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Cancer and dietary management

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dietary management of cancer

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Cancer and dietary management

  1. 1. CANCER AND DIETARY MANAGEMENT by Dev Ram SUNUWAR M.Sc. Nutrition and Dietetics1
  2. 2. OBJECTIVE At the end of the presentation, participants will be able to  Know about the cancer and its progression  Know the epidemiological fact in global regional and national context  Learn the risk factor of cancer and its symptoms  Know how to cancer can be prevented and its dietary management 2
  3. 3. OUTLINE Introduction Epidemiology- global, national scenario Classification  Risk factor Pathophysiology Sign and symptoms management Conclusion 3
  4. 4. WHAT IS CANCER? Cancer is a large group of diseases (over 200) characterized by uncontrolled growth and spread of abnormal cells. 4 American Cancer Society, Cancer Facts and Figures 2005
  5. 5. CANCER ???  Division – uncontrolled cell division  Growth – formation of a lump (tumour) or large numbers of abnormal white cells in the blood  Mutation – changes to how the cell is viewed by the immune system  Spread – ability to move within the body and survive in another part 5
  6. 6. KEY FACTS Cancer is a leading cause of death worldwide, accounting for 8.8 million deaths in 2015. The most common causes of cancer death are consists of:  Lung (1.69 million deaths)  Liver (788 000 deaths)  Colorectal (774 000 deaths)  Stomach (754 000 deaths)  Breast (571 000 deaths) (WHO) 6
  7. 7. WHO- CANCER COUNTRY PROFILE 2014 NEPAL 7
  8. 8. 8
  9. 9. 9
  10. 10. CLASSIFICATION OF CANCER Type Tissue or cell of origin example carcinoma Endoderm or ectoderm Epithelial lining of gout (e.g. adenocarcinoma of colon) or brocnchus (e.g. squamous cell) or small cell carcinoma of bronchus sarcoma mesoderm Osteosarcoma, fibrosarcoma leukemia White blood cell Acute lymphoblastic leukaemia Lymphoma Monocyte, macrophage Hodgkin’s disease Adenomas Tumours that come from glandular tissue thyroid, the pituitary gland the adrenal gland. They are often benign. 10 B.Srilakshi ‘dietetics’)
  11. 11. RISK FACTORS  Heredity  Environmental factors  Ionising radiation- X-ray, gamma ray, radioactive subsatnces  Chemical substances- cause mutation. Benzene and asbestos, tobacco  Dietary factors- may cause cancer by direct carcinogens or carcionogens may be produced by cooking. 11
  12. 12. FOOD RELATED CAUSE TO CANCER Type of cancer Food items Breast cancer, premenopause Alcoholics drinks Breast cancer, postmenopause Alcoholics drinks, body fatness, sedentary living Colon, rectum cancer, kidney cancer Red meat, processed meat, barbecuing meat, high intake of fat, body fatness, abdominal fatness, sedentary living Lung Arsenic in drinking water Stomach, liver, mouth, pahrynx, larynx, oesophagus, pancreas High intake of alcohol, body fatness Prostrate Diet in high calcium Folate deficiency Cervical cancer 12 B.Srilakshi ‘dietetics’)
  13. 13. FOOD RELATED CAUSE TO CANCER Vitamins and minerals •Low blood carotonoids levels cause lung cancer •Low dietary vitamin C cause oro-phryangeal, stomach and esophgeal cancer •Low vitamin E cause lung, cervix and colorectal cancer •Selenium and zinc deficiency may also increase risk of cancer Nitrates Cause nasophryngeal, stomach and colorectal cancer aflatoxins Cause liver cancer Energy dense foods, sugar drink fast foods. Cancer in any part of the body 13 B.Srilakshi ‘dietetics’)
  14. 14. ENVIRONMENTAL RISK FACTOR CONTD…  Estrogens- breast and endometrial cancer.  Viruses- hepatitis-B virus in human primary liver cancer, human papilloma virus and epstein barr virus are considered oncogenic.  Stress- influence the integrity of the immune system and nutritional status  Age- developing colorectal cancer increase with age 14
  15. 15. 15
  16. 16. SYMPTOMS OF CANCER Oral cancer Ulcers, white or red patches inside the oral cavity or difficulty in swallowing Lung/throat cancer Persistent cough, chest pain, blood in sputum, shortness of breath, weight loss, loss of appetite, hoarseness Stomach cancer Indigestion, heartburn, abdominal pain, bloating of stomach, loss of appetite, tiredness, diarrhoea. Constipation Colon cancer Change in bowel habits, malena Breast cancer A lump in the breast or under arm area, change in shape size, color of breast, discharge from the nipple Cervical/uterine cancer Unusual vaginal discharge, pain in pelvic area Kidney cancer Hematuria, fevers, weight loss, pain in left loin, anemia, high BP Bladder cancer Frequent and painfulurine, Prostrate cancer Urination problem Melanoma Change in size, shape or color of a wart 16
