Cancer Treatment

Pathophysiology
Cancer starts with a gene mutation in a single that causes the cell to grow and multiply without control. As a
result, some cells don't die when they should, and other cells are created when they shouldn't be. As the
abnormal cells proliferate, they move into surrounding cells and interfere with normal cell functions. Invasive
cells are considered malignant cancer cells. Some invade tissues and form tumors, as in breast cancer; others
take over cells such as red bloods cells (leukemia) or pigment cells (melanoma). When the cancer moves from
the site where it first occurred to distant part s of the body, it is said to metastasize.
Causes and risk factors
Genetic predisposition
Viruses
Frequent sun exposure
Radiation exposure.
Carcinogenic chemical exposure

Frequent alcohol consumption

Diet high in animal proteins/saturated fats
Diet low in fruits/vegetables (bioactives)
Hyperglycemia
Obesity/metabolic syndrome

Diagnostic criteria
CT Scan: Noninvasive procedure. Uses computerized x-ray images from multiple angles of areas inside
the body. Used to evaluate abnormalities, such as suspicious lesions
MRI Scan: Noninvasive procedure. Uses radio waves and a powerful magnet to record detailed images of
tissues. Shows differences between cancerous and normal tissues (esp in brain, liver, and spinal cord)
PET Scan: Uses a small, venous radioactive glucose injection to mark areas with high glucose activity
(correlates with cancer). .
Biopsy: Invasive surgical procedure where a tissue sample is taken/examined by a pathologist. Sentinel
Node Biopsy examines a lymph node nearest original cancer site to examine extent/stage of cancer.
TNM staging system: Describes the amount/spread of cancer. T describes the tumor size. N describes
spread of cancer to nearby lymph nodes. M describes metastasis.
Tumor Classification: Ranks by tumor type (solid/liquid), origin, growth properties, invasive properties.
Labs
Carcinoembryonic Antigen (CEA)
Complete Blood Count w/ Differential
WBC,RBC, HCT, HGB, Neutrophils,
Lymphocytes, Platelets
Ferritin

Liver Function Test

Metabolic Profile: lipids, proteins, glucose,
electrolytes, enzymes
Natural Killer cell (NK-cell)

Rx / OTC / DNI
More than 100 different cancer drugs. Numerous supplements are used as well. See the Cancer Drug
Information fact sheets at the National Cancer Institute web site for more information: www.cancer.gov/

General DNI: ensure adequate hydration/increase fluids. Other DNIs vary greatly and could include
avoiding high fat foods, high fiber foods, caffeine and grapefruit juice. Patients may also need to take
medication on an empty stomach. See Food Medication Interactions for more information.
Medication to manage side effects: Erythropoietin, granulocyte stimulating factor, anti-emetics, appetite
stimulants, anti-diarrheals, laxatives, saliva/tear substitutes, mucosal protectants, blood thinners,
anti-inflammatories.
Supplements should be taken with extreme caution and carefully screened for DNIs
GI support: glutamine, probiotics
Hormone modulatioQn/support: melatonin, saw palmetto
Immune support: curcurmin, fish oil, garlic, ginger, green tea, inositol, probiotics, vitamin D
Liver support: milk thistle
Tissue support and repair: demulcent herbs (aloe, marshmallow), whey protein

Goals for Medical Nutrition Therapy

Prevent weight loss and preserve lean body
mass by ensuring adequate energy intake
Increase protein intake
Fluid management-proper hydration and
electrolyte balance
Manage N/V/D, constipation

Promote food safety

Enteral/Parental nutrition
Prevent or correct nutrient deficiencies (use
supplements with caution-some individuals
need more or less than the DRI)
Manage taste and smell alterations

Medical Nutrition Therapy

For side effect management in Cancer Treatment:
Prevent weight loss/gain: Preserve lean body mass with protein; adequate kcal
Manage nausea, vomiting, diarrhea, constipation and taste changes
Alterations in taste and smell: use strong spices and herbs, serve food cold instead of hot, use plastic
utensils
Weight loss: small frequent, nutrient dense meals, add protein and fat to meals/snacks. Use caution with
a pt with cachexia due to possibility of re-feeding syndrome
Anorexia/poor appetite: eat in pleasant atmosphere, keep nutrient dense snacks close at hand, be as
physically active as possible
N/V: sip on clear, cold non-acidic liquids, avoid high fat, greasy, spicy, or overly sweet foods, and eat
bland, easy to digest foods.
Diarrhea: consume lots of clear liquids, decrease high fiber foods, avoid sugar alcohols, eat applesauce,
bananas, canned peaches, white rice/pasta to help firm up stool
Constipation: add fiber and fluids
Stomatitis, esophagitis, mucositis: liquid and soft-textured diet, room temp or cool, avoid citrus, spicy,
granular, and raw foods.
Decreased salivation: high moisture foods (gravies, sauces, beverages, citric acid containing foods,
sherbet, melons)
Early satiety: calorie-dense meals
Ensure proper hydration: Increase liquids, soups, popsicles, fruit such as melons
Promote Food Safety
o Clean surfaces
o No raw meat, fish or unpasteurized
o Prevent cross contamination
cheese or dairy
o Avoid salad bars, delis, pot lucks,
o Honor expiration dates
leftovers and reheated food
o Keep hot foods hot and cold foods
o No bagged sprouts or salads
cold
o Neutropenic precautions when
necessary
For more info, see the handout from the American Cancer Society at www.cancer.org
Nutrition Prescription
Kcal: REE x AF x IF
(IF = 1.2 1.3 or 1.4-1.6 for cachexia)
Protein: Non-stressed pt: 1.0-1.2 g/kg; Hypercatabolic pt: 1.2-1.6 g/kg;
Stem cell transplant pt: 1.5-2.0; Severely stressed pt: 1.5-2.5 g/kg
*for BMI >50 or IBW >125% use adjusted body weight
CHO: Low Glycemic Load: Minimize refined foods and simple sugars; eliminate allergens-DRI >130 g/d
Fiber: Increase fiber if diet is inadequate; emphasis on soluble fibers as tolerated- DRI: Females 21-25 g/d
Males 30-38 g/d
Fluids: BSA x 1500 = mL fluids [BSA (m2) = [square root of 9wt(kg) x ht(cm)] 60]
*needs may be higher if vomiting or diarrhea present