Nutrition and Cancer

NUTRITION AND CANCER
MDSC3103 HUMAN NUTRITION

Tropical Medicine Research Institute
Dr Kwesi Marshall
MAJOR LEARNING OBJECTIVES
 To outline the major stages of carcinogenesis
 To classify the major classes of cancer
 To describe the major hallmarks of cancer
 To list the principal causes of cancer
 To highlight potential cancer-modulating

nutrients
 To provide recommendations for reducing

cancer risk
LECTURE OUTLINE
 Cellular processes
 Cancer
 Carcinogenesis
 Causes of cancer
 Diet, nutrition, and cancer
 Panel recommendations
 Summary
CELLULAR PROCESSES
‘NORMAL’ CELLULAR PROCESSES
 Cell signalling
- Autocrine
- Paracrine
- Endocrine
 Cell growth
 Cell division/proliferation
 Cell differentiation
 Cell death
CANCER
WHAT IS CANCER?
 A disease characterized by the loss of the

normal control of cell division, which typically
results in the inappropriate excessive
multiplication of cells.
CANCER CLASSIFICATION SCHEMES
Cancers are commonly characterized on the

basis of:
 Tissue/cell types from which they develop
 Cancer sites within the body

CANCER CELL CLASSIFICATION
 Adenomas
 Carcinomas
 Gliomas
 Leukaemias
 Lymphomas
 Melanomas
 Sarcomas
CANCER SITE CLASSIFICATION
 Bladder cancer
 Breast cancer
 Cervical cancer
 Colorectal cancer
 Kidney cancer
 Mouth cancer
 Liver cancer
 Lung cancer
 Oesophageal cancer
CANCER SITES
 Ovarian cancer
 Pancreatic cancer
 Prostate cancer
 Stomach cancer
 Throat cancer
 Uterine cancer
CARCINOGENESIS
STAGES OF CARCINOGENESIS
 Initiation
- DNA damage and mutations in a single cell
 Abnormal cell division
 Promotion
 Tumour (neoplasm) development
 Cancer!
FACTORS THAT INFLUENCE
CARCINOGENESIS
 Factors that are necessary for triggering cancer
development are referred to as initiators.
 Factors that facilitate cancer development once

it has been initiated are referred to as
promoters.
 In addition, factors that might protect against

the development of cancer are referred to as
anti-promoters.
FIG 1. SCHEMATIC REPRESENTATION
OF A HYPOTHETICAL CANCER
PROMOTING PROCESS
CANCER HALLMARKS
 There are six ‘hallmarks’ of cancer.

CANCER HALLMARK 1
 Unlimited cell replication

CANCER HALLMARK 2
 Insensitivity to growth inhibitory signals

CANCER HALLMARK 3
 Evasion of apoptosis
CANCER HALLMARK 4
 Sustained angiogenesis
CANCER HALLMARK 5
 Invasion and metastasis

CANCER HALLMARK 6
 Growth signal autonomy

FIG. 2. PUTTING IT ALL TOGETHER:
THE SIX HALLMARKS OF CANCER
CAUSES OF CANCER
MAJOR CLASSES OF CANCER CAUSES
Broadly divided into:
 Endogenous causes
 Exogenous causes
 Chance!
ENDOGENOUS CAUSES OF CANCER
 Inherited mutations
- Tumour suppressor gene mutations
- Oncogenes (Ras, ERBB2)
 Somatic gene mutations
 Epigenetic modulation
ENDOGENOUS CAUSES OF CANCER
 Oxidative stress
 Inflammation
 Hormones
- Oestrogen
- Insulin-like growth factor
- Leptin
EXOGENOUS CAUSES
 Chemicals
 Infectious agents
- Viruses
- Bacteria
 Radiation
 Nutritional carcinogens
CHEMICAL CARCINOGENS
 Natural toxicants
- Aflatoxin B (Aspergillus sp. - Mould)
 Synthetic agents
- Tobacco smoke
- Polycyclic aromatic hydrocarbons
- Heterocyclic amines
- Diethylstilboesterol (DES)
VIRAL CAUSES OF CANCER
 Human papilloma virus
 Epstein-Barr virus
 Hepatitis B
 Hepatitis C
BACTERIAL CAUSES OF CANCER
 Helicobacter pylori
RADIATION
 Ionising radiation
- Cosmic radiation
- Natural radioactivity
- Medical exposure
- Nuclear accidents
 UV radiation
- UVA
- UVB
DIET, NUTRITION, AND CANCER
FIG. 3. FOOD, NUTRITION, OBESITY,
PHYSICAL ACTIVITY, AND CELLULAR
PROCESSES LINKED TO CANCER
CANCER: A SUMMARY
 Multifactorial process
 Multiple hits
 Long latent period
 Components of food might

- directly cause cancer
- directly protect against cancer
- Indirectly influence the process
NUTRITION AND CANCER:
A MAJOR QUESTION
 HOW MIGHT LIFETIME NUTRITIONAL

