilitation.
o For an adult patients with good nutritional status: 80 – 100 g
o For an malnourished patient – need more to replenish
tissues and maintain positive nitrogen balance.

PROTEINS CATEGORY
0.5
g/kg
Minimal day requirement
0.8 – 1.0
g/kg
Normal maintenance level
1.5 – 2.5
g/kg
If increased protein demands exist,
e.g., protein losing enteropathy (irritation and swelling
to the small intestine), hyper metabolism or extreme
wasting.
Protein requirements are:

 Glutamine (a-amino acid used in biosynthesis of protein) is
suggested for clinical use of oncology (cancer) patients.
 In cancer patient depletion of glutamine develops over a time.
 Cancer cachexia (wasting syndrome characterized by weight loss,
anorexia, asthenia and anaemia) due to massive depletion of
skeletal muscle glutamine.
 This can have negative impact on the function of host tissue that
are dependent on adequate stores of glutamine for optimal
functioning e.g., intestinal epithelial cells and lymphocytes (A type
of immune cell that is made in the bone marrow and is found in the
blood and in lymph tissue).
 The extent of normal tissue damage from radiation or
chemotherapy may be influenced by the presence of adequate
tissue glutamine stores.

 Tumors located in digestive tract have causing obstruction
resulting in poor intake.
 Deficiency of Vit. D – arises from prolonged general
malnutrition.
 Normal metabolism of micronutrients may alter disease
process.
 Reaction of lower GIT may results in malabsorption and
micronutrients deficiency.
 Supplementations may be required in all these
circumstances.

 Radiation and chemotherapy induced side effects like-
nausea, vomiting, diarrhea can lead to electrolyte
balance.
 Whose intake is limiting for a prolonged period, daily
multi-vitamin and multi-mineral supplement
recommended for patients.
 In addition dietary supplements are given to improve the
nutritional status.
 There is evidence that Vit. D (400-800IU) helps to protect
against several types of cancers.

Fluids are increased to reduce losses from
gastrointestinal problems and any additional loss caused
by infection and fever.
Sufficient fluid intake is necessary to help the kidneys rid
the body of the breakdown products from destroyed
cancer cells and drugs themselves.
Increased fluid also help to protect the urinary tract
from irritation and inflammation.

 Oral and other enteral feeding modes pose fewer problems than do
alternative means.
 The spectrum of feeding modalities :
• Oral diet amplified with nutrient supplement for increased
protein, calories, vitamins and minerals.
• Enteral tube feeding with several routes of entry.
• Parenteral nutrition through central and peripheral veins.
SOME SIDE
EFFECTS OF
CANCER THERAPY
SUGGESTED DIETARY MANAGEMENT
Early satiety Small frequent meals, chewing foods well and eating slowly.
Avoiding foods excessively high in fat.
Liquid 30 to 60 min. before meal not at meals.

SOME SIDE
EFFECTS OF
CANCER THERAPY
Nausea and
Vomiting
Clear, cold and carbonated beverages with added polycose
(digestible source of CHO calories)
Sipping beverages slowly through a straw, small, frequent
meals low in fat.
Dry crackers or toast before arising
Tart or salt foods liquids 30 to 60 minutes before eating.
Dry mouth Drinking at least 2 litres liquid daily.
High calorie beverages are preferable to water.
Sauces, gravies broth To moisten foods and to make them
easier to swallow.
Chewing sugar-free gum or sugar free candy to stimulate
salivation. Artificial saliva is given.

SOME SIDE EFFECTS OF
CANCER THERAPY
Taste alterations Experimenting with different flavours and seasonings.
Substitution of other proteins for red meats.
Loss of appetite Small, frequent feedings.
High calorie, high protein snacks and beverages.
Sore mouth and throat Soft, non acid foods, blended or liquified foods.
Foods and beverages at room temperature using straw
with liquids.
Swallowing problem Avoiding highly seasoned foods.
Liquid feedings or pureed foods.
Frequent feedings.
Tube feeding.
Adding butter and sauces to foods.
Finely chopped foods.