  17. 17. MANAGEMENT OF CANCER 1. Prevention: Measures known to reduce the risk of cancer:  Avoiding smoking or exposure to tobacco smoke  Avoiding occupational carcinogens (for example, asbestos)  Avoiding prolonged exposure to sunlight without sunscreen protection  Avoiding excessive alcohol intake  Avoiding use of hormone therapy (for example- estrogen and progesterone ) for symptoms of menopause 17
  18. 18. MANAGEMENT OF CANCER.. Measures that may reduce the risk of cancer:  Limiting intake of high-fat foods, particularly from animal sources (for example, high-fat meats and whole-fat dairy products)  Limiting intake of processed meat  Increasing intake of fruits and vegetables  Increasing intake of whole-grain foods  Being physically active  Keeping weight below the obese level 18
  19. 19. DIETARY MANAGEMENT Objective of nutritional therapy  To meet the increased metabolic demands of the disease and disease and prevent catabolism as much as possible  To alleviate symptoms resulting from the disease and its treatment through adaptation of food and the feeding process. 19
  20. 20. ENERGY Calorie requirements are  20-25kcal/kg for non ambulatory or sedentary patient  30-35kcal/kg for slightly hypermetabolic, weight gain/anabolism  40-45kcal/kg for hypermetabolic or severly stressed patient, signicicant malabsorption. 20
  21. 21. PROTEIN Additional protein is required for regenaeration, healing and rehabilitation.  0.8-1.0g/kg- normal maintenance level  1.5-2.5g/kg if increased protein demands exist. E.g. protein losing enteropathy, hyper metabolism or extreme wasting 21
  22. 22. VITAMINS AND MINERALS  Optimal intake of vitamins and minerals are recommended  Vitamin D(400-800IU) helps to protect against several types of cancer including breast cancer. 22
  23. 23. VITAMINS AND MINERALS  Optimal intake of vitamins and minerals are recommended  Vitamin D(400-800IU) helps to protect against several types of cancer including breast cancer. 23
  24. 24. BENEFICIAL EFFECTS OF NUTRIENT ANTIOXIDANTS Nutrient Beneficial effect Beta carotene Reduced risk of various cancers especially lung cancer and also stomach, cervix, oesophageal Vitamin C Reduced risk of upper GI tarct, cervix cancer, cardiovascular disease. Vitamin E Significant decreases in the risk of oral and pharyngeal cancer, CVS Selenium Reduced risk of esophageal and stomach cancer 24
  25. 25. MANAGEMENT OF CANCER CONTD… 2. Screening , self examination and medical history:  Some types of cancer -- such as those of the skin, breast, mouth, testicles, prostate, and rectum -- may be detected by routine self-exam or other screening measures before the symptoms become serious.  Laboratory studies of blood, urine, and stool can detect abnormalities that may indicate cancer 25
  26. 26. MANAGEMENT OF CANCER CONTD… 3. Diagnosis, staging and Treatment  When a tumor is suspected, imaging tests such as X-rays, computed tomography (CT),magnetic resonance imaging (MRI), ultrasound, and fiber- optic endoscopy examinations help doctors determine the cancer's location and size 26
  27. 27. DIAGNOSIS…  To confirm the diagnosis of most cancers , a biopsy needs to be performed in which a tissue sample is removed from the suspected tumor and studied under a microscope to check for cancer cells. 27
  28. 28. STAGING  If the diagnosis is positive (cancer is present), other histopathological tests are performed to provide specific information about the cancer.  This essential follow-up phase of diagnosis is called staging  It helps the doctors to evaluate the prognosis of the patient and to choose the appropriate treatment . 28
  29. 29. STAGING... Cancer staging is carried out on the basis of....  Size of tumor  Invasion  Lymph nodes  Metastasis 29
  30. 30. STAGES OF CANCER ( EG. BOWEL) 30 Stage 0: cancer cells - within the bowel lining. little risk of spread ( carcinoma in situ) Stage I: cancer grown through the inner lining up to muscle wall, but no further. Stage II: cancer has grown through the outer covering of the bowel wall Stage III: Cancer has spread to the lymph nodes Stage IV: Cancer that has spread to other organs such as lung, liver.
