Lung Cancer

﷽
LUNG CANCER
CANCER
CANCER
 Uncontrolled division of abnormal cells in a part of body

 Malignant growth/ tumor due to an uncontrolled cell division
 Inter-related set of diseases (not just one diseases)
 Malignant/ Metastasized Tumor

 Cancerous cells which can injure healthy tissue and spread to the other
region of the body.
 Benign Tumor
 These are not cancerous and often they can remove. In most cases they do
not come back and do not spread to the other body parts.
CANCER – TYPES
 Major types depending upon location in the body as follows;
Carcinoma
 Form in epithelial cell (surface of skin, mouth, nose, throat, lung, and GIT)
or glands such as breast or thyroid
Sarcoma
 Involve bones, connective and supportive tissues surrounding organs and
tissues e.g. cartilage, muscle, tendon, abdomen, heart, CNS and blood
vessels
Lymphoma
 Cancer of lymph glands (act as a filter for body impurities) involving
abnormal lymphocytes that congregate in lymph gland to produce solid
masses.
Myeloma
 Cancer of antibodies producing plasma cells or haemopoitic cells.
LUNG CANCER
 Lung cancer is the uncontrolled growth of abnormal cells that

start off in one or both lungs
 It is also the most preventable form of cancer.
 There are two major types of lung cancer:

 1. Non-small cell lung cancer (87%)
 2. Small cell lung cancer (13%)
About 85% of lung cancers are non-small cell lung cancers.
CAUSES
 10% due to the inherited and unknown conditions

 90% has their roots in the environment and lifestyle
Environmental Factors
Aflatoxins Alcohol
Asbestos Tobacco
Lifestyle Facors
Obesity Red/ Processed meat
Salt preserved foods B-carotene Supp.
High calcium diets Low physical
activity
DIAGNOSIS
 Physical exam and health history

 X-ray
 CT scan
 Biopsy
 Endo bronchial ultrasound
 Sign & Symptoms
 SOB, persistent cough, coughing blood, chest pain etc.

PATHOPHYSIOLOGY
 The abnormal cells do not develop into healthy lung tissue, they
divide rapidly and form tumors.
 The genes influenced in the pathogenesis of lung cancer produce

proteins involved in cell growth and differentiation, cell cycle
processes, apoptosis, angiogenesis, tumor progression, and
immune regulation.
 Lung infection (pneumonia) which may develop in a part of a

lung blocked off by a growing tumor.
GROWTH OF CANCER CELLS
2-6 weeks
2-6 weeks
Cancer cells reproduce
every 2-6 weeks
2-6 weeks
GROWTH OF CANCER CELLS
PATHOPHYSIOLOGY
TREATMENT
 Depends upon stages and types, some treatments follow as:

Chemotherapy
 Use of chemicals or medications for systematically treat cancer
Radiation
 Uses high-energy (ionizing) radioactive chemicals to treat cancer
Surgery
 Involves the surgical removal of cancerous tissue from the body
Biotherapy
 Use of biologic/ anti–angiogenic agents, to produce anti–cancer effects
(indirectly) inhibiting the growth of tumor vasculature
Hormonal therapy
 Used for the treatment of hormone-sensitive cancers (e.g., breast, ovarian,
prostate) by blocking of a hormone or its receptor site
TREATMENT
 Each type of lung cancer has various stages that behave

differently and require individualized treatments
 Depending on the stage, it may impact the body in various ways

as lung cancer patients often experience treatment-side effects
 Team of cancer experts may include a dietitian, physical

therapist, spiritual and behavioral counselor.
 Dietitian monitors nutrition status from the beginning to the end

of cancer treatment, making modifications as needed to minimize
side effects and treatment interruptions before they arise
MEDICAL NUTRITION THERAPY
Goals/ Objectives
 To achieve/ maintain optimal nutritional status and body weight
 To preserve the lean muscle tissue
 Identify, prevent and correct PEM & metabolic abnormalities
 Promote growth and development and maximize quality of life
 To prevent or reverse immuno-suppression
 To maximize benefits of therapies
Intervention
 Assessment tool; PG-SGA modified rating
 Caloric and Protein requirement; BEE
 Co-morbs; hepatic encephalopathy, DM, HTN, Dyslipidemias etc.
 Route of feeding: PO / NG / PEG / PO + tube feeds
 Diet Planning and Enteral feeds (Formula Selection)
Interventions
 Assessment tool; PG-SGA modified rating

