DIET THERAPY IN

CANCER
Group 7
What is cancer?
• It is a disease characterized by abnormal cell growth and can occur in any organ.
• In some way the genes lose control of cell growth, and reproduction
becomes unstructured and excessive.
• The developing mass caused by the abnormal growth is called a tumor, or neoplasm.
• Cancer is also called neoplasia.
• Cancerous tumors are malignant, affecting the structure and consequently the function
of organs.
• When cancer cells breakaway from their original site, move through the blood, and
spread to a new site, they are said to metastasize.
• The mortality rate for cancer clients is high, but cancer does not always cause death.
• When it is found early in its development, prompt treatment can eradicate it.
• Oncology is the study of cancer, and a physician who specializes in cancer cases is
called an oncologist.
THE CAUSES OF CANCER

• The precise etiology of cancer is not known, but it is thought that heredity,
viruses, environmental carcinogens, and possibly emotional stress contribute to
its development.
• Cancer is not inherited, but some families appear to have a
genetic predisposition for it.
• When such seems to be the case, environmental carcinogens should be
carefully avoided and medical checkups made regularly.
• Environmental carcinogens include radiation (whether from X-rays, sun, or
nuclear wastes), certain chemicals ingested in food or water, some chemicals that
touch the skin regularly, and certain substances that are breathed in, such as
tobacco smoke and asbestos.
• Carcinogens are not known to cause cancer from one or even a few
exposures, but after prolonged exposure. For example, skin cancer does not
develop after one sunburn.
CLASSIFICATIONS OF CANCER

• There are many types of cancer. A classification system was developed based
on the type of cell that produced the cancer. The majority of all cancers fall
unde
four headings: carcinomas, sarcomas, lymphomas, and leukemias.
• Carcinomas involve the epithelial cells (cells lining the body).
• These include the outer layer of the skin, the membranes lining the digestive
tract, the bladder, the womb, and any duct or tube that goes through organs
in the body.
• Sarcoma is cancer of the soft tissues of the body, such as muscle; fat; nerves;
tendons; blood and lymph vessels; and any other tissues that support, surround,
and protect the organs in the body.
• Soft-tissue sarcomas are uncommon.
• Sarcomas can also occur in bone rather than soft tissue and primarily in the
legs.
CLASSIFICATIONS OF CANCER

• Lymphomas are cancer of the lymphoid tissue. This includes the

• lymph nodes, bone marrow, spleen, and thymus gland.
• Leukemias develop from the white blood cells and also affect
the bone marrow and spleen.
• The site where the cancer is located will become part of
the diagnosis, such as basal cell carcinoma.
Skin Cancer

• Skin cancer is becoming more prevalent. There are three types of

skin cancer: basal cell, squamous cell, and melanoma.
• Basal cell carcinoma is the most common form of skin cancer,
affecting the outer skin layer and caused by exposure to sunlight.
• Squamous cell carcinoma affects the squamous cells that are in
the upper layer of the skin. Most cases arise from chronic
exposure to sunlight, but may also occur where skin has been
injured — burns, scars,or long-standing sores.
Skin cancer

• Melanoma is the most serious and deadliest form of skin cancer and
originates in the cells that produce the pigment melanin, which
colors our skin, hair, and eyes.
• The majority of melanomas are black or brown, but some
melanomas occasionally stop producing pigment and are skin
colored, pink, red, or purple.
• If caught early, melanoma is almost 100% curable; therefore a
yearly exam by a dermatologist is recommended for early diagnosis
of all skin cancers.
Viral Causes of Cancer

• The following viruses have been linked to cancer: Epstein

Barr, hepatitis B, and human papillomavirus (HPV).
• Epstein Barr may cause nasopharyngeal cancer, T-cell
lymphoma, Hodgkin’s disease, and gastric carcinoma.
• There is an anticancer vaccine available to prevent hepatitis B andits
serious consequences — liver cancer.
• A vaccine is now available to prevent cervical cancer caused by HPV.
• Cancer research is ongoing and continues in these and other areas.
RELATIONSHIPS OF FOOD AND CANCER