• Feeding the patient by normal ingestion of food and nutrient supplements
is most desirable.
• Based on individual nutritional assessment, a personal food plan is
developed with the patient.
• Often the diet of the hospitalised patient can be supplemented with
familiar foods from home as the clinical nutritionist plans with the family.
• A number of adjustment in food texture, temperature, amount, timing,
taste, appearance and form can be made to help alleviate symptoms.
• With support, the patient and family are better able to build a positive
mental attitude toward the diet as an integral part of the treatment.
• Food should be nutrient dense.
• Texture can be varied as tolerated, with appeal to sensory perceptions of
colour, aroma and taste to enhance the desire to eat.
• Often a series of mini meals using a wide variety of food items is better
tolerated than regular large meals.

• If appetite is better in the morning, a good breakfast should be
emphasised.
• Getting some exercise before meals and maintaining surroundings that
reduce stress may also help in the eating process.
• Since zinc deficiency is related to diminished taste, sometimes a zinc
supplement may be indicated.
• Salivary secretions are also affected by cancer therapy, so foods with a high
liquid content should be used.
• Nausea is often enhanced by foods that are hot, sweet, fatty or spicy, So
these can be avoided according to individual tolerance.
• Frequent small feedings of cold foods, soft to liquid in texture can be given.
• Eating dry foods such as crackers and dry toast on waking in the morning
may be helpful.
• Sore mouth often results from chemotherapy or radiation to the head and
neck area.

• Sore mouth is increased from any state of malnutrition or from
infections such as candidiasis (fungal infection caused by a yeast) with
numerous ulcerations of the oral and throat mucosa.
• Frequent small meals and snacks, soft in texture, bland in nature and
cool to cold in temperature are often better tolerated.
• Cancer patients can be benefitted from early and continued
individualised nutrition intervention.
• The intervention may start before therapy begins, continuing throughout
therapy and after completion for atleast 3 years.
• The diet should be supplemented with medium chain triglycerides if
there is fat malabsorption.
• When an adequate intake cannot be achieved orally, enteral or
parenteral support may be necessary to prevent or respond to
malnutrition.

 Supplements provide a healthy diet.
 Attention should be on diet with plenty of whole grains, vegetables,
legumes with soya bean, fish and omega-3 fatty acid.
 Most of the cancer patients with advanced cancer suffer from anorexia
and there is need for supplements.
 Commercial nutrition supplements may be useful for increasing energy
and/or protein intake in individuals unable to meet their nutritional
requirements through natural foods.
 Commercial nutritional supplements can be suggested when there is
impairment in the ability to consume or prepare conventional nutrient-
dense foods and fluids.

 When there is dysgeusia (disorder that distorts your sense of taste) and
lactose intolerance Patient need to be educated about the potential
harmful effects of herbal preparations megadoses of vitamins and minerals.
 Usually there is risk of contamination, adulteration, fake products and
having ingredients which are not permitted.
 They may have possible interactions that interfere with radiotherapy and
chemotherapy regimes.
 Whey protein is given to prevent clinical malnutrition and preventing cancer
patients dying due to malnutrition.
 Some mushrooms boost immunity and help in preventing and/or treating
cancer.
 Reishi mushroom, ganoderma lucidium is immune-stimulant(drugs that
stimulate the immune system by increasing the activity of any of its
components), anti-inflammatory and act as anti- tumour. It is known as
mushroom of immortality.

Maitake, grifola frondosa’s key component is B-glucan (It is immune
stimulant, activate certain cells and proteins that attack cancerous cells) .
Reishi mushroom Maitake Button mushroom
Mushrooms used in the prevention and treatment of cancer.

 White button mushrooms, agaricus bisporous has phytochemicals which
block the activity of the aromatase enzyme (an enzyme responsible for a
key step in the biosynthesis of estrogens) would decrease the production
of estrogen, which in turn helps control and possibly prevents the
growth of hormone dependent breast cancer cells.
 Nutrient supplements in a variety of forms and flavours may be used in
different ways to enhance nutrient density.
 When the patient is unable to eat but the gastrointestinal tract can still
be used, tube feedings may be needed to provide the necessary
nutritional support.