 PG-SGA is a patient-reported instrument for assessment of nutrition
status in patients with cancer
 Exam includes a subjective evaluation of 3 aspects of body
composition: fat, muscle, & fluid. Since this is subjective, each aspect
of the exam is rated for degree. Muscle deficit/loss impacts point score
more than fat deficit/loss. Definition of categories: 0 = no abnormality,
1+ = mild, 2+ = moderate, 3+ = severe.
 Dyslipidemia is the imbalance of lipids such as cholesterol, low-
density lipoprotein cholesterol, (LDL-C), triglycerides, and high-
density lipoprotein (HDL). This condition can result from diet, tobacco
exposure, or genetic and can lead to cardiovascular disease with severe
complications.
Interventions
 Co-morbs; DM, HTN

 Comorbidity occurs when a person has more than one disease or
condition at the same time. Conditions described as
comorbidities are often chronic or long-term conditions
 DM Clinical is a groundbreaking clinical research organization

leading the charge in areas such as COVID-19
 Hypertension (HTN or HT), also known as high blood pressure

(HBP), is a long-term medical condition in which the blood
pressure in the arteries is persistently elevated.
Interventions
 Hepatic encephalopathy (HE) or portosystemic encephalopathy

(PSE) is a reversible syndrome of impaired brain function
occurring in patients with advanced liver failure.
 Types of hepatic encephalopathy
• Stage 0: Minimal HE. Slight changes in memory and
concentration.
• Stage 1: Mild HE. Mood changes and sleep problems.
• Stage 2: Moderate HE. Inappropriate behavior, slurred speech,
trouble doing basic math.
• Stage 3: Severe HE. Disorientation, extreme sleepiness, or anxiety.
• Stage 4: Coma.
REVERSING CO – MORBS
 Complications, develop due to the tumors on surrounding tissues

 Cancer cachexia
 Neutropenia
 Altered metabolism
 Mal-absorption
 Fluid and electrolyte disturbance
Special nutritional strategies for corresponding abnormality

NUTRIENT MODIFICATIONS
Energy
 Individual energy needs to maintain their weight and prevent
weight loss associated with cancer
 Differ according to diagnosis, anticancer therapies, presence of
other diseases fever, infection and other metabolic complications
Conditions Energy Needs
Cancer, nutritional repletion, weight gain 30-40 kcal/kg/day
Cancer, norm metabolic 25-30 kcal/kg/day
Cancer, hyper metabolic, stressed 35 kcal/kg/day
Hematopoietic cell transplant 30-35 kcal/kg/day
Sepsis 25-30 kcal/kg/day
Obese 21-25 kcal/kg/day
Protein
 It is also important but the amount of protein also varies to the
patient conditions e.g.
Conditions Energy Needs

Non-stressed patients (undergoing treatment) 1.0 to 1.2 g/kg
patients with substantial protein losses or cachexia 1.2 to 1.5 g/kg
Carbohydrates, Fats and Fluids

 45–65% energy should be come from carbohydrates
 Food should be rich in nutrients, phyto-chemical & fibers
 Less fiber for patient with nausea, vomiting, diarrhea etc.
 Fat intake during chemotherapy may vary from patient to patient

 Low fat is recommended in case of nausea and diarrhea etc.
 Fats gives calories to patient with weight loss, able to tolerate
 Fluid – maintaining hydration status/ electrolyte balance

