Health education on the scourge of cancer and its nutritional recommendations

Introduction

Cancer is a major burden of disease worldwide. Each year, tens of millions of people are diagnosed with cancer around the world and more than half of patients eventually die from it. In many countries, cancer ranks the second most common cause of death following cardiovascular disease. With significant improvement in treatment and prevention of cardiovascular diseases, cancer has or will soon become the number one killer in many parts of the world. As elderly people are most susceptible to cancer and population aging continence in many countries, cancer will remain a major health problem around the globe.

Biesheuvel, Weigel and Heindel (2011) described cancer as one of the world most killer disease today that has defied total cure. It is one of the major causes of death in Nigeria especially among the woman who die from cervical and breast cancer. The burden of cancer is increasing globally with an expected 20 million new cases in 2020, half of which will be low and middle income countries.

According to the World Health Organization (WHO) report, Nigeria alone is estimated to have 350,000 new diagnosed cases annually which by the 2020. The four common cancer found in Nigeria are prostate and liver cancer in males and breast and cervical cancer in females. In Nigeria the disease is not only causing anxiety among the old and middle aged women but also in teenagers. Expert says “cervical cancer is caused by human papilloma virus (HPV)”. Both cervical and breast cancer can be prevented if detected early and the right vaccine taken.

According to Saunders(2009), the rate of cancer is alarming because we have not put in place measures to defect and treat cancer at pre-cancer and early cancer stages. He said we also have in abundance cancer promoting factors like infections diet and poor life styles.

Conceptual framework

Cancer is an abnormal growth of the cell in human body. Reeder and Vogel (2008) defined cancer as the uncontrolled growth of abnormal cells anywhere in a body. These abnormal cells are termed cancer cells, malignant cells or tumours.

According to Hartmann, Schaid, Woods, Crotty and Myers(2009) cancer is a name given to a collection of related disease. Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally human cells grow and divide to form new cells as the body needs them. When cells grow old or become damage, they die and new cells take their place. However, when cancer develop, this orderly process breakdowns i.e. the cell become more abnormal in which old or damage cell survive when they should die and new cell grow when  they are not needed. These cells grow rapidly without stopping and from growth called tumours. Many cancer term solid tumours which are masses of tissue cancer of the blood such as leukaemia generally do not form solid tumour.

Cancerous tumours are malignant which means they can spread into or invade nearby tissues. In addition, as these tumour grow, some cancer cell can break off and travel to distant place in the body through the blood or the lymph system and form new tumour far from the original tumour unlike malignant tumours, benign tumours do not spread into or invade nearby tissue. Benign tumour can sometimes be quite large however, when remove, they usually don’t grow back, whereas malignant tumours sometimes do (Nelson, Smith and Gridffin, 2013).

Types of cancer

According to Blackburn and Wang (2009),there are more than 100 types of cancer and they are usually named for the organ or tissue where the cancers form. For example, lung cancer starts in cells of the lung.

