8.3 Treatments and Nutrition
5 min read•june 18, 2024
Cancer is a complex disease characterized by uncontrolled cell growth and division. It develops through genetic mutations, which can be inherited or acquired through environmental factors. Understanding the process of cancer development is crucial for effective diagnosis and treatment.
Cancer therapy involves multiple phases, from diagnosis and staging to various treatment modalities. These include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Each approach plays a unique role in combating cancer, often used in combination for optimal results.
Introduction to Cancer
Process of cancer development
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- Cancer develops from genetic mutations in normal cells causing uncontrolled growth and division
- Mutations can be inherited (passed down from parents) or acquired through environmental factors (exposure to carcinogens)
- Accumulation of multiple mutations over time leads to the transformation of normal cells into cancerous cells
- Key characteristics of cancer cells enable them to grow and spread uncontrollably
- Sustained proliferative signaling allows cancer cells to continuously divide and multiply
- Evasion of growth suppressors enables cancer cells to bypass normal cellular control mechanisms that limit cell division
- Resistance to cell death (apoptosis) allows cancer cells to survive and accumulate despite damage or stress
- Induction of angiogenesis involves the formation of new blood vessels to supply oxygen and nutrients to the growing tumor
- Activation of invasion and metastasis enables cancer cells to spread from the primary tumor site to other parts of the body
- Replicative immortality allows cancer cells to divide indefinitely without undergoing senescence or cell death
Genetic vs environmental cancer factors
- Genetic factors contribute to cancer development through inherited mutations
- Inherited mutations in tumor suppressor genes (BRCA1, BRCA2) increase the risk of developing certain cancers (breast, ovarian)
- Inherited mutations in proto-oncogenes (RET, PTEN) can lead to the activation of oncogenes and promote cancer growth
- Family history of specific cancers may indicate the presence of inherited genetic mutations that increase cancer risk
- Environmental factors play a significant role in cancer formation
- Exposure to carcinogens such as tobacco smoke, UV radiation, and asbestos can cause DNA damage and mutations
- Chronic inflammation resulting from infections (hepatitis B and C, H. pylori) can create a tumor-promoting environment
- Dietary factors like high-fat diets and low fiber intake may increase the risk of certain cancers (colon, breast)
- Lifestyle factors such as lack of physical activity and obesity can contribute to the development of various cancers
Types of cancer and features
- Carcinomas originate from epithelial cells and are the most common type of cancer
- Examples include lung, breast, colon, prostate, and skin cancers
- Carcinomas can be further classified based on the specific type of epithelial cell (squamous cell carcinoma, adenocarcinoma)
- Sarcomas arise from connective tissues such as bone, cartilage, muscle, and fat
- Examples include osteosarcoma (bone), liposarcoma (fat), and leiomyosarcoma (smooth muscle)
- Sarcomas are relatively rare compared to carcinomas
- Leukemias originate in blood-forming tissues (bone marrow) and are characterized by the abnormal production of white blood cells
- Examples include acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL)
- Leukemias can be classified based on the type of white blood cell affected (myeloid or lymphoid) and the rate of progression (acute or chronic)
- Lymphomas develop from cells of the lymphatic system, such as lymph nodes and the spleen
- Examples include Hodgkin's lymphoma and non-Hodgkin's lymphoma
- Lymphomas are characterized by the abnormal growth and accumulation of lymphocytes
- Central nervous system (CNS) tumors arise from brain and spinal cord tissues
- Examples include gliomas (arise from glial cells), meningiomas (arise from the meninges), and medulloblastomas (arise from the cerebellum)
- CNS tumors can be benign (non-cancerous) or malignant (cancerous) and are classified based on the specific cell type and location
Tumor Classification and Cell Cycle
- Tumors can be classified as benign or malignant based on their growth characteristics and potential to spread
- Benign tumors are typically slow-growing, well-differentiated, and remain localized
- Malignant tumors are characterized by rapid, uncontrolled growth and the ability to invade surrounding tissues and metastasize
- The cell cycle plays a crucial role in cancer development and progression
- Dysregulation of the cell cycle can lead to uncontrolled cell division and tumor formation
- DNA repair mechanisms are essential for maintaining genomic stability and preventing cancer-causing mutations
- Defects in DNA repair pathways can contribute to the accumulation of genetic alterations and cancer development
Phases of Cancer Therapy
Phases of cancer therapy
- Diagnosis and staging involve identifying the type and extent of cancer to determine the appropriate treatment plan
- Diagnostic tests may include imaging (CT, MRI, PET scans), biopsy, and blood tests
