This document discusses the relationship between diet and cancer. It notes that cancer is characterized by uncontrolled cell growth and that diet accounts for approximately 40% of cancer risk. Western diets high in red and processed meats increase cancer risk, while eating a variety of fruits and vegetables may help protect DNA from damage. Maintaining a healthy weight and being physically active can also lower cancer risk by reducing hormones that promote cancer growth. Nutrition is important both for cancer prevention and treatment support.

1. Unit 22 – Diet and Cancer
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2. Cancer
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 Group of >100 different diseases
 Characterized by uncontrolled cell growth
 Individual cancers differ by:
- where they develop
- how quickly they grow
- type of treatment
- impact on nutritional status
 2nd leading cause of death in the US

3. Cancer Progression
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4. Estimated Cancer Prevalence 2007
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Urinary Bladder
Thyroid
Testis
Stomach
Prostate
Pancreas
Ovary
Oral Cavity and Pharynx
Lymphoma
Multiple Myeloma
Melanoma of Skin
Lung
Liver and bile duct
Leukemia
Larynx
Kidney
Hodgkin Disease
Esophagus
Endometrial/Uterine
Colon/Rectum
Cervix
Breast
Brain/CNS

5. What Causes Cancer?
 80-90% of cancers are
initiated by environmental
factors that alter DNA
 Most factors are
modifiable

6. Causes of Cancer
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 Aflatoxins – toxin made my  Arsenic
Aspergillus fungi  Asbestos
 Ethanol - alcoholic  Chromium hexavalent cpds
beverages
 Hepatitis B and C virus
 Coal-tars
 Human papilloma viruses:
 Herbal remedies containing some genital-mucosal types
plant species of the genus
Aristolochia  Mustard gas
 Salted fish (Chinese-style)  Solar radiation
 Soot  Sunlamps or sunbeds
 Tobacco, smokeless  X-radiation and gamma
radiation
 Wood dust
 Nitrates

7. What Causes Cancer?
 Diet accounts for approx. 40% of cancer risk
- Westernized dietary intake and lifestyle increase risk
of many types of cancer
 Genetic factors account for approx. 5-42% of risk
for some cancers
- Prostate, breast, and pancreatic cancers

8. Nutrition and Cancer
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 Prevention  1/3 of all cancers are
related to dietary factors
 Intake/utilization Cancer
and/or
impairment of nutrients treatment
 Absorption/metabolism
impairment

9. Nutrition in Cancer Prevention
 Eat a variety of fruits and veggies
- 5-9 servings per day
 Antioxidants and anti-inflammatory
compounds may protect DNA from
damage
 Damaged DNA may direct abnormal cell
multiplication

10. Nutrition in Cancer Prevention
 Limit red meats and processed
meats
 High intakes of saturated fats from
meat and dairy products increase
cancer risk
 Plant proteins provide unsaturated
fats plus vitamins, minerals, fiber,
and phytochemicals

11. Nutrition in Cancer Prevention
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Excess body weight and physical inactivity
 ↑ risk of esophageal, colon/rectal, postmenopausal
breast, endometrial, and renal cancers
 Increases hormones that promote cancer cell growth
 Promotes insulin resistance and hyperinsulinism
 Promotes low levels of inflammation which can
promote cancer cell growth and development

12. Nutrition in Cancer Prevention
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 Link between excess body weight,
exercise, and cancer risk so strong that:
 Recommended BMI range:
between 21 and 23
 Limit energy-dense foods:
(particularly processed foods high in
sugar and fat, and low in fiber)
 Physical activity:
at least 30 minutes every day

13. American Institute for Cancer Research
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Recommendations
 Avoid sugary drinks
 Limit foods high in salt
 Limit alcohol to 1-2 drinks per day (if any at all)
 Don’t use supplements to protect against cancer
 Breastfeed up to 6 months
 Do not smoke or chew tobacco

14. Impact of Cancer on Nutrition
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Site Potential Effects
Brain/CNS Eating disabilities, chewing/swallowing difficulty
Head and Neck Chewing/swallowing difficulty
Esophagus Dysphagia related to obstruction, GERD
Stomach Early satiety, N&V, impaired motility,
obstruction – may require EN or PN
Bowel Maldigestion/malabsorption,
obstruction – may require EN or PN
Liver Diarrhea
Pancreas Maldigestion/malabsorption, DM

15. Impact of Cancer on Nutrition
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Metabolic Changes
 alter use of fuels (CHO, pro, fat)
 promote loss of weight and lean body mass
 Glucose intolerance / insulin resistance
 Increased energy expenditure
 Increased protein turnover
 Reduced muscle protein synthesis
 Accelerated fat breakdown
 Kcal and nutrients  redirected to supporting growth of tumor
vs. fueling the body
 Increased inflammatory/immune response  increase
metabolism

16. Impact of Cancer on Nutrition
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Anorexia
 Contributing factor to weight loss and malnutrition
 Potential causes:
- pain, depression, anxiety, fatigue, early satiety, N&V
 Treatments contribute:
- taste alterations, loss of taste, sore mouth, dry mouth,
thick saliva, esophagitis, fatigue
 Optimizing intake:
- texture/temp modification, scheduled eating, meds to

17. Impact of Cancer on Nutrition
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Cachexia:
 wasting syndrome marked by weakness,
progressive loss of body weight, fat, and muscle
 Present in approx. 80% cancer related deaths
 Hard to reverse
 Nutrition aimed at preserving muscle and fat stores
- improves quality of life
- does not guarantee increased length of survival

18. Nutrition Therapy During Treatment
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 Improve tolerance to treatment
 Enhance immune function
 Aid in recovery
 Improve quality of life
 Enhance well-being

19. Nutrition Therapy during Treatment
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 Calories
- Nonambulatory/sedentary
25-30 kcal/kg body weight
- Hypermetabolic/weight gain
30-35 kcal/kg body weight
- Hypermetabolic, severely stressed, malabsorption
35 kcal/kg body weight

20. Nutrition Therapy during Treatment
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 Protein
- Nonambulatory/sedentary
1.0-1.2 g/kg body weight
- Hypermetabolic/weight gain
1.2-1.5 g/kg body weight
- Hypermetabolic, severely stressed, malabsorption
1.5-2.5 g/kg body weight

21. Tips to increase kcals and protein
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 Add cheese
- to toast, crackers, sandwiches, baked potatoes,
veggies, soups, and noodles
 Add peanut butter
- to toast, bread, English muffins, fruit
- blended into chocolate or vanilla milkshake
 Add nuts and seeds:
- sprinkled over cereals, fruit, desserts, veggies,
salads, and pasta

22. Altered Taste/Smell
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 Taste/smell impairment occurs in
more than ¾ PTs
 Can interfere with enjoyment of
eating
 ↓ tolerance of bitter foods
 ↑ tolerance of sweet foods
 Can significantly reduce intake

23. Strategies to Reduce Food-borne
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Illness Risk – Neutropenic Diet
 Proper hand washing
 Cook meat to “well-done”
 No raw eggs, even in dressings, “over-easy” eggs
 No sushi, raw seafood, raw meats, unpasteurized milk
 Wash fruits/veggies thoroughly
 Thaw food in fridge-not on counter or in sink
 Refrigerate leftovers immediately and discard after 3d
 Avoid salad bars and buffets when eating out

24. Low-Bacterial / Low-Microbial Diet
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 Order is up to the discretion of the physician
 Foods not allowed:
- fresh fruits and vegetables
- nuts and dried fruits
- foods from multi-serving containers
- deli meats and undercooked meats

25. For More Information
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 www.cancer.org