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Dn. Asma Abdul Rehman

Clinical Dietitian/Nutritionist
lecturer (Nutrition Dept)
Mphil(HND), UAF
SIH, RIC
Medical Nutrition Therapy For Cancer
 Cancer
• Cancer is a disease in which some of the body’s
cells grow uncontrollably or abnormal growth and
spread to other parts of the body.
• Cancer can start almost anywhere in the human
body, which is made up of trillions of cells.

• Normally, human cells grow and multiply (through

a process called cell division) to form new cells as
the body needs them.
• When cells grow old or become damaged, they die,
and new cells take their place.
 Malignant
Cancerous
spread into or invade
Tumor
A tumor is an abnormal
growth of body tissue Benign
Noncancerous
do not spread into, or
invade

Cancerous tumors spread into, or invade, nearby tissues and can

travel to distant places in the body to form new tumors (a process
called metastasis)
 Types of Cancer
Carcinomas
Sarcomas
A carcinoma begins in the skin or the
A sarcoma begins in the tissues that
tissue that covers the surface of
support and connect the body. A
internal organs and glands. Examples
sarcoma can develop in fat, muscles,
of carcinomas include prostate
nerves, tendons, joints, blood vessels,
cancer, breast cancer, lung cancer,
lymph vessels, cartilage, or bone
and colorectal cancer.

Leukemia's Lymphomas
Leukemia is a cancer of the blood. Lymphoma is a cancer that begins in
The 4 main types of leukemia the lymphatic system.
are acute lymphocytic There are 2 main types of
leukemia, chronic lymphocytic lymphomas: Hodgkin
leukemia, acute myeloid leukemia, lymphoma and non-Hodgkin
and chronic myeloid leukemia. lymphoma.
 According to WHO
• Cancer is a leading cause of death worldwide,
accounting for nearly 10 million deaths in 2020,
or nearly one in six deaths.

• The most common cancers are breast, lung, colon

and rectum and prostate cancers.

• Around one-third of deaths from cancer are due

to tobacco use, high body mass index, alcohol
consumption, low fruit and vegetable intake, and
lack of physical activity.
 Causes of
Cancer

External Internal
causes causes

Biological Physical Chemical Genetics

 Pathogenesis
• Carcinogenesis is the origin or development
of cancer.
• Oncology is the study of all forms of cancer

Genes involved in cancer

1. Proto-oncogenes
2. Tumor suppressor genes
3. DNA repair genes
• Proto-oncogenes are involved in normal cell growth and
division. However, when these genes are altered in certain
ways or are more active than normal, they may become
cancer-causing genes (or oncogenes), allowing cells to
grow and survive when they should not.
• Tumor suppressor genes: are the opposite of oncogenes;
these genes become deactivated in cancer cells.
• Adenomatosis polyposis coli (APC), breast cancer types
BRCA1 and BCRA, and tumor suppressor p53, a protein
that is involved in preventing cancer.
• DNA repair genes are involved in fixing damaged DNA
 Phases of Carcinogenesis
• Carcinogenesis is a biologic, multistage
process that proceeds on a continuum in three
distinct phases:
Initiation
Promotion
Progression (tumor formed)
 Nutrition and Carcinogenesis
• World Cancer Research Fund indicate a cancers
that occur in higher-income countries are due to:
Poor nutrition
Physical inactivity
Excess weight