- Staging assesses the size and spread of the tumor using the TNM system (Tumor size, lymph Node involvement, Metastasis)
- Surgery aims to remove the primary tumor and/or affected lymph nodes
- Surgery can be used for diagnosis (biopsy), staging (assessing the extent of cancer), and treatment (removing the tumor)
- Types of surgery include lumpectomy (breast cancer), prostatectomy (prostate cancer), and colectomy (colon cancer)
- Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors
- Radiation can be delivered externally (external beam radiation) or internally (brachytherapy)
- Radiation therapy can be used before, during, or after surgery to improve treatment outcomes
- Chemotherapy is a systemic treatment that uses drugs to kill rapidly dividing cancer cells throughout the body
- Chemotherapy drugs can be administered orally, intravenously, or through other routes (intrathecal, intraperitoneal)
- Chemotherapy can be used as a primary treatment or in combination with other therapies (surgery, radiation)
- Targeted therapy involves drugs designed to target specific molecules involved in cancer growth and progression
- Examples include small molecule inhibitors (tyrosine kinase inhibitors) and monoclonal antibodies (trastuzumab for HER2-positive breast cancer)
- Targeted therapies are more specific than chemotherapy and may have fewer side effects
- Immunotherapy stimulates the body's immune system to fight cancer cells
- Examples include immune checkpoint inhibitors (pembrolizumab, nivolumab) and CAR T-cell therapy
- Immunotherapy can be used alone or in combination with other treatments
- Hormone therapy is used for cancers that are sensitive to hormones, such as breast and prostate cancers
- Hormone therapy blocks the production or action of hormones to slow cancer growth
- Examples include tamoxifen (breast cancer) and leuprolide (prostate cancer)
- Palliative care focuses on relieving symptoms and improving quality of life for patients with advanced cancer
- Palliative care can be provided at any stage of cancer treatment and may include pain management, nutritional support, and emotional support
- Hospice care is a type of palliative care provided to patients with a limited life expectancy (usually less than 6 months)
Additional Treatment Approaches
- Adjuvant therapy is given after primary treatment (such as surgery) to reduce the risk of cancer recurrence
- Neoadjuvant therapy is administered before the primary treatment to shrink tumors and improve surgical outcomes
- The goal of cancer treatment is to achieve remission, where there are no detectable signs of cancer and symptoms are reduced or eliminated
Key Terms to Review (46)
Alcohol: Alcohol is a psychoactive substance that can depress the central nervous system. It is commonly consumed in beverages and has various effects on physical and mental health depending on the amount ingested.
Alpha-Glucosidase Inhibitors: Alpha-glucosidase inhibitors are a class of medications that slow the absorption of carbohydrates in the small intestine, helping to control blood glucose levels in individuals with diabetes. These inhibitors work by blocking the activity of the enzyme alpha-glucosidase, which is responsible for breaking down complex carbohydrates into simpler sugars that can be more easily absorbed.
Antithyroid Medications: Antithyroid medications are a class of drugs used to treat hyperthyroidism, a condition characterized by an overactive thyroid gland. These medications work by inhibiting the production and release of thyroid hormones, helping to restore normal thyroid function and alleviate the symptoms of hyperthyroidism.
B12: Vitamin B12, also known as cobalamin, is an essential water-soluble vitamin crucial for red blood cell formation, neurological function, and DNA synthesis. It is primarily found in animal products and requires intrinsic factor for absorption in the small intestine.
Basal Metabolic Rate: Basal metabolic rate (BMR) is the minimum amount of energy the body requires to perform basic life-sustaining functions at rest, such as maintaining organ function, breathing, and circulation. It represents the baseline energy expenditure needed to keep the body alive and functioning without any additional physical activity or energy demands.
Biguanides: Biguanides are a class of oral antidiabetic medications used to manage type 2 diabetes. They work by reducing hepatic glucose production and increasing peripheral glucose uptake, ultimately lowering blood glucose levels.
Calcitriol: Calcitriol is the active form of vitamin D, crucial for calcium and phosphate metabolism in the body. It plays a key role in maintaining bone health and proper functioning of the immune system.
Calcium: Calcium is a crucial mineral for the development and maintenance of strong bones and teeth. It also plays essential roles in muscle contraction, nerve signaling, and blood clotting.
Chromium: Chromium is a trace mineral essential for the metabolism of carbohydrates, lipids, and proteins. It enhances insulin action and assists in maintaining normal blood glucose levels.
Diabetes: Diabetes is a chronic condition characterized by high blood glucose levels due to the body's inability to produce or effectively use insulin. It significantly impacts nutritional needs and requires careful management of diet and lifestyle.
