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CH. 14
DIET AND CANCER
Nutrition & Diet Therapy, 10th e Ruth A. Roth
Nutritional Foundations and Clinical Applications, A Nursing
Approach, 5th e Mosby
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Objectives
• Discuss how nutrition can be related to development or
prevention of cancer
• State effects of cancer on nutritional status of host
• Describe nutritional problems resulting from medical treatment
of cancer
• Describe nutrient therapy for cancer clients
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Cancer
• Second leading cause of death in U.S.
• Characterized by abnormal cell growth
• Can occur in any organ
• Cancerous tumors:
• Malignant
• Affect structure
• Consequently, affect function of organs
• High mortality rate
• But does not always cause death
• Oncology
• Study of cancer
• Oncologist
• Physician who specializes in cancer
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Causes of Cancer
• Precise etiology unknown
• Contributing factors:
• Heredity, viruses, environmental carcinogens, and possibly emotional
stress
• Not inherited
• But some families appear to have genetic predisposition
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Causes of Cancer
• Viruses linked to cancer:
• Epstein Barr
• Nasopharyngeal cancer, T-cell lymphoma, Hodgkin’s disease, and gastric
carcinoma
• Hepatitis B
• Liver cancer
• Human papillomavirus (HPV)
• Cervical cancer
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Causes of Cancer
• Environmental carcinogens
• Cause cancer after repeated exposure
• Radiation
• X-rays, sun, and nuclear wastes
• Certain chemicals ingested in food and water or touched by skin
• Substances breathed in
• E.g., tobacco smoke, asbestos
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Relationships of Food and Cancer

• Certain substances in foods considered carcinogenic:
• Nitrates
• Sodium nitrate and potassium nitrite are added to cured meat to preserve its
color, prevent fats from going rancid, and stop bacteria from growing. They’re
also found in drinking water thanks to nitrogen-based fertilizers as well as
livestock waste.
• when nitrates are used as a food additive or consumed, they can convert into
nitrites.
• changed to nitrosamines (carcinogens) during cooking.
• Method of food preparation (such as grilling, barbecuing and smoking
of meats) increases formation of these carcinogens in cured and
smoked foods associated with stomach and esophagus cancer
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Some tips to keep nitrates and nitrites low:

Minimize consumption of processed foods and cured meat

products like hot dogs, sausage, and cold cuts.
Eat organic foods. They’re not grown with synthetic nitrogen
fertilizers, which can boost a crop’s nitrate content significantly.
Eat a diet high in antioxidants. Certain vitamins, like vitamin
C, can reduce the conversion of nitrates.

http://healthychild.org/easy-steps/avoid-nitrates-and-nitrites-in-food/
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Relationships of Food and Cancer

• Certain substances in foods considered carcinogenic:
• High-fat diets associated with uterine, breast, prostate, and colon
cancer
• Excessive caloric intake associated with gallbladder and endometrial
cancer
• Alcohol and cigarettes associated with lung, mouth, pharynx, and
esophagus cancer
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Relationships of Food and Cancer

• Certain diets seem to have health benefits:
• High-fiber helps protect against colorectal cancer
• Vitamin C-rich may protect against stomach and esophagus cancer
• Vitamin A-rich may protect against lung, bladder, and larynx cancer
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Relationships of Food and Cancer

• Health benefits:
• Phytochemicals occur naturally in plant foods
• Considered anticarcinogenic

• Legumes contain vitamins, minerals, protein, and fiber

• May protect against cancer

• High intake of soy foods associated with decreased risk of breast and
colon cancer
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Cancer, cont’d
• National Cancer Institute (NCI) cancer prevention guidelines
Avoid smoking and use of tobacco products
Do not drink too much alcohol
Eat five or more daily servings of fruits and vegetables
Eat a low-fat diet
Maintain or reach a healthy weight
Be physically active
Protect skin from sunlight
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The Effects of Cancer