• Some Dietary Carcinogens are naturally

occurring pesticides or herbicides. Food
preparation and preservation methods also may
contribute to dietary carcinogen ingestion.
• Dietary enhancers of carcinogenesis may be the
saturated fat in red meat or the polycyclic
aromatic hydrocarbons (PAHs) that form on the
surface of meat when grilling at high
temperatures.
• Dietary inhibitors of carcinogenesis include
antioxidants (e.g., vitamin C, vitamin A and the
carotenoids, vitamin E, selenium, zinc) and
phytochemicals (biologically active components
of plants)
 Smoked, Grilled, and Preserved
Foods
• Nitrates are added as preservatives to processed
meats.
• Nitrates can be readily reduced to form nitrites,
which in turn can interact with dietary substrates
such as amines and amides to produce nitroso
compounds (NOCs):
• Nitrosamines
• Nitrosamides, which are known mutagens and
carcinogens.
• Nitrates or nitrites are used in smoked, salted, and
pickled foods.
• NOCs are also produced endogenously in the
stomach and colon of people who eat large
amounts of red meat.
• Cooking meat at high temperatures over an open
flame (400° F or more) can cause the formation of
polycyclic aromatic hydrocarbons (PAHs) and
heterocyclic amines (HCAs).
• PAHs have shown clear indications of
mutagenicity and carcinogenicity.
• Normal roasting or frying food does not
produce large amounts of PAHs
• The source of the flame can also influence
PAH production; charcoal grilling promotes
the most, followed by flame gas, and finally
oven grilling
 Toxic Environments
• In fact, an estimated 6% of cancers diagnosed
each year (2% from environmental exposures
and 4% from occupational exposures)
• Outdoor air pollutants such as nitrogen
dioxide, ozone, and carbon monoxide.
• Exposure to heavy metals, pesticides,
herbicides, and occupational exposures also
may be noted.
 Toxicity from Bisphenol A
• Bisphenol A (BPA) is an industrial chemical
used since the 1960s in the manufacturing of
many hard plastic bottles and the epoxy linings
of metal-based food and beverage cans.
• It is also an ingredient in the production of
epoxy resin used in paints and adhesives.
 Cancer and Obesity Relation
• Obesity and high simple carbohydrate intakes
potentially increase insulin resistance and raise
circulating insulin levels.
• Obesity, age, hyperglycemia, and the incidence of
metabolic syndrome play a role in the circulating levels
of insulin-like growth factor-1 (IGF-1), a potentially
cancer-causing compound.
• IGF-1 is a polypeptide secreted primarily by the liver
and plays a key role in normal growth and
development.
• It can promote the development and progression of
prostate, breast, lung, and colon cancer. It has been
hypothesized to stimulate the growth of cancer cells
and inhibit their death.
 Medical Diagnosis and Staging of
Cancer
• According to the ACS, the following early warning
signs and symptoms of cancer are described using the
acronym “CAUTION”:
• Change in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in breast or elsewhere
• Indigestion or difficulty in swallowing or chewing
• Obvious change in a wart or mole
• Nagging cough or hoarseness
• Laboratory evaluation is composed of analysis of blood,
urine, and other body fluids.
• In particular, oncologists evaluate
Tumor markers (alpha-fetoprotein [AFP]
Cancer antigen [CA] 125, CA 19-9
Carcino-embryonic antigen [CEA]