EXPOSURES INFLUENCE CANCER
DEVELOPMENT?
A HIERARCHY OF EVIDENCE
 Meta-analyses of randomized controlled trials
(RCTs)
 RCTs
 Non-randomized trials
 Observational
- cohort
- case-control
- ecological
PUTATIVE DIETARY PRO-
CARCINOGENS
 n-6 PUFAs (Omega 6)
 Saturated fatty acids
 Trans fatty acids
 Dietary mutagens
- Aflatoxin B (positively associated with liver
cancer)
 Alcohol
PUTATIVE DIETARY ANTI-
CARCINOGENS
 Carotenoids (lycopene, lutein)
 Retinoids
 Vitamin C
 Vitamin E
 Phytoestrogens
 Phytosterols
 Organosulphur compounds
 Isothiocyanates
MORE PUTATIVE DIETARY ANTI-
CARCINOGENS
 Selenium
 Zinc
 n-3 PUFAs (Omega 3)
 Folate
 Dietary restriction
 Dietary fibre
PROBLEMS INTERPRETING POSSIBLE
DIET-CANCER ASSOCIATIONS
 Diversity of potentially important and often
correlated dietary factors
 Relatively small influence (effect size) on risk
 Dietary intake estimates are typically inaccurate

PANEL RECOMMENDATIONS
PANEL RECOMMENDATIONS
The World Cancer Research Fund’s

recommendations can be divided into:
 General recommendations
 Special recommendations
 Format of recommendations
- Public health goals
- Personal recommendations
RECOMMENDATION 1
BODY FATNESS
 Be as lean as possible within the normal range

of body weight
RECOMMENDATION 2
PHYSICAL ACTIVITY
 Be physically active as part of everyday life

RECOMMENDATION 3
FOODS AND DRINKS THAT PROMOTE WEIGHT
GAIN
 Limit consumption of energy-dense foods
 Avoid sugary drinks

RECOMMENDATION 4
PLANT FOODS
 Eat mostly foods of plant origin

RECOMMENDATION 5
ANIMAL FOODS
 Limit intake of red meat and avoid processed

meat
RECOMMENDATION 6
ALCOHOLIC DRINKS
 Limit alcoholic drinks

RECOMMENDATION 7
PRESERVATION, PROCESSING,
PREPARATION
 Limit consumption of salt
 Avoid mouldy cereals (grains) or pulses

(legumes)
RECOMMENDATION 8
DIETARY SUPPLEMENTS
 Aim to meet nutritional needs through diet alone

SPECIAL RECOMMENDATION 1
BREASTFEEDING
 Mothers to breastfeed; children to be breastfed

SPECIAL RECOMMENDATION 2
CANCER SURVIVORS
 Follow the recommendations for cancer

prevention
SUMMARY
SUMMARY POINTS
 Cancers generally develop from mutations in a
few genes of a single cell.
 Gene mutations that lead to cancer depend on

endogenous processes, exogenous mutagens
and chance.
 Obesity and alcohol consumption have been

associated with particular cancers.
 Dietary-derived nutrients might play important

roles in protecting against certain cancers.

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NUTRITION AND CANCER

MDSC3103 HUMAN NUTRITION

 To classify the major classes of cancer

 To describe the major hallmarks of cancer

 To list the principal causes of cancer

 To highlight potential cancer-modulating

 To provide recommendations for reducing

 Diet, nutrition, and cancer

 A disease characterized by the loss of the

Cancers are commonly characterized on the

 Tissue/cell types from which they develop

 Cancer sites within the body

 Abnormal cell division

 Tumour (neoplasm) development

 Factors that facilitate cancer development once

 In addition, factors that might protect against

 There are six ‘hallmarks’ of cancer.

 Unlimited cell replication

 Insensitivity to growth inhibitory signals

 Invasion and metastasis

 Growth signal autonomy

 Somatic gene mutations

 Human papilloma virus

 Long latent period

 Components of food might

 HOW MIGHT LIFETIME NUTRITIONAL

 Saturated fatty acids

 Trans fatty acids

 n-3 PUFAs (Omega 3)

 Relatively small influence (effect size) on risk

 Dietary intake estimates are typically inaccurate

The World Cancer Research Fund’s

 Be as lean as possible within the normal range

 Be physically active as part of everyday life

 Limit consumption of energy-dense foods

 Avoid sugary drinks

 Eat mostly foods of plant origin

 Limit intake of red meat and avoid processed

 Limit alcoholic drinks

 Limit consumption of salt

 Avoid mouldy cereals (grains) or pulses

 Aim to meet nutritional needs through diet alone

 Mothers to breastfeed; children to be breastfed

 Follow the recommendations for cancer

 Gene mutations that lead to cancer depend on

 Obesity and alcohol consumption have been

 Dietary-derived nutrients might play important

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