Cancer

Clinical Nutrition

Donna Plummer EdD RD

 Objectives
• Students will be able to define cancer
• Students will be able to state the risk factors for various types of cancers
• Students will be able to describe behavior interventions to reduce risk of
cancer
• Students will be able to describe nutrition intervention for the treatment of
cancer
 What is Cancer?
• Cancer refers to diseases in which abnormal cells divide out of control and
are able to invade other tissues.
• Cancer cells can spread to other parts of the body through the blood and
lymph systems
• There are more than 100 different types of cancer.
• Most cancers are named for the organ or type of cell in which they start—
for example, lung cancer begins in the lung
 Epidemiology of Cancer
• American cancer society predicts lifetime risk for developing CA in the
US
• Slightly less than half of males and slightly more than 1/3 of females
• Annually ¼ of all deaths and the second most common cause of death in
US
• I/3 of all cancer deaths can attributed to nutrition and lifestyle behavior
(poor diet, physical inactivity, overweight and obesity, tobacco)
 Top 10 causes of
death in the US
• 2017 and 2018
• CDC website
 Carcinogenesis
• The development of cancer
• Oncogenes
• Alter genes that promote growth and inhibit cell apoptosis
• Tumor suppression genes
• Becomes deactivated in cancer cells which lead to unregulated cell growth
 Phases of Carcinogenesis
• Carcinogen – physical, chemical or viral agent that induces cancer
• Initiation
• Transformation of cells by interaction with chemicals, radiation, virus. May remain dormant for years
• Promotion
• Damaged cells begin to multiply. Not regulated by the body’s regulatory mechanism
• Progress
• Tumor cells aggregate and grow into fully malignant tumor/neoplasm (new abnormal tissue with no
useful function)
 Death rate
• Death rate from cancer has decreased due to early detection and improved
treatments
• To some extent is now threated as chronic disease
 Sources of dietary carcinogens
• Some dietary carcinogens are naturally occurring herbicides and
pesticides produced by the plants or self reservation.
• Pesticides and herbicides added during farming
• Dietary saturated fats in red meats
• Food preparation and preservation methods
• Polycyclic aromatic hydrocarbons (PAH) formed when grilling meats
 Dietary Carcinogen Inhibitors
• Antioxidants
• Vit C
• Carotenoids
• Vit E
• Selenium
• Zinc
• Phytochemicals
• One potential mechanism of action of anticancer phytochemicals is that they regulate cellular signal
transduction pathways and hence affects cancer cell behaviors such as proliferation, apoptosis, and invasion.
 Table of phytochemical
• Strengthening the immune system
• Reducing inflammation  
• Preventing DNA damage and helping DNA repair
• Slowing cancer cell growth
• Regulating hormones
• Preventing damaged cells from reproducing 
 Inflammation
• Cancers associated with chronic
inflammation
 Inflammation
• Increases risk of the metabolic syndrome, which includes the triad of
hypertension, hyperglycemia and dyslipidemia; type 2 diabetes; NAFLD;
hypertension; cardiovascular disease (CVD); chronic kidney disease;
various types of cancer; depression; neurodegenerative and autoimmune
diseases; osteoporosis and sarcopenia
Effects of chronic inflammation
• Several causes of low-grade systemic chronic inflammation
(SCI) and their consequences have been identified. As
shown on the left, the most common triggers of SCI (in
counter-clockwise direction) include chronic infections,
physical inactivity, (visceral) obesity, intestinal dysbiosis,
diet, social isolation, psychological stress, disturbed sleep
and disrupted circadian rhythm, and exposure to xenobiotics
such as air pollutants, hazardous waste products, industrial
chemicals and tobacco smoking. As shown on the right, the
consequences of SCI (in clockwise direction) include
metabolic syndrome, type 2 diabetes, non-alcoholic fatty
liver disease (NAFLD), cardiovascular disease, cancer,
depression, autoimmune diseases, neurodegenerative
diseases, sarcopenia, osteoporosis and immunosenescence.
 Inflammatory markers
• Include C-reactive protein
• Cytokines – interleukin 1, tumor
necrosis factors
• Stimulate by cortisol and excess
omega 6 fatty aids
Reactive Oxygen Species (ROS)/Free radical