 Altered fluid balance occur with fever, edema, fistulas, vomiting
or diarrhea etc.
Vitamins and Minerals

 Cancer patients take large amounts of vitamin and minerals to
replace existing nutritional deficiencies by poor diet and lifestyle
 Vitamins A, C, and E and mineral selenium could repair cancer

cells that have been intentionally damaged by chemotherapy
 Antioxidants such as melatonin may protect the body from side

effects of chemotherapy.
 During and after a cancer diagnosis, supplementation or

restriction of micronutrients may be required as DRI levels
ENTERAL / PARENTERAL NUTRITION SUPPORT
 Nutrition support is used in limited situations during cancer

treatment.
 Generally, tube feedings and parenteral nutrition are provided to

patients who have long-term or permanent gastrointestinal
impairment or are experiencing complications that interfere with
food intake.
 For example, many patients undergoing radiation therapy require

long-term tube feeding and may need to continue tube feedings at
home
INDICATIONS FOR ENTERAL FEEDS
 Low body weight, as defined by less than 80% of ideal weight
 Mal-absorption of nutrients due to disease or anticancer therapy
 Recent, unintentional weight loss >10% of usual weight
 Inability to eat or drink for more than 5 days.
 Moderate or high nutritional risk status as determined by

screening or an assessment tool
ENTERAL / PARENTERAL NUTRITION
CONCLUSION
 Heredity accounts for 10% of cancers while 90% cases have their
roots in the environment and lifestyle related problems
 Lung cancer therapy is an irritating process with a range of side

effects that may become cause of patient death
 MNT applied as a supportive care that not only maintains the

nutritional status, but also reverse the vide range of symptoms
 Main objective, as a nutritionist, is to take their daily intake,

interpret changes where needed and counselling about the
optimal nutritional
THANKS!!!

Lung Cancer

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﷽

 Uncontrolled division of abnormal cells in a part of body

 Malignant/ Metastasized Tumor

 Lung cancer is the uncontrolled growth of abnormal cells that

 It is also the most preventable form of cancer.

 There are two major types of lung cancer:

 10% due to the inherited and unknown conditions

 Physical exam and health history

 SOB, persistent cough, coughing blood, chest pain etc.

 The genes influenced in the pathogenesis of lung cancer produce

 Lung infection (pneumonia) which may develop in a part of a

 Depends upon stages and types, some treatments follow as:

 Each type of lung cancer has various stages that behave

 Depending on the stage, it may impact the body in various ways

 Team of cancer experts may include a dietitian, physical

 Dietitian monitors nutrition status from the beginning to the end

 Assessment tool; PG-SGA modified rating

 Co-morbs; DM, HTN

 DM Clinical is a groundbreaking clinical research organization

 Hypertension (HTN or HT), also known as high blood pressure

 Hepatic encephalopathy (HE) or portosystemic encephalopathy

 Complications, develop due to the tumors on surrounding tissues

Special nutritional strategies for corresponding abnormality

Conditions Energy Needs

Carbohydrates, Fats and Fluids

 Fat intake during chemotherapy may vary from patient to patient

 Fluid – maintaining hydration status/ electrolyte balance

Vitamins and Minerals

 Vitamins A, C, and E and mineral selenium could repair cancer

 Antioxidants such as melatonin may protect the body from side

 During and after a cancer diagnosis, supplementation or

 Nutrition support is used in limited situations during cancer

 Generally, tube feedings and parenteral nutrition are provided to

 For example, many patients undergoing radiation therapy require

 Low body weight, as defined by less than 80% of ideal weight

 Mal-absorption of nutrients due to disease or anticancer therapy

 Recent, unintentional weight loss >10% of usual weight

 Inability to eat or drink for more than 5 days.

 Moderate or high nutritional risk status as determined by

 Lung cancer therapy is an irritating process with a range of side

 MNT applied as a supportive care that not only maintains the

 Main objective, as a nutritionist, is to take their daily intake,

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