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What are the dietary factors that may initiate carcinogenesis? (4)
- Aflatoxin
- Heterocyclic Amines (HCA) & Polycyclic Aromatic Hydrocarbons (PAH)
- Nitrosamines
- Alcohol
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What
dietary factors may prevent the development of cancer and how do they do
so? (4)
- 1. Ascorbic Acid inhibits nitrosamine formation
- 2. Antioxidants scavenge free radicals
- 3. Phytochemicals activate liver enzymes that eliminate cancer cells
- 4. Potential effects of fiber
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____ and ____ protect lipids and cell membranes
____ protects cytosol and aqueous body fluids
- Tocopherols & carotennoids
- Ascorbic acid
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Antioxidant compounds and their food sources:
Beta Carotene
Vitamins A and E
Selenium
Lutein
Lycopene –
Catechins
- Beta Carotene: orange fruits & veg
- Vitamins A and E:
- Selenium: bread, meat
- Lutein: collards, spinach, kale
- Lycopene: tomatoes, watermelon
- Catechins: green tea
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What are the Potential effects of fiber (3)
- Bind PAH and other potential carcinogens so not able to
- make contact with intestinal mucosa
- Shorten transit time which lessens exposure
- Bulking agent – less exposure of intestinal mucosa to carcinogens
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How might fiber and fruits and vegetables
decrease the risk of developing cancer? (5)
- Induction of detoxifying enzymes- in liver that detox
- cancer cells; fruits & veg increase amts of detoxifying enzymes
- Antioxidant effects –prevention of free radical formation
- Inhibition of nitrosamine formation- nitrosamine is
- initiator of cancer
- Dilution and binding of carcinogens- fiber & water in
- fruit & veg as go thru GI tract prevent compounds from making contact w/mucosa of GI tract
- Altered hormone metabolism- insulin regulation
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What
are the dietary recommendations for cancer prevention from the American
Cancer Society and the National Cancer Institute?
- Eat a healthy diet, with an emphasis on plant sources
- Choose foods and drinks in amounts that promote healthy weight
- Eat five or more servings of a variety of vegetables and fruits each day
- Choose whole grains in preference to processed (refined) grains
- Limit consumption of processed red meats
- Choose foods that maintain a healthful weight
- If you drink alcoholic beverages, limit intake; no more than 1 drink/day for women, 2 for men
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Why
might a cancer patient have difficulty maintaining his/her nutritional
status? (9)
- Pain
- Mucositis
- Xerostomia
- Nausea
- Vomiting
- Taste changes
- Early satiety
- Fatigue
- Diarrhea
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What factors may affect nutritional status and nutrient metabolism when a person has cancer of oral cavity, pharynx, esophagus? (4)
Effects on food intake:
· Dry mouth
· Dysphagia
· Obstruction
· Fistula
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What factors may affect nutritional status and nutrient metabolism when a person has cancer of GI tract? (4)
- Effects on food intake and utilization:
- · Obstruction
- · Nausea and vomiting- common side effect of chemo
- · Malabsorption- b/c of mucsistis, in GI as well as in mouth
- · Fistula- due to cancer itself or radiation therapy
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What factors may affect nutritional status and nutrient metabolism when a person has pancreatic cancer? (3)
- § Reduced enzyme secretion/production
- § Reduced insulin secretion
- § Obstruction of pancreatic/bile duct
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What factors may affect nutritional status and nutrient metabolism when a person has cancer of the kidney? (5)
- § Effects on processing wastes
- § Obstruction of ureters
- § Altered Vitamin D metabolism
- § Altered fluid and electrolyte metabolism
- § Anemia- rbc production is impaired
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What factors may affect nutritional status and nutrient metabolism when a person has liver cancer? (4)
- § Impaired prothrombin synthesis
- § Reduced bile production
- § Impaired albumin synthesis- edema is result
- § Many metabolic abnormalities
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What are the nutritional implications of glucocorticoids (prednisone, dexamethasone) and what dietary changes might be needed?
- -Nutritional Implications:
- Increased appetite (but high protein)
- Obesity: (plus fluid retention, resulting in high bp)
- Glucose intolerance: (may need to manage amt of
- carbs they get; some need to be given insulin)
- Hypertension
- Impaired wound healing (b/c of catabolic affect)
- Loss of calcium from bone: (give calcium supplement)
- Protein catabolism
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Why are glucocorticoids given?