• Although the relationships of food and cancer have not been proved,
there appear to be associations between them — both good and bad.
• Certain substances in foods, for example, are thought to be carcinogenic.
• Nitrites in cured and smoked foods such as bacon and ham can be changed
to nitrosamines (carcinogens) during cooking.
• Regular ingestion of these foods is associated with cancers of the stomach
and esophagus.
• High-fat diets have been associated with cancers of the uterus, breast,
prostate, and colon.
• The regular, excessive intake of calories is associated with cancers of
the gallbladder and endometrium.
• People who smoke and drink alcohol immoderately appear to beat greater risk
of cancers of the mouth, pharynx, and esophagus than those who do not.
RELATIONSHIPS OF FOOD AND CANCER

• On the positive side, it is thought that diets high in fiber help

to protect against colorectal cancer.
• Diets containing sufficient amounts of vitamin C– rich foods
may protect against cancers of the stomach and esophagus.
• Diets containing sufficient carotene and vitamin A– rich foods
may protect against cancers of the lung, bladder, and larynx.
• Phytochemicals, substances that occur naturally in plant foods, are
thought to be anti-carcinogenic agents. Examples include flavonoids,
phenols, and indoles, and fruits and vegetables appear to have an
abundance of them
RELATIONSHIPS OF FOOD AND CANCER

• It is advisable to eat nine or more servings of fruits and vegetables

each day, including two 1⁄2 cups of vegetables and 2 cups of fruit, on
a 2,000-calorie diet.
• Legumes such as soy beans, dried beans, and lentils contain
vitamins, minerals, protein, and fiber and may protect against cancer.
• High intakes of soy foods are associated with a decreased risk
of breast and colon cancer.
RELATIONSHIPS OF FOOD AND CANCER

• Appropriate amounts of protein foods are essential for

the maintenance of a healthy immune system.
• An immune system that has been damaged — possibly through
malnutrition — may be acontributing factor in the development
of cancer.
• Excessive protein and fat intake, however, may be a factor in
the development of cancer of the colon.
RELATIONSHIPS OF FOOD AND CANCER

• The most important principle is moderation. An occasional serving

of bacon or buttered popcorn or wine is not likely to cause cancer,
but the regular, excessive use of carcinogenic foods may contribute
to
cancer.
• Vitamins that are thought to prevent cancer should be ingested
in foods that naturally contain them.
• Excessive intake of vitamin supplements can be harmful.
• For example, abnormally large amounts of vitamin A can cause
bone pain and fragility, hair loss, headaches, and liver and skin
problems.
THE EFFECTS OF CANCER

• One of the first indications of cancer maybe unexplained weight loss because the
tumor cells use for their own metabolism and development the nutrients the
host has taken in.
• The host may suffer from weakness, and anorexia may occur, which compounds
the weight loss. The weight loss includes the loss of muscle tissue and
hypoalbuminemia, and anemia may develop.
• The sense of taste and smell maybe affected. Some foods may taste
different: They may not have much taste, or everything may taste the same.
• Cancer clients, after chemotherapy, may experience a metallic taste when
eating protein foods.
• Many clients complain of food tasting too sweet.
• Radiation to the neck and head can cause damage to the taste buds and
could also affect taste and smell, causing loss of appetite and weight loss.
THE EFFECTS OF CANCER

• Cancer clients become satiated earlier than normal, possibly because

of decreased digestive secretions.
• Insulin production may be abnormal, and hyperglycemia can delay
the stomach’s emptying and dull the appetite.
• Some cancers cause hypercalcemia. If this is chronic, renal stones
and impaired kidney function can occur.
• The effects of cancer on the host are particularly determined by the
location of a tumor. For example, an esophageal or intestinal tumor can
cause blockage in the gastrointestinal tract, causing malabsorption.
• If the cancer is untreated, the continued anorexia and weight loss
will create a state of malnutrition, which in turn can lead to cachexia
and, ultimately, death.
NUTRITIONAL CARE OF THE CANCER CLIENT

• The nutrient and calorie needs of the cancer client are

actually greater than they were before the onset of the
disease.
• The cancer causes an increase in the metabolic rate, tissue must
be rebuilt, and the nutrients lost to the cancer must be replaced.
• Clients who can maintain their weight or minimize its loss
increase their chances of responding to treatment and, thus, their
survival.
• Clients on high-protein and high-calorie diets tolerate the side
effects of therapy and higher doses of drugs better than those who
cannot eat normally.
• And those clients who can eat will feel better than those who
cannot.
NUTRITIONAL CARE OF THE CANCER CLIENT

