Cancer Flashcards
(39 cards)
Differentiate between high, medium and low risk cancers
High Risk • Head & Neck, Oesophago-gastric and Pancreatic Cancers Medium Risk • Prostate, Colorectal, Lung Low Risk • Breast, Sarcomas and NHL
How does malnutrition affect the general population?
- Reduced immunity
- Impaired muscle function, weakness
- Impairments to organ functions e.g. cardiac and respiratory
- Delayed wound healing and skin integrity
- Reduced mobility, loss of independence
- QoL
How does weight loss predict outcome in lung Ca?
- delivery of fewer cycles of chemotherapy
- more treatment delays
- more anaemia
- more symptoms at presentation
- less symptomatic benefit from chemotherapy
What assessment of ‘body composition’ do we make in clinical practice?
• Weight • BMI • BSA • Nutrition Screening • Visible signs of fat loss o Orbital, Triceps • Visible signs of muscle loss o Clavicle, Temporal • Fluid: oedema / ascites
Describe the link between sarcopenia and weight loss.
Syndrome of reduced muscle mass AND reduced muscle strength OR function. Frequently but not exclusively occurs in with ageing.
• Not restricted to thin or wasted individuals
• Sarcopenic obesity
Compare primary to secondary sarcopenia.
Primary sarcopenia: age related
Secondary: activity-related -
Resulting from bed rest, sedentary lifestyle and deconditioning.
Disease: Associated with malignancy, inflammatory disease or endocrine disease.
Nutrition:
Resulting from inadequate dietary intake of energy and/or protein, secondary to malabsorption or anorexia.
Toxicity aggravates loss of weight&muscle, and vice versa; what else did prado et al find muscle loss was linked to?
Muscle loss in cancer patients is associated with poor functional status, more treatment delays, dose reductions, termination of treatment and decreased survival
Prado et al, 2008, 2009, 2011
What did Collins et al and martin et al find was the link between lung cancer and weight?
Collins et al BMJ 2015 – Systematic review of lung cancer
Prevalent regardless of BMI
Associated with poorer functional status and survival
Important to evaluate loss of muscle mass and function rather than loss of weight alone
Martin et al J Clin Oncol 2013 – 1500 lung and GI cancer patients
}Muscle depletion results in poorer prognosis regardless weight loss or BMI
Why are lung cancer patients malnourished?
- less food intake, greater energy expenditure
- Iatrogenic causes of less intake
- Inadequate symptom control
- Tumour site
- Cancer cachexia
Explain iatrogenic malnutrition
As a result of anticancer therapies e.g. surgery, radiotherapy, chemotherapy
(Where significant difficulties are anticipated, feeding tubes can be placed prophylactically before undergoing treatment )
Explain how general surgery affects nutrition
- Fatigue, pain and loss of appetite
- Nil-by-mouth pre / post surgery
- Post op dietary restrictions or staged reintroduction of diet
- Head and neck cancer surgery can alter a patient’s ability to speak, chew, salivate, swallow, smell, taste, and/or see
- Potential background of alcohol excess
Explain how GI Surgery affects nutrition
Gastrointestinal cancer surgery (e.g., oesophageal, gastric, pancreatic, liver, gallbladder, bile duct and small and large intestine): • Gastric paresis • Malabsorption of nutrients • Hyperglycaemia • Fluid and electrolyte imbalance • Anastomotic and chyle leaks • Dumping syndrome • Vitamin and mineral deficiencies
Explain how chemotherapy affects nutrition.
Most common nutrition-related side effects are : Anorexia early satiety, Taste changes (dysgeusia) Nausea, vomiting, Mucositis/ oesophagitis Diarrhoea and constipation Fatigue
Malnutrition and weight loss impact the ability to regain health and acceptable blood counts between chemotherapy cycles;; directly affecting the ability to stay on treatment schedules
Explain how radiotherapy affects malnutrition
Odynophagia & dysphagia (pain or difficulty swallowing) Mucositis Shortness of breath (from fibrosis) Dysgeusia, Xerostomia, Pain Fatigue
Explain how Stem Cell Transplants
affect nutrition
Higher doses of chemo +- TBI result in more intense side effects
Anorexia, fatigue and depression can persist after treatment
Prolonged neutropenia and immunosuppression – theoretical risk
of food borne infection – dietary restrictions
Graft versus host disease can significantly increase requirements and / or result in large GI losses
Explain the symptoms of lung & GI cancer
No appetite 38% Early satiety 27% Pain 23% Taste changes 20% Nausea 18% Dry mouth 17% Constipation 14% Vomiting 11% Diarrhoea 11% Significant association with number of symptoms & rate of weight loss
Describe agents used in the symptom management for nutrition
Prokinetic agents Antiemetic agents Antidiarrheal agents Pancreatic enzymes aka PERT. Laxatives Agents for oral care (e.g., saliva stimulants, cleansing agents, antifungal agents, topical anaesthetics, mouthwashes, and healing/coating agents). Analgesia
Explain the effects of tumour site on malnutrtion
Functional and physiological causes of malnutrition:
GI function/ motility
Obstruction
Malabsorption
}What is cancer cachexia?
Multifactorial syndrome, which leads to on-going loss of skeletal mass with or without the loss of fat mass, that cannot be fully reversed by conventional nutrition support and leads to progressive functional impairment
Describe the Pathophysiology of Cachexia?
Abnormal metabolism (increased inflammatory response : CRP,
IL1, IL6, IL10 and TNF-alpha)
Increased anaerobic respiration
Increased protein utilisation
How are glucose and fats and proteins metabolized in cachexia vs starvation?
Glucose – less in starvation more in cachexia
Fat – more in both
Protein – varies in starvation, more in cachexia
Energy expenditure decreases in starvation – causing slow weight loss, increases in cachexia – causing rapid weight loss
How is CHO metabolism disturbed?
Metabolism of glucose to lactate –>
Lactate converted to pyruvate in liver–>
Pyruvate utilised in gluconeogenesis –>
Insulin resistance/impaired oral glucose tolerance test –mediated by inflammatory cytokines or gluco-regulatory hormones
How is protein metabolism disturbed?
Overall whole-body protein turnover is ↑
↓synthesis (despite ↑acute phase proteins)
↑proteolytic pathways e.g.
ATP ubiquitin-proteasome proteolytic pathway
Lysosomal system
How is lipid metabolism disturbed?
↑lipolysis and fat oxidation, dependant on stage of disease and extent of
malnutrition
