Cancer Tables

Hypermetabolism

Causes: Tumor release factors increasing REE, fat, CHO, protein needs.

Treatment: Increase intake of energy and protein.

Anorexia, early satiety, lack of vomiting

Causes: Tumour obstructing the GI tract, tumour changing gut motility and function, release of cytokines that effect appetite nausea. Side effects of treatment, psychological effects of cancer.

Treatment:

• Make every mouthful count.

• Oral supplements.

• Small frequent meals, appetite usually best in the morning.

• Avoid high fibre.

• Cool or cold foods might be better.

• Avoid cooking.

• Anti-emetics (meds to prevent N/V).

• Alcohol or cannabinoids

Malabsorption or diarrhea

Causes:

• Malabsorption can cause diarrhea, steatorrhea, bacterial overgrowth, B12, and other deficiencies.

• Malnutrition can cause flattening of villi.

• Tumour cells in the membrane of GI can lose proteins, causing obstruction or dilation of lymphatics in villi.

• Mechanical obstruction of GI.

Treatment:

• Treat underlying cause

• Anti-Diarrheal meds.

• Small frequent meals w fluid intake.

• Limit bowel stimulants.

• Decrease fat.

• Emphasise soluble fiber.

• Encourage K rich foods - lost in diarrhea.

• Supplement micronutrients if needed.

Mucositis and Esophagitis

Mucositis: Inflamed mouth lesions - painful eating.

Esophagitis: Inflamed esophagus - painful swallowing.

Causes: Radiation to head/neck, or chemo.

Treatment:

• Avoid irritants.

• Soft blended foods.

• Adequate fluids.

• Rinse mouth often.

• Analgesics.

• Antacids before meals may help esophagitis.

Dysgeusia

• Taste changes, especially in meat. Contributes to anorexia.

Causes:

• As a result of chemo/radiation, taste buds are rapidly dividing cells.

Treatment:

• Rinse mouth with club soda or salt water.

• Drink with meals.

• Encourage flavour experimentation.

• Some people might prefer mild foods.

• If meat tastes metallic:

  • Room temp, mix with stuff, add acid, plastic cutlery, alt proteins.

Xerostomia

• Dry mouth, difficult to eat.

Causes:

• Chemo or radiation to the head or neck.

Treatment:

• Chew gum, candy, xylotol pastilles.

• Oral spray, saliva substitute.

Eutopic Hormones

• Hormones whose production increases when a cell becomes cancerous.

• Ie. Breast cells and insulin.

• Bronchial epithelial cells calcitonin.

• Can cause changes in calcium balance, glucose homeostasis, metabolic rate.

Treatment:

• Depends on the hormone.

• If glucose, treat as diabetes.

• Metabolic rate: monitor energy needs and adjust.

Hyper or hypocalcemia

Hyper: causes nausea, weakness, high bp, lethargy, confusion.

Causes:

• Bone metastasis can release osteoclast activating factors.

• Some tumors release factors which act similar to PTH.

• Tumor production of calcitriol.

Treatment:

• Do not reduce dietary calcium

• Replace fluids.

• Give calcitonin or bisphosphonates.

Osteomalacia

Causes: Some tumors are associated with reduced calcitriol, PTH, hypophosphatemia, hypocalcemia, which can induce osteomalacia.

Treatment: Resection of tumour.

Humoral hyponatremia of malignancy

Low blood sodium associated with cancer

Causes:

• Common in lung cancer, produced by the tumor.

• Also can be a side effect of treatment.

Treatments:

• Fluid restriction.

• Meds or saline infusions.

Anemia

Causes: Nutrient deficiencies, hemolysis, bone marrow failure, infection, direct paraneoplastic effect.

Treatment: Treat underlying cause.