• Despite their nutritional needs, however, anorexia is a major problem

for cancer clients.
• It is particularly difficult to combat because cancer clients tend to develop
strong food aversions that are thought to becaused by the effects of
chemotherapy.
• Clients receiving chemotherapy near mealtime associate the foods at that
meal with the nausea caused by the chemotherapy and often form
aversions to those particular foods.
• These aversions result in limited acceptance of food and contribute
further to the client’smalnutrition.
• It is preferable that chemotherapy be withheld for 2 to 3 hours before
and after meals.
NUTRITIONAL CARE OF THE CANCER CLIENT

• The appetite and absorption usually improve after chemotherapy, so the

client can
improve nutritional status between chemotherapy treatments.
• Obviously, diet plans for cancer clients require special attention.
• The client’s diet history should betaken, as usual, at the outset of
hospitalization.
• Nutrient and calorie needs must be determined by the dietitian, and the
client’s diet plan should be made in consultation with the client.
• It is essential that favorite foods, prepared in familiar ways, be
included. Nutritious
• food is useless if the client refuses it. If chewing is a problem,a soft diet
maybe helpful.
• If diarrhea is a problem,a low-residue diet may help.
NUTRITIONAL CARE OF THE CANCER CLIENT

• If the client is scheduled to undergo radiation or chemotherapy,

these factors must be included in the diet planning.
• High-protein and highcalorie diets may be recommended.
• Energy demands are high because of the hypermetabolic state
often caused by cancer.
• Calorie needs will vary from client to client, but 45 to 50 calories
per kilogram of body weight maybe recommended.
NUTRITIONAL CARE OF THE CANCER CLIENT

• Carbohydrates and fat will be needed to provide this energy and spare protein
for tissue building and the immune system.
• Clients with good nutritional status will need from 1.0 to 1.2 grams of protein
per kilogram of body weight a day.
• Malnourished clients may need from 1.3 to 2.0 grams of protein per kilogram
of body weight a day.
• Vitamins and minerals are essential for metabolism and tissue maintenance,
and they maybe supplied in supplemental form.
• During chemotherapy and radiation therapy, the recommendation is to eliminate
vitamin A and vitamin E in supplemental form and in the diet. Intake of these
vitamins may prevent cancer cells from self destructing and work against cancer
therapy.
• Fluids are important to help the kidneys eliminate the metabolic wastes and
the toxins from drugs.
NUTRITIONAL CARE OF THE CANCER CLIENT

• The client’s food habits may require change if, before the illness, the
client had avoided desserts and high-calorie foods to maintain normal
weight.
• Sometimes clients may be willing to eat foods that are brought from
home. Some may find cold foods more appealing than hot foods.
• Meats may taste bitter so milk, cheese, eggs, and fish may be
more appealing.
• If foods taste sweeter to the cancer client than to the well person,
then foods with citric acid maybe more acceptable.
• Supplementation with high-calorie, high-protein, liquid foods between
meals may be useful but should not be used if their consumption
reduces the client’s appetite at meals.
NUTRITIONAL CARE OF THE CANCER CLIENT

• If the client suffers from dry mouth, salad dressings, gravies,

sauces, and syrups appropriately served on foods can be helpful.
• Several small meals may be better tolerated than three large meals.
• It is preferable to serve the nutritionally richer meals early in the day
because the client is less tired and may have a better appetite at
that time.
• If nausea or pain is a continuous problem, drugs to control
the problem, particularly at mealtimes, may be helpful.
• Although oral feedings are definitely preferred, enteralor total
parenteralfeedings may become necessary if cachexia is extreme
NUTRITIONAL CARE OF THE CANCER CLIENT

• Sometimes an oral diet with a nutritional supplement may be used

in conjunction with total parenteral feeding
• As the client improves, calorie and nutritional content of the
diet should be gradually increased.
CONSIDERATIONS FOR THE HEALTH CARE
PROFESSIONAL
• It is important that the dietitian establish a good relationship with the client
and that constant reminders to eat be avoided.
• The client usually understands the situation, and such comments are
only depressing reminders of the cancer.
• When appropriate, however, it maybe helpful to:
• 1. Explain why it is important that the client eat
• 2. Encourage him or her to eat foodshe or she enjoys
• 3. Recommend that he or she avoid eating at the time of daywhen
nausea typically occurs
• 4. Refrain from serving foods that give off odors that contribute to nausea
• If the prognosis for the client is not good, nutritional care will not be as
important as the client’s feelings and immediate comfort.