Lung Cancer Michelle Briceno The University of Southern Mississippi
Topics to be Covered
Etiology
Pathophysiology
Clinical Manifestations
Staging
Medical Treatments
Medical Nutrition Therapy
Nutrition Education
Laboratory Values
Etiology Tobacco Smoking
1 out of every 9 smokers
30% cancer deaths worldwide
p53 gene mutation
Secondhand Smoke Hecht et al. (1993) study
Radon Exposure 2nd leading cause of lung cancer
Natural gas in homes
Underground miners
Etiology
Asbestos
Occupational exposures Arsenic, beryllium, cadmium, chloromethyl esters,
chromium, nickel, silica, vinyl, chloride, and diesel exhaust
Family History & Genetics
Pathophysiology
Smoking & Secondhand
Environmental/Occupational Exposure
Carcinogenesis 1 .Initiation
2. Promotion 3. Progression
NSCLC
Peripheral Tumors (Bronchioles)
Central Tumors (Bronchi)
SCLC
Central Tumors (Bronchi)
Genetics
Clinical Manifestations
Cough
Dyspnea
Hoarseness
Chest pain
Wheezing
Hemoptysis
Nausea and Vomiting
Swelling of face and arms
Anorexia
Weight loss
Fatigue
Finger clubbing
Headaches
Seizures
Staging
Staging Type
Size
Rate of metastasis
Magnetic Resonance Imaging
CAT Scans
PET Scans
Medical Treatments
Small Cell Lung Cancer Combination treatment
Chemotherapy & Radiation
Non-small Cell Lung Cancer Surgery Chemotherapy and/or Radiation
Medications to treat symptoms: fatigue, nausea, weight loss, appetite changes, esophagitis, anorexia, diarrhea, early satiety, dysgeusia
Medical Nutrition Therapy
Calories (kcal/kg/day)
Protein (g/kg)
Fluid (mL/kg)
• Obese 21-25 kcal • Sepsis 25-30 kcal • Hypermetabolic 35
kcal • Normometabolic
25-30 kcal • Weight gain 30-40 kcal
• Normal 0.8-1.0 g • Nonstressed CA
1.0-1.5 g • Wasting/
hypermetabolism 1.5-2.5 g
• 30-35mL
Vitamin and Mineral Supplements
Low serum levels vitamins A, C, E associated with development of cancer. Beta-carotene greatest protective effect from lung cancer. Multivitamin supplement >150% necessary DRI useful for
patients receiving therapies.
Evidence Analysis Library Supplementation of beta-carotene increases mortality and
cardiovascular death (EAL, 2004). Vitamin E supplementation increases secondary cancers and
decrease cancer-free survival duration (EAL, 2006). Vitamin C showed no effect (EAL, 2009).
National Cancer Institute suggests no form of supplementation. Fruit, vegetable, and whole grain consumption
Glutamine and Fish Oil
Low glutamine increases tissue damage from therapies. Glutamine supplement used to replenish stores. EAL states no evidence to support or refute supplementation
to reduce symptoms.
Fish Oil Improvement in appetites Reduction in fatigue Improvement in C-reactive protein levels Preserves lean body mass.
EAL states significant effects on preservation of lean body mass.
Nutrition Education
Side effects of chemotherapy and radiation
Tips on nausea and vomiting, diarrhea, constipation, dry mouth, sore mouth, taste alterations, sensitivity to smells, appetite loss, and decreased intake.
Early satiety and shortness of breath. Small meals throughout day
Fluids between meals
Liquid nutritional drinks- high calorie and protein
Adequate fruit, vegetable, and whole grain intake for vitamin and mineral sources.
Lab Values Albumin & Pre-Albumin
Decreased values Increased risk of developing nutritional deficiencies
C-reactive protein (CRP) Inflammation Increase with decreasing albumin and pre-albumin Increased risk of developing nutritional deficiencies
Creatinine Increased levels used to detect stages of lung cancer
Tumor markers ALK gene, cytokeratin fragments 21-1, EGFR mutation, KRAS
mutation, p53 mutation
Lab Values
Glucose Increased with Cushing syndrome, malnutrition, stress, infection Decreased with secondary cancers
Electrolytes (Na, K, Ca) Increased values from dehydration
Hgb/Hct Decreased values from depressed RBCs from blood loss and anemia
BUN Decreased from malnutrition and syndrome of inappropriate anti-diuretic secretion (SIADH)
Cholesterol/TG Decreased levels from malnutrition
Summary
Protein, calorie, and fluid needs on individual basis.
Initial nutrition education addresses side effects of disease and treatments.