Dietary Reference Intakes: Dietary Reference Intakes (DRIs) are a set of nutrient reference values that provide guidance on the amounts of essential nutrients needed for optimal health and to reduce the risk of chronic diseases. These values are used to assess the adequacy of nutrient intakes and to plan healthy diets for individuals and populations.
DPP-4 Inhibitors: DPP-4 inhibitors are a class of oral medications used to treat type 2 diabetes. They work by blocking the enzyme dipeptidyl peptidase-4 (DPP-4), which normally breaks down the incretin hormones GLP-1 and GIP, leading to increased insulin secretion and decreased glucagon release to help regulate blood sugar levels.
Enteral Nutrition: Enteral nutrition refers to the delivery of nutrients directly into the gastrointestinal tract, typically through a feeding tube. It is a method of providing nourishment to individuals who are unable to meet their nutritional needs through oral intake alone.
Fractures: Fractures are breaks or cracks in bones that occur when the bone is subjected to more force than it can withstand. They can significantly impact a patient's mobility and overall health, requiring proper medical and nutritional interventions for healing.
Furosemide: Furosemide is a loop diuretic commonly used to treat fluid retention and swelling caused by heart failure, liver disease, and certain kidney disorders. It works by causing the kidneys to get rid of unneeded water and salt from the body through urine.
GLP-1 Receptor Agonists: GLP-1 receptor agonists are a class of medications used to treat type 2 diabetes. They work by activating the glucagon-like peptide-1 (GLP-1) receptors, which stimulate the release of insulin, suppress the release of glucagon, and slow gastric emptying, leading to improved blood glucose control and reduced appetite.
Gluconeogenesis: Gluconeogenesis is the metabolic process by which the body synthesizes glucose from non-carbohydrate precursors, such as amino acids, lactate, and glycerol. This process is essential for maintaining blood glucose levels, especially during periods of fasting or starvation, when the body needs to generate glucose from alternative sources to meet its energy demands.
Glycemic Index: The glycemic index is a measure of how quickly a food containing carbohydrates raises blood sugar levels. It provides a numerical value that ranks carbohydrate-containing foods based on their effect on blood glucose levels. This concept is particularly relevant in the context of carbohydrate metabolism, endocrine wellness, and the impact of nutrition on chronic endocrine illnesses.
Hydrochlorothiazide: Hydrochlorothiazide is a diuretic medication commonly used to treat high blood pressure and fluid retention. It helps the kidneys eliminate excess sodium and water from the body.
Hyperglycemia: Hyperglycemia is a condition characterized by elevated levels of glucose in the blood. It is commonly associated with diabetes and can lead to serious health complications if not managed properly.
Hyperparathyroidism: Hyperparathyroidism is a condition characterized by excessive production of parathyroid hormone (PTH) by the parathyroid glands. This leads to an imbalance in calcium and phosphorus levels in the body, which can have significant impacts on overall health and well-being.
Hypocalcemia: Hypocalcemia is a medical condition characterized by an abnormally low level of calcium in the blood. This electrolyte imbalance can have significant impacts on various bodily systems, including the cardiovascular, renal, and musculoskeletal systems, as well as the overall health and well-being of an individual.
Hypoglycemia: Hypoglycemia is a condition characterized by abnormally low levels of blood glucose. It can cause symptoms ranging from mild discomfort to severe neurological impairment and requires prompt treatment to prevent complications.
Hypoglycemia: Hypoglycemia is a condition characterized by an abnormally low level of blood glucose, often occurring in individuals with diabetes or certain other medical conditions. It is a critical concern in the context of neurologic wellness, endocrine system function, and various treatments that can impact blood sugar regulation.
Insulin: Insulin is a hormone produced by the pancreas that plays a crucial role in regulating blood sugar levels and facilitating the body's use of glucose for energy. It is a key player in carbohydrate metabolism, the function of digestive organs, and the overall health and wellness of the endocrine system.
Lactic Acidosis: Lactic acidosis is a metabolic condition characterized by an abnormal buildup of lactic acid in the bloodstream. It occurs when the body produces more lactic acid than it can remove, leading to a drop in blood pH and disruption of normal bodily functions.
This term is particularly relevant in the context of treatments and nutrition, as lactic acidosis can arise from various medical conditions and dietary factors, and its management often involves nutritional interventions.
Levothyroxine: Levothyroxine is a synthetic form of the thyroid hormone thyroxine (T4) used to treat hypothyroidism. It helps restore the body's natural hormone levels, improving metabolism and energy.