-Suppress the immune system & are anti-inflammatory agents (given after organ transplants to prevent body from attacking it)
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What
are the nutritional implications of chemotherapy? (7)
- Taste abnormalities
- Candidiasis/herpes simplex
- Mucositis/stomatitis- severe ulcers in mouth, and this occurs all the way down GI tract, which causes pain and malabsorption
- Esophagitis
- N/V, anorexia
- Diarrhea and malabsorption
- Anemia & neutropenia: b/c of impact that chemo has on bone marrow; pt will have low Hct & Hgb
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What impact would surgical treatment of oral cavity, pharynx, esophagus cancers have on the patient? (5)
- • Difficulty chewing and swallowing
- • Dysgeusia (altered-taste)- such as metallic taste, so food doesn’t taste good
- • Xerostomia (dry mouth)- suck on hard candies
- • Difficulty speaking- esp if have cancer in larynx
- • Often malnourished at diagnosis- b/c haven’t been able to eat well- esophagus is oftentimes narrowed; oftentimes cause is cig & alcohol use which makes it worse
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What impact would surgical treatment of gastrectomy (stomach made smaller) due to stomach cancer have on the patient? (3)
- • B12 deficiency-less intrinsic factor being made
- • Impaired absorption of divalent cations in small intestine
- • Dumping syndrome
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What impact would surgical treatment of intestinal tract due to cancer have on the patient? (6)
- • Fluid and electrolyte imbalance
- • Lactose intolerance
- • Bile salt losses – steatorrhea which are lost in ileum
- • Impaired vitamin & mineral absorption
- • Ileostomy/colostomy: colostomy turns out better b/c u
- don’t have chance to reabsorb any of the fluid that we have lost. Esp if lost the ileoceal valve. works as a break helps
- • Short bowel syndrome may need PN
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Diff b/w colostomy and ileostomy
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colostomy- lose lower part of intestine, ileostomy- lose the whole colon
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What impact would surgical treatment of liver cancer have on the patient?
- • Hyperglycemia: carb intolerance
- • Hypertriglyceridemia
- • Fluid and electrolyte imbalance
- • Fat malabsorption: b/c bile is made by liver
- • Vitamin and mineral malabsorption
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What recommendations would you make to a patient
suffering from dumping syndrome? (8)
- · Lie down after eating- so gravity doesn’t help mvmt down
- · Avoid liquids with meals
- · Limit simple carbohydrates
- · Introduce milk products slowly- some become lactose intolerance
- · Moderate temperature for food and drinks
- · Avoid cold drinks due to increased gastric motility
- · Pectin delays gastric emptying and slows CHO absorption
- · Small frequent feedings
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What dietary recommendations would you suggest to avoid (4) and encourage (6) to a patient with an ileostomy?
- Avoid
- o Water-insoluble fiber (dietary fiber)
- o Stoma blockers: fibrous foods, nuts, seeds, skins,
- popcorn
- o Gas forming foods: asaparagus, beans, cabbage fam,
- cucs, melon, onions, milk, carbonation
- o Odor producing foods: asparagus, eggs, fish, garlic,
- onions, green pepper, highly spiced foods
- Encourage
- o Viscous fiber: oatmeal, applesauce, bananas, rice)
- o Adequate fluid, Na, K
- o Chew foods well to avoid clogging stoma
- o Odor reducing foods: buttermilk, cranberry juice,
- parsley, yogurt
- o Vit supps if needed
- o Low fat diet if steatorrhea (losing fat in stool)
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What foods should someone on a low bacteria diet avoid? What ppl should be on this diet?
- • Limit foods containing significant numbers of
- gram-negative bacilli, yeasts or molds (or cook well)
- • Avoid rare or medium-cooked meats
- • Avoid deli meats
- • Avoid raisins and nuts
- • Avoid raw fruits and vegetables
- • Avoid yogurt with active cultures
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Why might use of herbal supplements be a concern
in cancer patients? (3)
- • Affects on blood clotting, or can cause blood thinning
- (Chemotherapy can cause low platelet counts)
- • Contamination, potential for (Patients receiving chemotherapy are immunocompromised b/c may be neutropenic)
- • High dose anti-oxidants (May decrease effectiveness of chemotherapy or radiation)
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In general, the nutritional implications of surgical interventions of:
Gastric cancer:
Pancreatic cancer:
Small intestine:
Liver cancer:
Kidney cancer:
- Gastric cancer: can result in dumping syndrome
- Pancreatic cancer: problems with digestion; glucose metabolism
- Small intestine: absorptive problems
- Liver cancer: many metabolic abnormalities based on functions
- Kidney cancer: effects on nutrients eliminated by kidneys and hormones derived from kidneys
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General guidelines in management of ileostomy (6)
- Individualize based on tolerance and ostomy output
- Avoid water-insoluble (dietary) fiber
- Encourage viscous fiber (oatmeal, applesauce, bananas, rice)
- Consume adequate fluid, sodium and potassium to replace losses
- Chew all foods well
- Avoid foods that can block stoma: fibrous foods, nuts, seeds, skins, popcorn
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