Role of food :
 In cancer prevention diet is an important area of intervention.
 400 gm/day consumption of fruits and vegetables can prevent atleast 20 per cent of
cancer incidence.
Nutrients as a cancer preventing agent:
• Intake of B-carotene, vit E and C rich foods decreases the risk of some cancers.
The beneficial effects of nutrient antioxidants
NUTRIENT BENEFICIAL EFFECTS
B-carotene Reduce risk of lung, stomach, cervix, oesophageal and throat cancers.
Vitamin C Reduce risk of upper GIT, cervix cancer and CVD.
Vitamin E Reduce risk of oral, pharyngeal cancer and CVD.
selenium Reduce risk of oesophageal and stomach cancer.
Reduce development of bladder cancer in women.

Phytochemicals as anti-cancer agent:
Biologically active substance present in plants are known as
phytochemicals.
PHYTOCHEMICALS BENEFICIAL EFFECT SOURCES
terpenes Carotenoids are one sub class of
terpenes.
Act as antioxidants.
alpha-carotene inhibits tumor
growth
Tomatoes, parsley, orange and
spinach.
lycopene Two times as powerful as B-
carotene in the destruction of
free radicals.
Reduce the risk of prostate
cancer
Tomatoes, red grape fruits,
guava, dried apricots.
Lutein and zeaxanthin Form of catotenoids
reduce the risk of lung cancer.

Limonoids • They have chemopreventing
agent in liver detoxification
system.
• This system detoxifies
carcinogens by making them
more water-soluble for
excretion from body.
• Citrus fruits like grape fruits
and orange juice.
Phenols and flavonoids • Scavenge free radical
compounds, may reduce risk
of cancer.
• Anti-oxident activity.
• Flavonols not easily
destroyed by cooking.
• Parsley, carrot, citrus fruit,
broccoli, cabbage, cucumber,
yams, tomatoes, peppers,
soya products, berries,
potatoes, broad beans,
peapods, colored onions,
apples.
• Cherry tomatoes have more
flavonols than ordinary.
• Peanuts are rich in the anti-
oxidant flavonols.

Isoflavones • They have chemopreventing agent in liver
detoxification system.
• This system detoxifies carcinogens by making
them more water-soluble for excretion from
body.
• Citrus fruits like grape
fruits and orange juice.
Thiols • It is Sulphur containing phytonutrient.
• Cruciferous vegetables contain subclass of
thiols identified as, indols, dithiolthiones and
isothiocyanates.
• It involves in detoxification of carcinogens and
other foreign compounds.
• Reduce the risk of developing hereditary
cancers.
• Indole-3-carbinol prevents breast, colon,
prostate and cervix cancer.
• .

Organo-sulphuric
compounds
Di allyl sulfide
• Allyl sulphides increases the production of
gluathione S transferase, it is a phase II
enzyme of the liver detoxification system.
• Reduce mutagenesis and increase the
activity macrophages and T lymphocytes.
• Alluim or
onion family,
includes
garlic, shallots
and leeks.
Lignans • Have protective effect against hormone-
sensitive cancer by virtue of the
interference with sex hormone
metabolism.
• Flax seeds,
wheat bran,
barley.
Phytic acid • It alters development of disease process
of its ability to bind carcinogens.
• Whole grains.

Prebiotics and Probiotics / Intestinal integrity
Two factors that influence intestinal integrity are:
• The bacterial populations in the gut and
• The health of the gut mucosa, both of which are influenced by nutrition.
In an optimally functioning gut, there is a balance between beneficial and
pathogenic bacteria in the large intestine.
Researchers found that potentially carcinogenic agents (food dyes,
aflatoxins, pesticides, nitrites) and cancer-causing agents in non-foods
(smokeless tobaccos, medications) are bioactivated by enzyme systems in
gut bacteria.
These bioactivations which can lead to cancer are promoted at a higher rate
in GI systems with imbalanced floral populations.

Healthy microflora can be supported by two interventions:
prebiotics
probiotics.
Prebiotics:
Prebiotics include foods that contain substrates that nourish beneficial gut
microbiota.
These substrates include dietary fibre and fructo oligosaccharides (FOS).
Food sources of these FOSs include honey, beer, onion, banana and oats.
Probiotics:
Probiotics support intestinal health by inhibiting the over growth of toxic bacteria.
By competing for attachment sites and nutrients these beneficial bacteria inhibit
the proliferation of non-beneficial organisms.
Lactobacillus and bifidobacteria also produce organic acids that reduce intestinal
pH and retard the growth of pathogenic bacteria.
Fermented dairy products like curds contain live culture which prevent cancer.