  31. 31. TNM STAGING  T ((0),1-4): size or direct extent of the primary tumour  N (0-3): degree of spread to regional lymph nodes  N0: tumour cells absent from regional lymph nodes  N1(1 to 3 lymph nodes), N2 (4 or more)  M (0/1): presence of metastasis  M0: no distant metastasis  M1: metastasis to distant organs (beyond regional lymph nodes) 31
  32. 32. MANAGEMENT OF CANCER CONTD… 4. Treatment and cure:  Surgery  Radiation therapy  Chemotherapy: General complications: GI effects - Nausea , vomiting Bone marrow effects - Reduced RBC, WBC and Platelets Hair follicle effects - Hair loss(Hormone therapy, Immunotherapy, etc also are carried out acc. to need) 32
  33. 33. MANAGEMENT OF CANCER CONTD… 5. Palliative care :  It includes action to reduce the physical, emotional, spiritual and psychosocial distress experienced by people with cancer.  Primary goal _ to improve the person’s quality of life.  People at all stages of cancer treatment - to provide comfort 33
  34. 34. A 25 years old male patient has presented with a known diagnosed case of Ca.nasopharynx in TUTH dietetics OPD for diet consultation. He is 5 feet 2 inch tall and 45kg weight. What kind of diet plan will you adopt ? Patients weight = 45kg Height = 5’.2” i.e.157.8cm IBW= 51.82kg BMI = 18.21 Energy requirement= 35 * 51= 1785kcal 34
  35. 35. MENU PLANNING FOR 1800KCAL Nutrient distribution Carbohydrate = 280gm (62%) Protein = 67.5gm(15%) Fat = 47gm(23%) Serving distribution Total serving = 23 Carbohydrate =11.5 Protein = 8 Fat = 2 Vitamins/minerals= 1.5 35
  36. 36. Food groups List Unit Protein fat Carbohydr ate CHO 1 10 20 - 180 2 1.5 - - 27 protein 3 2 18 12 - 4 3 12 15 18 5 3 18 3 39 fats 6 2 - 18 - Vitamins/mi nerals 7 1.5 7.5 1.5 19.5 36
  37. 37.  Protein= 75.5gm(16%)  Fats= 50gm(24%)  Carbohydrate 285gm(60%) Breakfast ( 07:00-0800am) Milk 1 glass (130ml) Egg 1 pcs (50gm) Bread/biscuits 4 slice(120gm) Launch(10:11:00am) Rice 2 glass (240gm) Dal 1 cups Vegetables 1 glass Meat 4-5pcs Milk/yoghurt 1 glass Green salad few 37
  38. 38. Mid afternoon (01:00-02:00pm) Fruits 1 medium Snacks (03:00-04:00pm) Pulses/legumes 1 glass and egg white 1 pcs Bread 1pcs and vegetables 1/2 glass Dinner (07:00-08:00pm) Bread 3 slice or rice 1 and half glass Dal 1 glass Vegetables 1 glass Yoghurt/milk 1 glass Meat 3-4 pcs Green salad few 38
  39. 39. CONCLUSION  Cancer is a disease of Division, growth and spread  It has a number of causes many of them are preventable  The survival of the patient is determined by the stage of the disease, the earlier the detection or the smaller the tumour the better the survival 39
  40. 40. 10 Rules to Avoid Cancer 2. Don’t smoke. 3. Don’t smoke. 4. Avoid exposure to other known carcinogens, including aflatoxin, asbestos and UV light. 6. Eat fresh fruit and vegetables several times a day. 7. Be physically active and avoid obesity. 8. Have vaccination against, or early detection/treatment of, cancer causing chronic infections. 9. Have the right genes. 10. Have good luck !!!!! 5. Enjoy a healthy diet, moderate in calories, salt and fat, and low in alcohol. 1. Don’t smoke 40
  41. 41. 41
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