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