• Produced as a result of normal cell function – energy production

• Can damage DNA
• Can damage phospholipid bilayer
• Increase cancer occurrence
• The concentration of free radicals depends on their production and their
clearance.
• Clearance of ROS is controlled by various enzymes and non-enzymatic
antioxidant such as vitamins E, A, C, Se, Zn and glutathione (make by liver)
 Alcohol
• Alcohol is associated with increase cancer risk of oral cavity, phrynx,
esophagus, liver, colon, rectum stomach, pancreas, gallbladder, liver and
breast
• Negatively affect outcome of other cancers
• Concurrent tobacco and alcohol use greatly increase risk of upper GI and
respiratory cancers
 Energy intake and body weight
• Body weight is the second most important lifestyle factor for risk of cancer
• 70.2% of US population are overweight or obese
• Positive association between body weight and cancers of mouth, larynx,
pharynx, esophagus, pancreas, gallbladder, breast (postmenopausal)
endometrium, kidney, colon, rectum gastric cardia, liver, ovary, thyroid,
multiple myeloma, meningioma
• Adipose tissue is active. Produces estrogen, leptin, proteins that increase
insulin levels and other hormones that increase inflammation
 Exercise
• The longer the person is over weight the greater the risk of caner
• Physical activity helps with weight management
• Helps with management of blood glucose levels
• Increase myosin production that is anti -inflammatory
 Dietary factors
• Fats
• Eating more omega 3 fats in relation to omega 6 fatty acids, potentially reduces risk
by reducing inflammation, reduces cell proliferation, and angiogenesis while
increasing cell apoptosis
• Omega 3 sources - Fatty fish, walnuts, flaxseed
• Sugar
• High glycemic foods may increase risk by increasing IGF-1
 Dietary Factors
• Proteins
• Preserved meats smoking, salting , chemical preservatives – nitrates from nitrites interact
with dietary amines to produce nitrosamine and nitrosemides which are know
carcinogens
• Grilling meats at temps over 400 degrees produces polycystic aromatic hydrocarbons –
increase risk of cancer. Open flame with dripping of fat on flame from charcoal, beef,
chicken
• Organic and genetically modifies
• Study says not difference !? Plants that make its own herbicide.
 Chemical exposure
• 1976 toxic substance controlled act requires health and safety information.
However many products were grandfathered in
• 248 compounds have been identified as carcinogenic
• Exposure to chemicals through water air, food and beverages
• Agriculture workers exposed to pesticides have higher rate of cancer
• Bisphenol A (BPA) in plastic water bottles, paints and adhesives
• FDA says it should not cause cancer as it is rapidly removed from the body
 BPA expression in rat offspring
• https://neuroepic.mcdb.lsa.umich.
edu/wp/14-bpa-not-a-gouti-thing-f
or-you/
• The good news is diets high in
methyl donors such as folic acid.
Methyl donors, such as leafy
green vegetables, citrus fruits,
beans, and pasta, repress
expression
 Chemoprevention
• Polyphenol in fruits, vegetables, green tea, curcumin (turmeric),
resveratrol in red grapes and berries, cinnamon, coffee ….. Have the
ability to modulate epigenetic alterations in cancer cells
• Antioxidants and bioactive compounds
• Vitamin D
• Coffee and tea
• Soy and phytoestrogen protects against breast cancer especially if
consumed early in life
 Chemoprevention cont’d
• Vegetarian diet protective against cancer through anti-inflammatory effect,
changes in gene expression
• Physical activity
• Important part of cancer prevention and treatment
• Helps regain and maintain muscle, strength, flexibility, relives symptoms
of stress, strengthen immune system, regulate sex hormone, insulin and
prostaglandins
 Treatment Goals

• Cure
• Control
• Palliate
 Nutrient Need
• Energy
• 25-35kcal/kg
• Protein
• 1.2-2.0kal/kg when stressed
• Fluid
• 1-1.5ml/kg
• Micronutrients
• Standards MVI with mineral supplement may be needed due to poor PO intake
 Alteration in protein metabolism
• Increase protein breakdown and decrease protein synthesis
• Cancer cachexia – progressive weight loss, poor appetite, muscle wasting,
immunosuppression.
• Caused by cytokines produces by the cancer cells or the immune system
• Pro-inflammatory cytokines – tumor necrosis factor alpha and beta, interleukin 1 and 6,
interferon
• Juven contains the amino acids glutamine and arginine in addition to beta-hydroxy-beta-
methylbutyrate (HMB). This agent may promote muscle protein synthesis and increase
muscle mass
 Effect of loss of lean body mass
Loss of lean body mass Associated mortality
10% Decreased immunity 10%
Increased infections
20% Decreased healing, 30%
Weakness, infection
30% Too weak to sit, pressure ulcers , 50%
pneumonia
40% Death 100%
 Effect of Juven
• Increase in weight and LBM
• https://touchoncology.com/wp-content/uploads/sites/2/2015/07/private_art
icles_1203_pdf_onco67371.pdf
 Alteration in energy metabolism
• Tumor cells has a high demand for glucose and high rate of anaerobic
metabolism. Producing lactic acid
• Glucose intolerance/resistance
• Increased fat breakdown
• Overfeeding increase rate of cancer cells growth
 Ketogenic diet
• https://www.sciencedirect.com/science/article/pii/S2212877819304272
• The ketogenic diet, a high-fat, low-carbohydrate diet with adequate
amounts of protein, appears to sensitize most cancers to standard
treatment
• Makeup of ketogenic diet varied in studies from 90% fat with 2%
carbohydrate to 70% fat 30% carbohydrate
• MCT oil increases absorption of fat and rate of ketone formation which
allows larger percentage of carbohydrate
 Ketogenic diet cont’d
• In most preclinical studies, KD slowed tumor growth, prolonged the
survival rate, delayed the initiation of tumors, and reversed the process of
cancer-induced cachexia.
• 60% of the preclinical studies reported an antitumor effect of KDs, 17%
did not detect an influence on tumor growth and 10% reported adverse or
pro-proliferative effects.
• In multiple studies, the KD sensitized cancer cells to classic chemo- or
radiotherapies
 Insulin and Cancer
• Insulin and/or IGF receptor signaling pathways contributes to
tumorigenesis
• A study including 9778 patients identified hyperinsulinemia as a risk
factor in cancer prognosis
• Clinical studies have demonstrated a reverse correlation between the level
of ketosis and the levels of glucose, insulin and/or IGF-1
 Intermittent fasting
• Overnight fast of 14 hours or longer - reduction in recurrence for breast
cancer
• KD is good but long-term need to include plants for phytochemicals