Resistant Starch
 A strong correlation exists between high
intake of resistant starch present in
substances like beans and lower risk of
colorectal cancer.
 Resistant starch increases the production
of short chain fatty acids.
 Butyrate may slow the growth of colon
tumour cells.

Dietary Fibre
1. mechanisms of dietary fibre against colon cancer:
2. The fibre dilutes bile acids or binds to it thereby preventing its role
in mutation or cell proliferation.
3. Fermentation of dietary fibre results in production of short chain
fatty acids lowering the intestinal pH.
4. This inhibits conversion of primary bile acids to secondary bile
acids.
5. The secondary bile acids are believed to promote mutation in
intestine.
6. At low pH the solubility of free bile acids is reduced, diminishing
their availability for carcinogenic activity.
7. Fermentation of dietary fibre results n production or butyrate
which has been shown to be antineoplastic.

8. Dietary fibre exerts its beneficial effect by speeding the passage of faeces
through the large intestine so that carcinogens are in contact with the
intestinal wall for much shorter period of time.
Additionally the bulk and water of faeces may dilute the carcinogen
to a nontoxic level.
9. Dietary fibre also influences the colonic microbial metabolism, influences
fermentation in the colon and the production and distribution of
short chain fatty acids in the colon.
10. It modifies pH, increases the faecal nitrogen and influences mutagens
and faecal enzymes in the colon.
11. Many human studies find that the consumption of fructo oligo
saccharides (FOS) increases beneficial bifidobacteria in the gut, while
decreasing concentrations of potentially harmfull E. coli, clostridia
and bacteroids.

PHYSICAL ACTIVITY
• Life time total physical activity reduces the risk of post menopausal breast
cancer.
• Exercise can have significant benefits for breast cancer survivors during and
after treatment.
• The general aerobic prescription is for moderate intensity activity (50-75% heart
rate reserve) 3-5 days per week, 20 to 60 minutes per session.
• Resistance training should also be incorporated into the programmes.
• Men who have been treated for colorectal cancer can reduce their risk of dying
from the disease by engaging in regular exercise. They live longer.
INSULIN RESISTANCE
• The glycaemic index may have relevance to cancer prevention. In addition,
insulin resistance and insulin like growth factors have been implicated in the so-
called diet related cancers at colon, breast and prostate.
• glycaemic index and colon cancer risk. A sedentary lifestyle in conjunction with
a high glycaemic index diet increases the risk of colon cancer.

IMPORTANCE OF FRUITS AND VEGETABLES IN DIET:
1. Fruits and vegetables intake has been examined in relationship to the incidence of various types of
cancers.
2. Raw and fresh vegetables, fruits, leafy green vegetables, cruciferae (cabbage), lettuce and carrots are
protective against cancer.
3. Vegetable intake is asociated with a substantial reduction of risk for several epithelial cancers.
4. Persons with low fruit and vegetable intake have been found to experience twice the risk of cancer
compared to those with high intake.
5. Fruits in particular were significantly protective in cancers of the oesophagus, oral cavity and Iarynx
and urinary tract neoplasm.
6. Strong evidence of a protective effect of fruit and vegetables has been seen in cancers of pancreas,
stomach, cervix, ovary, endometrium, colon, bladder and breast.
7. The biochemical and biological rationale for an effect of these foods is extremely strong, because
fruits and vegetables are rich sources of antioxidant nutrients and other phytochemicals.
8. They are also rich in phytochemicals such as dithiolthiones, glucosinolate and indoles, lycopene,
isothiocyanates, flavonoids, phenols, phytates, protease inhibitors, plant sterols, allium compounds
and lignans.
9. These agents have both complementary and overlapping mechanism of action, including the
induction of detoxification enzymes, inhibition of nitrosamine formation, provision of substrate for
formation of antineoplastic agents, dilution and binding the carcinogens in the digestive tract,
alteration of hormone metabolism and antioxidant effects.

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