dietary management of cancer

1. CANCER AND DIETARY
MANAGEMENT
by
Dev Ram SUNUWAR
M.Sc. Nutrition and Dietetics1

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. OUTLINE
Introduction
Epidemiology- global, national scenario
Classification
 Risk factor
Pathophysiology
Sign and symptoms
management
Conclusion
3

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. 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. 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. WHO- CANCER COUNTRY PROFILE 2014
NEPAL
7

8. 8

9. 9

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. 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. 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. 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. 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

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. 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. 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. 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.
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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. 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. 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. 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. 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. 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. 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. 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. 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 .
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29. STAGING...
Cancer staging is carried out on the basis of....
 Size of tumor
 Invasion
 Lymph nodes
 Metastasis
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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. 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. 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)
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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
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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. 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. 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.  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. 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. 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. 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
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