Early satiety and shortness of breathe addressed.
Supplementation
Important of fruit, vegetable, and whole grain consumption.
Questions?
Reference Center for Disease Control and Prevention. (2013). Lung Cancer. Retrieved from http://www.cdc.gov/cancer/lung/basic_info/what-is-lung-cancer.htm Cranganu, A., & Camporeale, J. (2009). Nutrition Aspects of Lung Cancer. Nutrition in Clinical Practice, 24(6), 688-700. doi: 10.1177/0884533609352249 Dela Cruz, C. S., Tanoue, L. T., & Matthay, R. A. (2011). Lung cancer: Epidemiology, etiology, and prevention. Clinics in Chest Medicine, 32(4), 605-644. doi:10.1016/j.ccm.2011.09.001 Evidence Analysis Library (2004). In patients at risk for lung cancer, what effect does supplemental beta-carotene have on the risk for all-cause mortality and cardiovascular death?. Retrieved from http://andevidencelibrary.com/conclusion.cfm?conclusion_statement_id=128&highlight=cancer&home=1 Evidence Analysis Library (2005). What evidence suggests a relationship between the intake of glutamine to reduce symptoms and the reduction of symptoms associated with cancer?. Retrieved from http://andevidencelibrary.com/conclusion.cfm?conclusion_statement_id=250126&highlight=glutamine%20&home=1 Evidence Analysis Library (2006). What evidence suggests a relationship between supplementation of antioxidant vitamin E and the efficacy of radiotherapy treatment in patients with head and neck cancer?. Retrieved from http://andevidencelibrary.com/conclusion.cfm?conclusion_statement_id=250585&highlight=cancer&home=1 Evidence Analysis Library (2009). What is the relationship between supplemental vitamin E, vitamin C or beta-carotene and all cause mortality in adults?. Retrieved from http://andevidencelibrary.com/conclusion.cfm?conclusion_statement_id=251285&highlight=vitamin%20C&home=1 Evidence Analysis Library (2013). What is the effect of a dietary supplement containing fish oil on lean body mass in adult oncology patients?. Retrieved from http://andevidencelibrary.com/conclusion.cfm?conclusion_statement_id=252050&highlight=fish%20oil%20and%20cancer&home=1 Harmsma, M., Schutte, B., & Ramaekers, F. C. S. (2013). Serum markers in small cell lung cancer: Opportunities for improvement. Biochimica et Biophysica Acta, 1836, 255-272. Hecht, S. S., Carmella, S. G., Murphy, S. E., Akerkar, S., Brunnemann, K. D., & Hoffmann, D. (1993). A tobacco-specific lung carcinogen in the urine of men exposed to cigarette smoke. The New England Journal of Medicine, 329(21), 1543-1546. Mahan, L. K., Escott-Stump, S., & Raymond, J. L. (2012). Medical nutrition therapy for cancer prevention, treatment, and recovery. In B. L. Grant & K. K. Hamilton (Eds.), Krause’s Food and the Nutrition Care Process (pp. 832-863). St. Louis, Missouri: Elsevier Saunders. National Cancer Institute at the National Institutes of Health (2014). Lung Cancer. Retrieved from http://www.cancer.gov/cancertopics/types/lung Nelms, M., Sucher, K. P., Lacey, K., & Roth, S. L. (2011). Neoplastic disease. In D. A. Cohen (Eds.), Nutrition therapy & pathophysiology (pp. 702-734). Belmont, California: Wadsworth, Cengage Learning. Pershagen, G., Akerblom, G., Axelson, O., Clavensjo, B., Damber, L., Desai, G., . . . Swedjemark, G.A. (1994). Residential radon exposure and lung cancer in Sweden. The New England Journal of Medicine, 330(3), 159-164. Pfeifer, G. P., Denissenko, M. F., Olivier, M., Tretyakova, N., Hecht, S. S., & Hainaut, P. (2002). Tobacco smoke carcinogens, DNA damage and p53 mutations in smoking-associated cancers. Oncogene, 21, 7435-7451. Ridge, C. A., McErlean, A. M., & Ginsbery, M. S. (2013). Epidemiology of lung cancer. Seminars in Interventional Radiology, 30(2), 93-98. doi: 10.1055/s-0033-1342949 Teh, E., & Belcher, E. (2014). Lung cancer: diagnosis, staging and treatment. Cardiothoracic Surgery, 32(5), 242-248. Travis, W. (2011). Pathology of Lung Cancer. Clinical Chest Medicine, 32, 669-692. doi: 10.1016/j.ccm.2011.08.005