• Carcinoma: Carcinoma are the most common type of cancer. They are formed by epithelial cells which are the cell that cover the inside and outside surface of the body. There are many types of epithelial cells, which often have a Colum-like shape when viewed under a microscope under carcinoma there are also different type which include;
• Adenocarcinoma: Is a cancer that forms in epithelial cell that produce fluids or mucus. They are sometime called granular tissue example are cancer of the breast, colon and prostate.
• Basal cell carcinoma: Is a cancer that begins in a lower or basal (base) layer of the epidermis which is a person’s on outer layer of skin.
• Squamous cell carcinoma:Is a cancer that forms in squamous cells, which are epithelial cells that lie just beneath the outer surface of the skin. Squamous cells also line many other organs including stomach, intestine, lungs, bladder and kidney. Squamous cell carcinoma is sometime called epidermoid carcinoma.
• Transitional cell carcinoma: Is a cancer that forms in a type of epithelial tissue called transitional epithelium or urothelium. This tissue is found in the lining of the bladder, urethra and part of the kidney and a few other organs some cancer of the bladder, urethers and kidney are transitional cell carcinoma.
• Sarcoma: Sarcoma are cancer that form in soft tissue and borne, including muscle, fat, blood vessels, lymph vessels and fibrous tissue (such as tendons and ligaments). Osteosarcoma is the most common cancer of bone. The most common type of soft tissue sarcoma are leimyosarcoma, Kaposi sarcoma, malignant fibrous histiocytoma, liposarcoma and dermatofibro sarcoma.
• Leimyosarcoma: Is a malignant (cancer) tumor of smooth muscles cells that can arise almost anywhere in the body, but is most common in the uterus, abdomen or pelvis.
• Kaposi sarcoma: Is a type of cancer in which lesion (abnormal area) grow in the skin, lymph nodes, lining of the mouth, nose and throat and other tissue of the body.
• Malignant fibrous histiocytoma: A soft tissue sarcoma that usually occurs in the limbs, most commonly the legs and may also occur in the abdomen.
• Lip sarcoma: A rare cancer of the fat cells.
• Dermatofibrosarcoma: A type of tumour that begins as a hard nodule and grows slowly. These tumours are usually found in the dermis (the inner layer of the two main layer of tissue that make up the skin) of the limbs or trunk of the body
• Leukaemia: Cancer that begins in the blood forming tissue of the bone marrow are called leukaemia. These cancer do not form solid tumours, instead large numbers of abnormal white blood cells (leukaemia cell and leukemic blast cell) build up in the blood and bone marrow, crowding out normal blood cells. The low level of normal blood cells can make it harder for the normal blood cells can make it harder for the body to get oxygen to it tissue, control bleeding or fight infections.
• Lymphoma: Lymphoma is cancer that begins in lymphocyte (T.cells or B. cells). These are disease fighting white blood cells that are part of the immune system. In lymphocytes build up in lymph nodes and lymph vessels as well as in other organs of the body.
• Melanoma: Melanoma is cancer that begins in cells that become melanocyte, which are specialized cells that make melanin (the pigment that gives skin its colour) most melanomas form in the skin, but melanoma can also form in other pigmented tissue such as the eye.

Causes of cancer

1. Genetic factors
2. Lifestyle factors such as tobacco use, diet and physical activity.
3. Certain types of infections
4. Environmental exposures to different types of chemicals and radiation

• Genetic factors: Some types of cancer run in certain families but most cancer is most clearly linked to the genes we inherit from our parents. Gene changes that start in a single cell over the course of a person’s life cause most cancers.
• Lifestyle factors such as tobacco use, diet and physical activity: Research has shown that poor diet and not being active are two keys factors that can increase a person’s cancer risk.
• Certain types of infection: In the United States and other developed countries, a small portion of cancer is thought to be linked to infections.
• Environmental exposure to different types of chemicals and radiation: Exposure to certain environment which include substance as chemical in tobacco smoke, smoke from cigarette and radiation such as ultraviolet rays from the sun.

When cancer spread

In metastasis, cancer cells break away from where they (primary cancer), travel through the blood or lymph system and form new tumour (metastatic tumour) in other part of the body. The metastatic tumour is the same type of cancer as the primary tumour. A cancer that has spread from the where it first started to another place in the body is called metastatic cancer. The process by which cancer cell spread to another part of the body is called metastatic (Lacroix, 2010)

Signs and symptoms

It depends on the types of cancer, where it is located and where the cancer cells have spread.

• Change in bowel or bladder habits
• A sore throat that does not heal
• Unusual bleeding or discharge (for example nipple secretions or a sore that will not heal that oozes material
• Thickening or lump in the breast, testicle or elsewhere.
• Nagging cough or hoarseness

Diagnosis of cancer

If you have a symptom or your screening test result suggests cancer, the doctor must find out whether it is due to cancer or some other cause. The doctor may ask about your personal and family medical history and do a physical exam. The doctor also may order lab test, scans or other tests or procedure.

Lab test

High or low levels of certain substances in your body can be a sign of cancer. So, lab tests of the blood, urine or other body fluid that measure these substances can help doctor make a diagnosis. However, abnormal lab result is not a sure sign of cancer. Lab tests are an important tool but doctor cannot rely on them alone to diagnose cancer.

