21

KEY TERMS
cachexia

DIET AND CANCER

carcinogens
chemotherapy
dysphagia
endometrium
genetic predisposition
hypoalbuminemia
malignant
metastasize
neoplasia
neoplasm
oncologist OBJECTIVES
oncology
phytochemicals
After studying this chapter, you should be able to:
resection
xerostomia { Discuss how nutrition can be related to the development or the
prevention of cancer
{ State the effects of cancer on the nutritional status of the host
{ Describe nutritional problems resulting from the medical treatment of
cancer
{ Describe nutritional therapy for cancer clients

Cancer is the second leading cause of death in the United States. 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 unstruc-
tured 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 break away 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.

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¶ neoplasm THE CAUSES OF CANCER
abnormal growth of new tissue
The precise etiology of cancer is not known, but it is thought that heredity,
¶ neoplasia viruses, environmental carcinogens, and possibly emotional stress contribute
abnormal development of cells 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
¶ malignant carcinogens should be carefully avoided and medical checkups made regularly.
life-threatening Environmental carcinogens include radiation (whether from X-rays, sun, or
nuclear wastes), certain chemicals ingested in food or water, some chemicals
¶ metastasize that touch the skin regularly, and certain substances that are breathed in, such
spread of cancer cells from one organ to
as tobacco smoke and asbestos.
another
Carcinogens are not known to cause cancer from one or even a few expo-
¶ oncology sures, but after prolonged exposure. For example, skin cancer does not develop
the study of cancer after one sunburn.

¶ oncologist
doctor specializing in the study of cancer CLASSIFICATIONS OF CANCER
¶ carcinogens There are many types of cancer. A classification system was developed based on
cancer-causing substances the type of cell that produced the cancer. The majority of all cancers fall under
four headings: carcinomas, sarcomas, lymphomas, and leukemias.
¶ genetic predisposition
inherited tendency
{ 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.
{ 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. Those at high risk have fair skin, light hair, and blue,
green, or gray eyes and spend considerable leisure time in the sun. 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. Melanoma
is the most serious and deadliest form of skin cancer and originates in the cells
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SUPERSIZE USA
For the last 15 years, a fast-food lunch of a double cheeseburger, large
French fries, and a large soda has been your standard order. You are a meat-
and-potatoes person—none of those other vegetables for you. Over the years
you have gained considerable weight. How would your eating habits and the
weight gain put you at risk for cancer?
High-fat diets have been associated with cancer of the prostate, colon, breast,
and uterus. Excessive calories are associated with cancers of the gallbladder
and endometrium. Also, you are not getting many vitamins, minerals, and
phytonutrients that are protective.

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 derma-
tologist 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 papilloma virus (HPV). Epstein Barr may cause nasophar-
yngeal cancer, T-cell lymphoma, Hodgkin’s disease, and gastric carcinoma.
There is an anticancer vaccine available to prevent hepatitis B and its 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 calo-
ries is associated with cancers of the gallbladder and endometrium. People ¶ endometrium
who smoke and drink alcohol immoderately appear to be at greater risk of mucous membrane of the uterus
cancers of the mouth, pharynx, and esophagus than those who do not.
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 suffi-
cient carotene and vitamin A–rich foods may protect against cancers of the lung,
bladder, and larynx. Phytochemicals, substances that occur naturally in plant ¶ phytochemicals
foods, are thought to be anticarcinogenic agents. Examples include flavonoids, substances occurring naturally in plant
phenols, and indoles, and fruits and vegetables appear to have an abundance foods
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of them. It is advisable to eat nine or more servings of fruits and vegetables each
day, including 21 ⁄ 2 cups of vegetables and 2 cups of fruit, on a 2,000-calorie diet.
Legumes such as soybeans, 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.
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 a contributing factor in the develop-
ment of cancer. Excessive protein and fat intake, however, may be a factor in
EXPLORING THE WEB
the development of cancer of the colon.
Choose one particular type The most important principle is moderation. An occasional serving of
of cancer. Research the
bacon or buttered popcorn or wine is not likely to cause cancer, but the regular,
relationship of food to this
type of cancer using the excessive use of carcinogenic foods may contribute to cancer. Vitamins that are
Internet. Can alterations in thought to prevent cancer should be ingested in foods that naturally contain
diet prevent, cure, or help them. Excessive intake of vitamin supplements can be harmful. For example,
combat this type of cancer? abnormally large amounts of vitamin A can cause bone pain and fragility, hair
loss, headaches, and liver and skin problems.

In The Media
STUDY LINKS OBESITY TO ELEVATED RISK OF OVARIAN CANCER
Ovarian cancer has a 5-year survival rate of only 37% and is the most
fatal of gynecologic malignancies. A new epidemiological study,
conducted among women who have never used menopausal hormone
therapy, found that obese women are at an increased risk of developing
ovarian cancer when compared with women of normal weight. Obesity
may enhance ovarian cancer risk in part through its hormonal effects.
Excess body mass in postmenopausal women leads to an increased
production of estrogen, which in turn may stimulate the growth of ovarian
cells and play a role in the development of ovarian cancer.
(Source: Adapted from American Cancer Society, 2009.)

