HUN4445 Exam3 Cancer

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  1. What are the dietary factors that may initiate carcinogenesis? (4)
    • Aflatoxin
    • Heterocyclic Amines (HCA) & Polycyclic Aromatic Hydrocarbons (PAH)
    • Nitrosamines
    • Alcohol
  2. 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
  3. ____ and ____ protect lipids and cell membranes
    ____ protects cytosol and aqueous body fluids
    • Tocopherols & carotennoids
    • Ascorbic acid
  4. Antioxidant compounds and their food sources:
    Beta Carotene
    Vitamins A and E
    Lycopene –
    • Beta Carotene: orange fruits & veg
    • Vitamins A and E:
    • Selenium: bread, meat
    • Lutein: collards, spinach, kale
    • Lycopene: tomatoes, watermelon
    • Catechins: green tea
  5. 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
  6. 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
  7. 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 
  8. Why
    might a cancer patient have difficulty maintaining his/her nutritional
    status? (9)
    • Pain
    • Mucositis
    • Xerostomia
    • Nausea
    • Vomiting
    • Taste changes
    • Early satiety
    • Fatigue
    • Diarrhea
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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

  14. 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
  15. Why are glucocorticoids given?
    -Suppress the immune system & are anti-inflammatory agents (given after organ transplants to prevent body from attacking it)
  16. 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
  17. 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
  18. 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
  19. 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
  20. Diff b/w colostomy and ileostomy
  21. colostomy- lose lower part of intestine, ileostomy- lose the whole colon
  22. 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
  23. 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
  24. 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)
  25. 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
  26. 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)
  27. 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
  28. 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 
Card Set:
HUN4445 Exam3 Cancer
2012-11-19 18:16:19
HUN4445 Exam3 Cancer

HUN4445 Exam3 Cancer
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