• Depend on location of tumor
• May cause unexplained weight loss (One of the first
indications of cancer because the tumor cells use for their own
metabolism and development the nutrients the host has taken in)
 weakness, early satiety, and anorexia
• May lead to loss of muscle tissue, hypoalbuminemia, and
anemia
• Cancer cachexia (severe malnutrition and wasting caused by chronic
disease)
• Result of the effect of tumor involvement, metabolic changes, and
antineoplastic therapy
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Cancer,
Benefits of Nutritional Adequacy
• Decrease surgical complications
• Meet increased energy and protein requirements
• Repair and rebuild normal tissues
• Increase therapy tolerance
• Improve quality of life
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Treatment of Cancer
• Surgical removal, radiation, chemotherapy, or combination of
methods
• Side effects can affect nutrition
• Surgery of the mouth, for example, might well affect the ability to chew or
swallow.
• Gastric or intestinal resection can affect absorption and result in
nutritional deficiencies.
• The removal of the pancreas will result in diabetes mellitus.
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Treatment of Cancer
• Radiation and chemotherapy may cause:
• Radiation of the head or neck can cause a decrease in salivary
secretions
• Xerostomia
• Dry mouth
• Dysphagia
• Difficulty swallowing
• Anorexia
• Nausea and vomiting
• Radiation reduces the amount of absorptive tissue in the small
intestine.
• Also can cause bowel obstruction or diarrhea.
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Treatment of Cancer
• Chemotherapy reduces the ability of the small intestine to
regenerate absorptive cells, and it can cause hemorrhagic
colitis.
• Both radiation and 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.
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Cancer,
Anorexia
• Caused by cancer or its treatment
• Etiology: usually multifactorial
• Changes in taste and smell
• Decreased transit time
• Subsequent, early satiety
• Opportunistic infections
• Side effects of therapy and medications
• Emotional and psychologic effects
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Nutritional Care
• Calorie needs greater than before illness
• Clients who can eat normally tolerate side effects of therapy
better
• Clients can form aversions to food (they associate the foods
eaten with anorexia of chemotherapy)
• Making anorexia worse
• It is essential that favorite foods, prepared in familiar ways,
be included. Nutritious food is useless if the client refuses it.
• Soft diet if chewing problems
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Nutritional Care
• Low-residue diet for diarrhea
• High-protein, high-calorie diets and plenty of fluids for
clients undergoing radiation or chemotherapy
• 45 to 50 calories per kg of body weight per day
• Carbohydrates and fat needed to provide energy and spare
protein for tissue building and immune system
• 1.0 to 1.2 g of protein per kg per day
• Malnourished clients may need from 1.3 to 2.0 g of protein per
kg per day
• Vitamins and minerals essential
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Nutritional Care
• 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.
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Nutritional Care
• Encourage foods that increase appetite:
• Foods brought from home
• Cold foods
• May be more appealing

• Milk, cheese, eggs, and fish

• May be more appealing than meat
• Can taste bitter
• If the client suffers from dry mouth, salad dressings, gravies,
sauces, and syrups appropriately served on foods can be
helpful.
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Nutritional Care
• Although oral feedings are definitely preferred, enteral or total
parenteral feedings may become necessary if cachexia is
extreme.
• 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
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Nutritional Care
• Several small meals may be better tolerated than three
large meals
• serve the nutritionally richer meals early in the day
• The patient is less tired and may have a better appetite at that time.
• Control nausea and pain
• drugs to control the problem, particularly at mealtimes, may be helpful
• Nutritional supplements may be needed
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Stop and Share

• Consider the following scenario:
• A client with cancer feels that comments to encourage eating are
depressing reminders of the cancer and her situation. How can you be
helpful to her?
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Stop and Share

• At appropriate time, explain why eating is important
• Encourage her to eat foods she enjoys
• Recommend avoiding eating at time of day nausea is likely to
occur
• Recommend refraining from food that gives off odors that
contribute to nausea
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• If the prognosis for the client is not good, nutritional

care will not be as important as the client's feelings and
immediate comfort.
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Conclusion
• Cancer
• Disease characterized by abnormal cell growth
• Energy needs increase
• Due to hypermetabolic state and tumor’s need for energy nutrients
• Surgery, radiation, and chemotherapy can cause side effects that
affect nutrition
• Improving nutritional state difficult
• Due to illness and anorexia
• Parenteral or enteral nutrition may be necessary
• Health care professional can help client improve nutrition