Chapter 16: MNT for PBT

Question 1

Cancers that originate in the brain are called?

Answer 1

Primary brain tumors

Question 2

True or False: Benign tumors can be disabling or life threatening to due pressure on and destruction of normal brain tissue

Answer 2

True

Question 3

True or False: Benign brain tumors are treated with the same modalities as malignant ones?

Answer 3

True

Question 4

What are the 3 common treatment methods for PBT?

Answer 4

Chemo, RT, surgery

Question 5

How many types of PBT are there?

Answer 5

120

Question 6

How are PBT classified?

Answer 6

By histology. Grades 1-4, I-IV, or G1-G4

Question 7

True or False: G4 tumors are high grade tumors that reproduce rapidly, often invading normal brain tissue, developing new blood vessels, and resulting in areas of necrosis, but rarely spread to other parts of the body.

Answer 7

True

Question 8

What is secondary brain tumor?

Answer 8

Secondary (metastatic) tumors have spread to the brain from other types of cancer. Treatment options are different than PBT as they are based on where the cancer originated.

Question 9

Most common types of PBT

Answer 9

Anaplastic astrocytoma and glioblastoma (38% of PBT)
Meningiomas (27% of PBT)

Question 10

What is the largest risk factor for developing PBT?

Answer 10

Radiation exposure is the largest risk factor for PBT

Question 11

Common side effects of treatment for PBT

Answer 11

Fatigue
Loss of appetite
Nausea
Vomiting
Alopecia
Loss of taste
Seizures

Question 12

Why is hyperglycemia common with PBT?

Answer 12

Patients frequently receive dexamethasone to decrease peritumoral edema and radiation side effects.

Increased serum glucose is a/w insulin resistance, promotion of hepatic glucose production, and decreased insulin secretion from islet cells.

Question 13

True or False - glucose management is a common goal for PBT population

Answer 13

FALSE

Patients are unlikely to have long-term diabetic complications and intense management of BG may decrease QoL

Question 14

Common Chemos

Answer 14

Temozolomide (Temodar) - nausea, vomiting, constipation, fatigue

Procarbizine (Matulane) - nausea, vomiting, anorexia, stomatitis; avoid alcohol; AVOID TYRAMINE RICH FOODS

Lomustine (CNCU, CeeNu) - nausea, vomiting, anorexia, stomatitis; avoid alcohol

Vincristine (Oncovin) - constipation, wt loss, nausea, vomiting; avoid alcohol

Irinotecan (Camptosar) - diarrhea, anorexia, nausea, vomiting

Carmustine (Gliadel) - nausea, vomiting

Question 15

Targeted Therapy

Answer 15

Bevacizumab (Avatin) - anorexia, stomatitis, nausea, vomiting, constipation, diarrhea

Question 16

Anti-epileptics

Answer 16

Keppra, Vimpar, Lamictal, Depakote

Question 17

Two treatment modalities being explored for PBT?

Answer 17

Ketogenic diet and Short-term Starvation (STS)

Question 18

What is the largest challenge with the ketogenic diet?

Answer 18

Compliance

Question 19

Modified Keto

Answer 19

Most people doing keto are doing “modified keto.” Daily carbohydrate intake is 10-20 grams. Ketogenic ratios of 1:1 or 2:1 are achieved. Instead of weighing foods, patients can read food labels

Question 20

Classic Keto

Answer 20

Developed in 1950s
NOT a standard of care
4:1 ratio (90% of diet is fat) or 3:1 ratio (87% of diet is fat) to achieve ketosis

Question 21

Negative side effects of ketogenic diets

Answer 21

Inadequate oral intake
Constipation
Nausea and vomiting
Weight loss
Acidosis
Hyperlipidemia
Vitamin and mineral deficiencies
Carnitine deficiency
Osteoporosis
Kidney stones
Decreased QoL

Question 22

The side effects of PBT are comparable to ____

Answer 22

traumatic brain injuries

Question 23

True or False: Brain tumors are considered low nutrition-risk cancers.

Answer 23

True

Question 24

True or False: Headache is the most common presenting symptom of brain cancer.

Answer 24

True

Question 25

Brain Stem cancers frequently cause ___ and ___?

Answer 25

Nausea, Vomiting

Question 26

What is SIADH?

Answer 26

Syndrome of Inappropriate Antidiuretic Hormone secretion. It is occasionally caused by primary and metastatic brain tumors.

Question 27

Nutrition impact symptoms a/w PBT

Answer 27

Dysphagia, constipation, fatigue, low or increased appetite, xerostomia, hyperglycemia, dysgeusia, ageusia

Question 28

Goal of nutrition in PBT

Answer 28

Controlling physical symptoms that contribute to nutritional decline from the tumor itself, treatment and NIS

Caregiver support

End of life care