THE EFFECTS OF CANCER

One of the first indications of cancer may be 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 hypoalbuminemia, and anemia may develop. The sense of taste and smell may
abnormally low amounts of protein in be affected. Some foods may taste different: They may not have much taste, or
the blood everything may taste the same. Cancer clients, after chemotherapy, may experi-
ence 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.
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.
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The effects of cancer on the host are particularly determined by the loca-
tion 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 malnu-
trition, which in turn can lead to cachexia and, ultimately, death. ¶ cachexia
severe malnutrition and body wasting
caused by chronic disease

THE TREATMENT OF CANCER

Medical treatment of cancer can include surgical removal, radiation,
chemotherapy, or a combination of these methods. These treatments, ¶ chemotherapy
unfortunately, have side effects that can further undermine the nutritional treatment of diseased tissue with
status of the client. The nutritional effects of surgery in general are discussed chemicals
in Chapter 22. Cancer surgery, however, can have some additional effects.
Surgery on the mouth, for example, might well affect the ability to chew or
swallow. Gastric or intestinal resection can affect absorption and result in ¶ resection
nutritional deficiencies. The removal of the pancreas will result in diabetes reduction
mellitus.
Radiation of the head or neck can cause a decrease in salivary secre-
tions, which causes dry mouth (xerostomia) and difficulty in swallowing ¶ xerostomia
(dysphagia). This reduction in saliva also causes tooth decay and sometimes sore, dry mouth caused by a reduction
the loss of teeth. Radiation reduces the amount of absorptive tissue in the small of salivary secretions; may be caused by
radiation for treatment of cancer
intestine. In addition, it can cause bowel obstruction or diarrhea.
Chemotherapy reduces the ability of the small intestine to regenerate
¶ dysphagia
absorptive cells, and it can cause hemorrhagic colitis. Both radiation and difficulty swallowing
chemotherapy depress appetite. They may cause nausea, vomiting, and
diarrhea leading to fluid and electrolyte imbalances, which can lead to fluid
retention. However, when the therapy is completed and the client is able to
return to a well-balanced diet, these problems may disappear.

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.
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 be caused 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 accep-
tance of food and contribute further to the client’s malnutrition. It is preferable
that chemotherapy be withheld for 2 to 3 hours before and after meals. The
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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 be taken, as usual, at the outset of hospitaliza-
tion. 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. Nutri-
tious food is useless if the client refuses it.
If chewing is a problem, a soft diet may be helpful. If diarrhea is a problem,
a low-residue diet may help (see Chapter 20). Clients should be evaluated
inconspicuously.
If the client is scheduled to undergo radiation or chemotherapy,
these factors must be included in the diet planning. High-protein and high-
calorie 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 may be
recommended.
Carbohydrates and fat will be needed to provide this energy and spare
SPOTLIGHT protein for tissue building and the immune system. Clients with good nutri-
on Life Cycle tional 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
Children receiving chemotherapy protein per kilogram of body weight a day. Vitamins and minerals are essen-
may experience nausea tial for metabolism and tissue maintenance, and they may be supplied in
and vomiting, putting their supplemental form. During chemotherapy and radiation therapy, the recom-
nutrition status at risk. Giving
mendation is to eliminate vitamin A and vitamin E in supplemental form
chemotherapy at bedtime may
help alleviate nausea and and in the diet. Intake of these vitamins may prevent cancer cells from self-
vomiting in children. It may destructing and work against cancer therapy. Fluids are important to help
allow them to sleep through the kidneys eliminate the metabolic wastes and the toxins from drugs.
the emetic effects. Playing The client’s food habits may require change if, before the illness, the client
soft music, such as lullabies, had avoided desserts and high-calorie foods to maintain normal weight.
or playing a recording of a Sometimes clients may be willing to eat foods that are brought from
caregiver singing soft songs is
home. Some may find cold foods more appealing than hot foods. Meats may
soothing and distracting and
may alleviate symptoms of
taste bitter so milk, cheese, eggs, and fish may be more appealing. If foods taste
nausea and vomiting. sweeter to the cancer client than to the well person, then foods with citric acid
may be 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.
EXPLORING THE WEB If the client suffers from dry mouth, salad dressings, gravies, sauces, and
Search the Internet for the syrups appropriately served on foods can be helpful. Several small meals may
nutritional needs of the be better tolerated than three large meals. It is preferable to serve the nutrition-
chemotherapy client. How do ally richer meals early in the day because the client is less tired and may have
these needs change as the a better appetite at that time. If nausea or pain is a continuous problem, drugs
client progresses through
to control the problem, particularly at mealtimes, may be helpful. Although
therapy? Once therapy is
complete, how do the client’s oral feedings are definitely preferred, enteral or total parenteral feedings may
nutritional needs change? become necessary if cachexia is extreme. Sometimes an oral diet with a nutri-
Plan some sample menus for tional supplement may be used in conjunction with total parenteral feeding
the chemotherapy client. (see Chapter 22). As the client improves, calorie and nutritional content of the
diet should be gradually increased.