Imaging procedure

Imaging procedure create picture of areas inside your body that help the doctor see whether a tumour is present. These pictures can be made in several ways:

• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive a dye or other contrast material helps make these pictures easier to read.
• Nuclear scan: For this scan, you receive an injection of a small amount of radioactive material, which is sometime called tracer. It flows through your bloodstream and collect in certain bones or organs. A machine called a scanner detects and measures the radioactivity. The scanner creates a picture of bones or organs on a computer screen or on film. Your body gets rid of the radioactive substance quickly.
• Ultrasound: An ultrasound device sends out sound waves that people cannot hear. The waves bounce off tissue inside your body like an echo. A computer uses these echoes to create a picture of areas inside your body. This picture is called a sonogram.
• MRI: A strong magnet linked to a computer is used to make detailed picture of areas in your body. Your doctor can view these pictures on a monitor and print them on film.
• Pet scan: For this scan, you receive an injection or a tracer then, a machine makes 3-D picture that show where the tracer collects in the body. This scan show how organs and tissue are working.
• X-rays: X-ray use low doses of radiation to create picture of the inside of your body.

Biopsy

In most case doctors need to do a biopsy to make a diagnosis of cancer. A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist then looks at the tissue under a microscope to see if it cancer. The sample may be removed in several ways:

With a needle: The doctor uses a needle to withdraw tissue or fluid.

With an endoscope: The doctor looks at areas inside the body using a thin, lighted tube called an endoscope. The scope is inserted through the natural opening such as the mouth. Then, the doctor uses a special tool to remove tissue or cells through the tube.

Complications of cancer

According to Kahlenborn, Modungo, Potter and Severs(2010) cancer can cause several complications including:

• Difficulty in breathing: Cancer may cause a feeling of being short of breath. Treatment may bring relief.
• Diarrhoea or constipation: Cancer can affect your bowels and cause diarrhoea or constipation.
• Chemical changes in your body: Cancer can upset the normal chemical balance in your body and increase your risk of serious complication. Sign and symptom chemical imbalance might include: excessive thirst, frequent urination, constipation and confusion.
• Brain and nervous system problems: Cancer can press on nearby nerves and pain and loss of function of one part of your body. Cancer that involves the brain can cause headaches and stroke like signs and symptoms such as weakness on one side of your body.
• Unusual immune system reaction to cancer: In some cases, the body’s immune system may react to the presence of cancer by attacking healthy cells called paraneoplastic syndrome, these very rare reaction can lead to a variety of sign and symptoms such as difficulty walking and seizures.
• Cancer that spreads: A cancer advances, it may spread (metastasize) to other part of the body.

Prevention of cancer

It is well accepted that your chances of developing cancer are affected by the lifestyle choices you make. So if you are concerned about cancer prevention, take comfort in the fact that some simple lifestyles changes can make a big difference. Consider these six cancer prevention tips by Kahlenborn et al. (2010):

• Don’t use tobacco: Using any type of tobacco puts you on a collision course with cancer. Smoking has been linked to various types of cancer such as cancer of the lung, mouth, throat, pancreas and cervix. Even if you don’t use tobacco, exposure to second-hand smoke night increases your risk of lung cancer. Avoiding tobacco is one of the most important health decisions you can make.
• Eat a healthy diet: Base your diet on fruits and vegetable and other food from plant source. Eat lighter and leaner by choosing fewer high calorie foods including refined sugar and fat from animal sources. If you choose to drink alcohol, do so only in moderation. The risk of various types of cancer increase with the amount of alcohol you drink and the length of time you have been drinking regularly.
• Maintain a healthy weight and be physically active: Maintaining a healthy weight might lower the risk of various type of cancer. Physical activities count too. In addition to helping you control your weight, physical activity on its own might lower the risk of breast and colon cancer. The link between overweight, obesity and cancer is becoming stronger and so taking steps to avoid being overweight or obese is important in reducing the risk of cancer. One of the reasons for this linkage is the relationship between excess fat and hormonal balance in the body. Research shows that fat cell releases hormones such as oestrogen which increase the risk of cancer such as breast cancer.
• Protect yourself from the sun: Skin cancer is one of the most common kinds of cancer and one of the most preventable.

