Chapter 23: MNT for Gyn Onc

Question 1

Risk factors for ovarian cancer?

Answer 1

Age (50% of cases in women aged 63+)
BMI >30
Family history
Genetic mutations (BRCA 1, BRCA 2, RAD51C

Question 2

Decreased risk for ovarian cancer

Answer 2

Giving birth
Taking oral contraceptives for > 5 years
Breastfeeding
Tubal ligation
Increasing hip circumference in post-menopausal women
Prophylactic bilateral salpingo-oophorectomy (for people with genetic mutations, may reduce risk by 80%)

Question 3

Risk factors for cervical cancer?

Answer 3

Immunsuppression from medications for HIV
Long term infections with certain types of HPV
In utero exposure to diethylstilbestrol

Question 4

Decreased risk for cervical cancer

Answer 4

HPV vaccination

Question 5

Risk factors for endometrial cancer?

Answer 5

Hormones: birth control pills, total number of menstrual cycles, obesity, pregnancy, PCOS, ovarian tumors, tamoxifen use

Age: increases with age

Family hx: hereditary nonpolyposis colon cancer

Medical hx: metabolic syndrome, DM, high blood glucose, HTN, high TGs, prior pelvic radiation, endometrial hyperplasia, breast or ovarian cancer

Question 6

Decreased risk for endometrial cancer

Answer 6

Coffee consumption
Non-starchy vegetable intake
High fruit intake
Physical activity (probable decrease)
Following a Mediterranean diet

Question 7

T/F: 45.7% of gyn cancers are caught early and have a survival rate of 91.5%

Answer 7

TRUE

Question 8

Energy Requirements

Answer 8

Malnourished: 30-35 kcal/kg
Well nourished: 25-30 kcal/kg
Normal renal function: 1-1.5 g/kg protein
Cancer cachexia? 1.5-2.5 g/kg protein

Question 9

Radiation induced diarrhea

Answer 9

EBRT to pelvic region causes acute GI symptoms in 70% of patients including severe diarrhea

Question 10

Treatment for radiation induced diarrhea

Answer 10

Psyllium fiber supplementation
Probtioics
Loperamide or diphenoxylate
Octreotide

Question 11

Ovarian Cancer and Malignant Bowel Obstructions

Answer 11

Occurs in 20-50% of patients with ovarian cancer
Considered a preterminal event with gyn cancers
Often results from peritoneal carcinomatosis
May involve small or large intestine (or both)

Question 12

Interventions for malignant SBO?

Answer 12

Surgery, venting G-tube, palliative surgery

Question 13

When surgery is not an option for MBO….

Answer 13

Reported survival rate is 4-5 weeks for inoperable MBO
Venting G-tube for decompression or endoscopic stenting may be considered

Question 14

Best diet for MBO?

Answer 14

Low fiber

Question 15

Role of PN in MBO

Answer 15

Conflicting results
May prolong life by 4 weeks longer than those who do not use PN
Patients with good performance status at home and who could provide their own self-care at home did benefit from PN