Imaging Studies for Cancer Diagnosis and Disease

Monitoring
CT scan
MRI
PET
• Cancer staging is most frequently described as
stage I, II, III, or IV
• Stage I being the least amount of disease and
stage IV being the most advanced.
• Tumor-node-metastasis (TNM) staging system
is also commonly used by oncologists. T stands
for the size of the tumor, N stands for nodes or
whether it has spread into lymph nodes, and M
stands for metastasis, or whether the cancer has
spread to distant organs
 Medical Treatment
• Anti-neoplastic therapy (e.g., chemotherapy,
biotherapy, or hormonal therapy), radiation
therapy, and surgery used alone or in combination
with other cancer therapies.
• Chemotherapy is the use of chemical agents or
medications to systematically treat cancer. These
agents interfere with the steps or phases of the
cell-cycle, specifically with the synthesis of DNA
and replication of cancer cells. The basic five
phases of cell reproduction in normal and
malignant cells are the following:
• Hormonal therapy is systemic therapy used for the
treatment of hormone-sensitive cancers (e.g., breast,
ovarian, prostate) by blocking or reducing the source of
a hormone or its receptor site.
• Radiation oncologists work in the area of therapeutic
radiation therapy, which uses high-energy (ionizing
radiation) in multiple fractionated doses, or radioactive
chemicals to treat cancer.
• Surgery involves the surgical removal of cancerous
tissue. Response to cancer treatment is defined as
complete or par
 Medical Nutrition Therapy
Nutrition Screening
• Malnutrition Screening Tool (MST) is a
reliable nutrition screening tool.
Score >2 (at risk of malnutrition) → refer
to dietitian
Score < 2 (not at risk of malnutrition) →
re-screened weekly / next attending clinic to
detect changes.
Medical Nutrition Therapy
 Protein
• Protein needs for a catabolic client may be 1.2 g/kg/day
• Daily protein requirements generally are calculated
using actual body weight rather than ideal body weight
Fluid
• Adults without renal concerns is 20 to 40 ml/kg
• Another method to assess fluid needs recommends 1
ml/1 kcal of estimated calorie needs
 Fruits and Vegetables
• Fruit intake is protective against cancers of the mouth,
pharynx, larynx, esophagus, cervix, lung, and stomach.
• Non-starchy vegetables, such as spinach, tomatoes, and
peppers, probably provide protection against mouth,
pharynx, larynx, and esophageal cancers all vegetables, but
particularly green and yellow.
• Anti-carcinogenic agents found in fruits and vegetables
include antioxidants such as vitamins C and E, selenium,
and phytochemicals.
• Phytochemicals include carotenoids, flavonoids,
isoflavones, lignans, organosulfides, phenolic compounds,
and monoterpenes.
 Fruits and Vegetables
• These substances have complementary and
overlapping mechanisms, including the
induction of detoxification enzymes, inhibition
of nitrosamine formation, provision of
substrate for formation of chemotherapy
agents, dilution and binding of carcinogens in
the digestive tract, alteration of hormone
metabolism, and antioxidant effects
 Coffee and Tea
• Coffee contains various antioxidant and phenolic
compounds, some of which have been shown to have
anticancer properties
• Tea is also a good source of phenols and antioxidants.
Green tea is made from leaves that have been cooked,
pressed, dried and not roasted.
• Because of this, green tea, more so than black tea,
contains catechins that possess biologic activity with
antioxidant, anti-angiogenesis, and anti-proliferative
properties that are relevant to cancer prevention
Nutrition Intervention Strategies
Anorexia and Alterations in Taste and Smell
• Sometimes even before diagnosis, and then
throughout cancer treatment, individuals may
report anorexia, early satiety, and decreased
food intake. Alterations in taste and smell are
common problems
• Nutrition interventions that decrease the aroma
of foods, such as serving foods cold instead of
hot, may be helpful
 Cancer Cachexia
• Cancer cachexia and is characterized by progressive
weight loss, anorexia, generalized wasting and
weakness, immunosuppression, altered basal metabolic
rate, and abnormalities in fluid and energy metabolism.
There is also increased loss of adipose tissue, which is
related to an increased rate of lipolysis, rather than a
decrease in lipogenesis.
• Increased levels of lipid-mobilizing factor and
proteolysis-inducing factor secreted by tumor cells will
lead to increased loss of fat and muscle mass
 Diarrhea
• Diarrhea is a common side effect of certain chemotherapy
agents. Left unmanaged, it can lead to depletion of fluids,
electrolytes, malnutrition, and even hospitalization. The
intestinal mucosa and digestive processes can be affected,
thus altering digestion and absorption to some degree.
Protein, energy, and vitamin metabolism may be impaired.
Nausea and Vomiting
• Nausea and Vomiting Chemotherapy induced nausea and
vomiting are commonly classified as anticipatory (occurs
before receiving treatment), acute (occurs within the first 24
hours after receiving treatment), or delayed (occurs 1 to 4
days after treatment)
 Oral Changes
• People with altered taste acuity (dysgeusia, hypogeusia,
ageusia) may benefit from increased use of flavorings and
seasonings during food preparation. Meat aversions may
require the elimination of red meats, which tend to be strong
in flavor, or the substitution of alternative protein sources.
Mucositis
• Oral mucositis, an inflammation of the mucous membranes
lining the oropharynx and esophagus, is a common side
effect of some types of chemotherapy. Individuals with oral
or esophageal mucositis and strong-flavored, acidic, or
spicy foods also should be avoided
 Drug Nutrients Interaction
• Individuals with certain types of lung cancer who
are being treated with pemetrexed (Alimta)
require vitamin B12 (often by injection) and folic
acid supplementation throughout the duration of
their therapy to avoid significant anemia
associated with this chemotherapy agent.
• A severe hypertensive event is possible when
tyramine-rich foods and beverages are consumed
while taking procarbazine (Matulane), a
chemotherapy agent commonly used to treat brain
cancer
Role of Moringa Super Food
 ACS Recommendations for Cancer
Patients
• High-calorie, High-protein foods
• Be physically active
• A healthy eating pattern includes:
 Foods that are high in nutrients in amounts that help
you get to and stay at a healthy body weight
 A variety of vegetables – dark green, red and orange,
fiber-rich legumes (beans and peas), and others
 Fruits, especially whole fruits in a variety of colors
 Whole grains
• Eating pattern limits or does not include:
Red and processed meats
Sugar-sweetened beverages
Highly processed foods and refined grain
products
 According to National Cancer
Institute (NCI)
 Eat small, frequent meals
 Eat high-protein and high-calorie foods
 To avoid nausea and improve your appetite, do not
drink liquids with your meals
 Try to eat when you are feeling the best, no matter what
time of day
 Use meal substitutes, such as high-calorie, high-protein
drinks, when you do not feel like eating
 Try to increase your appetite through light
 Eat foods at room temperature
 Avoid spicy foods or foods with strong odors
Done with Today Session