Avoid midday sun: stay out of the sun when the sun rays are strongest. When you are outdoors, stay in the shade a much as possible. Wear tightly woven, loose fitting clothing that cover as much of your skin as possible

• Get immunized

Cancer prevention includes protection from certain viral infection.

• Hepatitis B: Hepatitis B can increase the risk of developing liver cancer. Hepatitis B vaccine is recommended for certain high risk adults. Such as adults who are sexually active but not in a mutually monogamous relationship, people with sexually transmitted infections, intravenous drugs users, man who have sex with men.
• Human papillomavirus (HPV): HPV is asexually transmitted virus that can lead to cervical and other genital cancers as well as squamous cells cancer of the head and neck. The HPV vaccine is recommended for girls and boys age 11-12. It is also available to both men and women age 26 or younger who didn’t have the vaccine as adolescences.
• Avoid risky behaviours: Another effective cancer prevention tactic is to avoid risky behaviours that can lead to infection that in turn might increase the risk of cancer. For example limit your number of sexual partners and use a condom when you have sex. The more sexual partners you have in your infection, the more likely you are to contact a sexually transmitted infection such as HIV of HPV. People who have HIV or AIDS have a higher risk of cancer of the anus, liver and lung. HPV is most often associated with cervical cancer, but might also increase the risk of cancer of the anus, penis and vigina.

Treatment

There are many type of cancer treatment. The types of treatment that you receive will depend on the type of cancer you have and how advanced it is. The main types of cancer treatment include:

• Surgery
• Radiation therapy
• Chemotherapy
• Immunotherapy
• Targeted therapy
• Hormone therapy.

Surgery: When used to treat cancer, is a procedure in which a surgeon removes cancer from your body. Many people with cancer are treated with surgery. Surgery works best for solid tumour that are contained in one area. It is a local treatment, meaning that it treats only the part of your body with the cancer. It is not used for leukaemia (a type of blood cancer) or for cancer that has spread.

Radiation therapy: Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancerous cells and shrink tumours. At high doses, radiation kills cancerous cell or slows their growth. Radiation therapy can be used to cure cancer, to prevent it from returning or to stop or slow its growth. Radiation may also be use to shrink a tumour to treat pain and other problem caused by the tumour. Radiation therapy does not kill cancerous cells right away. It takes days or weeks of treatment before cancerous cells start to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends.

Chemotherapy: Is a type of cancer treatment that uses drugs to kill cancer cells. Chemotherapy works by stopping or slowing the growth of cancer cells which grow and divide quickly. When used with other treatment, chemotherapy can make a tumour smaller before surgery or radiation therapy. This is called neoadjuvant chemotherapy. Destroy cancer cells that may remain after treatment with surgery or radiation therapy. This is called adjvant chemotherapy. Help other treatment work better kill cancer cell that have returned or spread to other parts of the body.

Immunotherapy: Is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other disease. It is made up of white blood cells and organs and tissue of the lymph system. Immunotherapy is a types or biological therapy. Biological therapy is a types of treatment that use substance made from living organism to treat cancer. One reason that cancer cell thrive is because they are able to hide from your immune system. Certain immunotherapy’s can mark cancer cell so it is easier for the immune system to find and destroy cancer. There are differ types of immunotherapy which include:

Monoclonal antibodies: Which are drugs that are designed to bind to specific targets in the body. They can cause an immune system response that destroys cancer cells. Other types of monoclonal antibodies can ‘mark’ cancer cells so it is easier for the immune system to find and destroy cancer.

Adoptive cell transfer: Which is a treatment that attempts to boost the natural ability of your T-cell to fight cancer. T cells are a type of white blood cell and part of the immune system.

Cytokines: which are proteins that are made by your body’s cell. They play important roles in the body’s natural immune response and also in the immune system ability to respond to cancer. The two main type of cytokines use to treat cancer are called intetrferous and interlenkins

Targeted therapy: is a type of cancer treatment that target the change in cancer cell that help them grow, divide and spread. Most target therapies help treat cancer by interfering with specific protein that help tumours grow and spread throughout the body. They treat cancer in many different ways.