Levothyroxine: Levothyroxine is a synthetic form of the thyroid hormone thyroxine (T4). It is the primary treatment for hypothyroidism, a condition where the thyroid gland does not produce enough thyroid hormones to meet the body's needs. Levothyroxine is used to replace the missing thyroid hormones and restore normal thyroid function.
Liothyronine: Liothyronine, also known as T3 (triiodothyronine), is a synthetic thyroid hormone used to treat hypothyroidism and other thyroid-related conditions. It is a critical component in the regulation of metabolism, energy production, and various physiological processes within the body.
Loop diuretics: Loop diuretics are a class of medications that promote the excretion of sodium, potassium, and water by inhibiting the reabsorption of these ions in the kidney's loop of Henle. They are commonly used to treat conditions such as edema and hypertension.
Loop Diuretics: Loop diuretics are a class of medications that work by inhibiting the reabsorption of sodium, chloride, and potassium in the thick ascending limb of the loop of Henle in the kidneys. This leads to increased excretion of these electrolytes, as well as water, making loop diuretics an effective treatment for conditions like edema, hypertension, and heart failure.
Malnutrition: Malnutrition refers to a state of nutritional imbalance, where an individual's intake of nutrients is either insufficient, excessive, or imbalanced, leading to adverse effects on their health, growth, and overall well-being. This term is particularly relevant in the context of nursing practice, population health, and the care of vulnerable populations.
Meglitinides: Meglitinides are a class of oral antidiabetic medications that work by stimulating the pancreas to release more insulin, helping to lower blood glucose levels in individuals with type 2 diabetes. They are a type of insulin secretagogue, meaning they trigger the release of insulin from the beta cells in the pancreas.
Metformin: Metformin is an oral medication primarily used to manage blood glucose levels in individuals with type 2 diabetes. It works by decreasing hepatic glucose production and improving insulin sensitivity.
Niacin: Niacin, also known as Vitamin B3, is a water-soluble vitamin that plays a critical role in energy metabolism and cellular function. It is essential for the health of the nervous system and skin.
Plasma parathyroid hormone (PTH): Plasma parathyroid hormone (PTH) is a hormone produced by the parathyroid glands that regulates calcium levels in the blood. It plays a crucial role in bone metabolism, kidney function, and vitamin D synthesis.
Potassium-Sparing Diuretics: Potassium-sparing diuretics are a class of medications that help the body eliminate excess fluid while preserving potassium levels. These diuretics work by blocking the reabsorption of sodium and water in the kidneys, leading to increased urination and fluid loss, but without the accompanying loss of potassium that often occurs with other types of diuretics.
SGLT2 Inhibitors: SGLT2 inhibitors are a class of medications used primarily to treat type 2 diabetes. They work by blocking the sodium-glucose cotransporter 2 (SGLT2) in the kidneys, which reduces the reabsorption of glucose and increases its elimination through urine, thereby lowering blood glucose levels.
Sodium–potassium–chloride transporter: The sodium–potassium–chloride transporter is a membrane protein that moves sodium (Na+), potassium (K+), and chloride (Cl-) ions across cells. It plays a crucial role in maintaining cell volume, osmotic balance, and electrochemical gradients.
Sulfonylureas: Sulfonylureas are a class of oral antidiabetic medications that work by stimulating the pancreas to produce more insulin, thereby helping to lower blood glucose levels in individuals with type 2 diabetes. These drugs play a crucial role in the management of diabetes, particularly in the context of nutrition and overall treatment strategies.
Thiazide diuretics: Thiazide diuretics are medications that help the kidneys remove excess sodium and water from the body. They are often used to treat hypertension and prevent fluid retention.
Thiazide Diuretics: Thiazide diuretics are a class of medications that work by inhibiting the reabsorption of sodium and chloride in the distal convoluted tubule of the kidney, leading to increased excretion of water and reduction in blood volume and pressure. They are commonly used to treat hypertension, edema, and certain types of kidney stones.
Thiazolidinediones: Thiazolidinediones (TZDs) are a class of oral antidiabetic medications that work by improving insulin sensitivity and reducing insulin resistance in the body. They are primarily used in the management of type 2 diabetes mellitus.
Thyroid medications: Thyroid medications are drugs used to treat thyroid disorders by regulating hormone levels. They are crucial in managing conditions such as hypothyroidism and hyperthyroidism.
Vitamin B12: Vitamin B12, also known as cobalamin, is a water-soluble vitamin essential for red blood cell formation, neurological function, and DNA synthesis. It is naturally found in animal products and can be taken as a supplement.
Vitamin D: Vitamin D is a fat-soluble vitamin essential for the regulation of calcium and phosphorus in the body, crucial for maintaining bone health. It can be obtained from sunlight exposure, dietary sources, and supplements.