They can:

• Help the immune system destroy cancer cell
• Stop cancer cell from growing
• Stop signals that help form blood vessels
• Deliver cell killing substances to cancer cells
• Cause cancer cell death

Hormone therapy: Is a cancer treatment that slow or stops the growth of cancer that uses hormones to grow

Nutritional recommendations

Nutrition is an important part of cancer treatment. Eating the right kinds of food before, during and after treatment can help you feel better and stay stronger. Cancer patient must eat a balance diet packed with nutrient that can help them stay strong and energetic.

Cancer patients should avoid stringent food restriction. Since cancer treatment often cause side effects like nausea and taste change leading to a loss of appetite, it is important that patient don’t  have too many dietary restriction imposed on them. The strategy is to serve them their favourite foods without too much fuss on the finer aspect of a healthy diet.

A good diet for cancer patient contains a mix of vegetables and meats and also by avoiding extremely sweet and oily foods. Preferred cooking methods are steaming, boiling and stir frying rather than deep frying, grilling, barbequing and baking.

A balance diet should provide the body with proteins (to build tissue, prevent infection, heal wounds and maintain a healthy immune system), carbohydrate and fats(energy source), vitamins and minerals(for proper growth, body functioning) and most importantly, plenty of water and fluid to prevent dehydration

Foods to include in your diet as a cancer patient include

Vegetable

• Tomatoes, carrot, peas, pumpkins and turnips for vitamins and fibre
• Tomatoes, tomato puree and parsley (especially good for prostate cancer patients)
• Cruciferous vegetable like broccoli, cauliflowers and cabbage contain plant chemicals that can convey bad oestrogen into good oestrogen and hence reduce cancer risk
• Green leafy vegetable for calcium and iron fruit

Fruits

• Oranges provide vitamin C
• Bananas, peaches, mangoes, pears and strawberries for vitamin and fibre.
• Avocadoes, guava, apricot, figs, prunes for energy

Protein

• Lean meat, fish, poultry, eggs
• Diary product, nuts, dried beans and chickpeas
• Fish and soy foods (especially for prostate cancer patient)

Carbohydrate

• Rice, noodles, whole grain bread and pasta
• Wholegrain crackers, oats corn, potatoes, beans, honey when consumed in moderation for its antibacterial and antifungal properties which help in preventing infections

Food to avoid as a cancer patient

• Deep fried, grilled, barbequed, baked meats since subjecting animal protein to high heat creates carcinogenic byproduct called heterocyclic amines
• Excessive intake of salt, sugar and oily foods
• Red meat and processed meats such as bacon, ham, sausages
• Preserved foods like pickles, jams and century eggs as they contain nitrites which are carcinogenic
• Minimize alcohol

Additionally, cancer patients should avoid excessive intake of vitamins supplements as they acts as antioxidants and can interfere with chemotherapy when taken in large dose.

References

Biesheuvel, C., Weigel, S. & Heindel, W. (2011). Mammography Screening: Evidence, History and Current Practice in Germany and Other European Countries”. Cancer care, 6 (2), 104–109.

Blackburn, G.L. & Wang, K.A. (2007). Dietary fat reduction and cancer outcome: results from the Women’s Intervention Nutrition Study (WINS). The American Journal of Clinical Nutrition, 86 (3), s878–81.

Hartmann, L.C., Schaid, D.J., Woods, J.E., Crotty, T.P. & Myers, J.L. (1999). “Efficacy of bilateral prophylactic mastectomy in women with a family history of cancer”. N Engl J Med,340 (2), 77–84.

Kahlenborn, C., Modugno, F., Potter, D.M. &Severs, W.B. (2006). “Oral contraceptive use as a risk factor for cancer: a meta-analysis.”. Mayo Clinic proceedings. Mayo Clinic,81 (10),1290–302.

Lacroix, M. (2006). Significance, detection and markers of disseminated breast cancer cells. Endocrine-related Cancer, 13 (4), 1033–67

Nelson, H.D., Smith, M.E. & Griffin, J.C.(2013). Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 158 (8),604–14.

Reeder, J.G. &Vogel, V.G. (2008). “Breast cancer prevention.”. Cancer treatment and research 141: 149–64.

Saunders, C. & Jassal, S. (2009). Cancer(1. ed. ed.). Oxford: Oxford University Press.