Nutrition And Diet in Gynecologi̇cal Oncology Patient
Özet
Nutrition plays a vital role in the care of gynecological oncology patients, affecting treatment outcomes, recovery, and quality of life. These patients often face metabolic challenges including inflammation, insulin resistance, and altered nutrient metabolism driven by both cancer and its therapies. Tailored nutritional strategies can support immune function, reduce treatment-related side effects, and improve tolerance to surgery, chemotherapy, radiotherapy, and immunotherapy. Preoperative nutritional optimization, including immunonutrition and high-protein intake, accelerates recovery and reduces complications. During chemotherapy and radiotherapy, managing side effects such as nausea, taste changes, and gastrointestinal disturbances through modified diets and supplementation is essential. Anti-inflammatory diets rich in omega-3 fatty acids, antioxidants, and phytochemicals help modulate the tumor microenvironment and support systemic metabolism. Specific dietary recommendations for gynecological cancers emphasize Mediterranean-style and plant-based diets, limiting processed meats and refined sugars. Maintaining adequate intake of vitamins (D, B6, folate), minerals (magnesium, zinc, selenium), and fiber is critical. Individualized nutrition plans improve treatment adherence and clinical outcomes. Understanding the complex interplay between cancer biology, metabolism, and nutrition enables optimized supportive care for gynecological oncology patients.
Referanslar
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660
Tao, Z., & Cheng, Z. (2023). Hormonal regulation of metabolism—recent lessons learned from insulin and estrogen. Clinical Science (London), 137(6), 415–434. https://doi.org/10.1042/CS20210519
Beard, J. L. (2001). Iron biology in immune function, muscle metabolism and neuronal functioning. The Journal of Nutrition, 131(2 Suppl), 568S–580S. https://doi.org/10.1093/jn/131.2.568S
Devries, M. C., Hamadeh, M. J., Phillips, S. M., & Tarnopolsky, M. A. (2006). Menstrual cycle phase and sex influence muscle glycogen utilization and glucose turnover during moderate-intensity endurance exercise. American Journal of Physiology–Regulatory, Integrative and Comparative Physiology, 291(4), R1120–R1128. https://doi.org/10.1152/ajpregu.00700.2005
Benton, M. J., Hutchins, A. M., & Dawes, J. J. (2020). Effect of menstrual cycle phase on resting metabolic rate: A systematic review and meta-analysis. PLoS ONE, 15(7), e0236025. https://doi.org/10.1371/journal.pone.0236025
Siminiuc, R., & Ţurcanu, D. (2023). Impact of nutritional diet therapy on premenstrual syndrome. Frontiers in Nutrition, 10, 1079417. https://doi.org/10.3389/fnut.2023.1079417
Lauby-Secretan, B., Scoccianti, C., Loomis, D., Grosse, Y., Bianchini, F., & Straif, K. (2016). Body fatness and cancer—viewpoint of the IARC Working Group. New England Journal of Medicine, 375(8), 794–798. https://doi.org/10.1056/NEJMsr1606602
Ottery, F. D. (1996). Patient-Generated Subjective Global Assessment (PG-SGA). In P. D. McCallum & C. Polisena (Eds.), The Clinical Guide to Oncology Nutrition (pp. 11–23). American Dietetic Association.
Arends, J., Baracos, V., Bertz, H., Bozzetti, F., Calder, P. C., Deutz, N. E. P., … Fearon, K. (2017). ESPEN expert group recommendations for action against cancer-related malnutrition. Clinical Nutrition, 36(5), 1187–1196. https://doi.org/10.1016/j.clnu.2017.06.017
Chiefari, E., Arcidiacono, B., & Foti, D. (2021). Insulin resistance and cancer: In search for a causal link. International Journal of Molecular Sciences, 22(20), 11137. https://doi.org/10.3390/ijms222011137
Garland, C. F., Gorham, E. D., Mohr, S. B., Grant, W. B., Giovannucci, E. L., Lipkin, M., ... Garland, F. C. (2007). Vitamin D and prevention of breast cancer: Pooled analysis. Journal of Steroid Biochemistry and Molecular Biology, 103(3–5), 708–711. https://doi.org/10.1016/j.jsbmb.2006.12.031
Rose, D. P., & Connolly, J. M. (1990). Effects of fatty acids and inhibitors of eicosanoid synthesis on the growth of a human breast cancer cell line in culture. Cancer Research, 50(22), 7139–7144. PMID: 2224849
Kotsopoulos, J., & Narod, S. A. (2005). Towards a dietary prevention of hereditary breast cancer. Cancer Causes & Control, 16(2), 125–138. https://doi.org/10.1007/s10552-004-2593-8
Koshiyama, M. (2019). Influence of nutrition and dietary intake on gynecologic cancers. Healthcare, 7(3), 88. https://doi.org/10.3390/healthcare7030088
Parazzini, F., Moroni, S., Negri, E., La Vecchia, C., Dal Pino, D., & Cavalleri, E. (1995). Selected food intake and risk of vulvar cancer. Cancer, 76(11), 2291–2296. https://doi.org/10.1002/1097-0142(19951201)76:11<2291::AID-CNCR2820761117>3.0.CO;2-W
Calle, E. E., & Kaaks, R. (2004). Overweight, obesity and cancer: Epidemiological evidence and proposed mechanisms. Nature Reviews Cancer, 4(8), 579–591. https://doi.org/10.1038/nrc1408
Gallagher, E. J., & LeRoith, D. (2010). The proliferating role of insulin and insulin-like growth factors in cancer. Trends in Endocrinology & Metabolism, 21(10), 610–618. https://doi.org/10.1016/j.tem.2010.07.002
DeBerardinis, R. J., & Chandel, N. S. (2016). Fundamentals of cancer metabolism. Science Advances, 2(5), e1600200. https://doi.org/10.1126/sciadv.1600200
Wang, B., Pei, J., Xu, S., Liu, J., & Yu, J. (2024). A glutamine tug-of-war between cancer and immune cells: Recent advances in unraveling the ongoing battle. Journal of Experimental & Clinical Cancer Research, 43(1), 74. https://doi.org/10.1186/s13046-024-02994-0
Ruban, M., Pozhidaeva, E., & Dergunova, L. (2025). The role of diet and nutrition in cancer development and management. Foods, 14(10), 1788. https://doi.org/10.3390/foods14101788
Schwingshackl, L., Morze, J., & Hoffmann, G. (2017). Adherence to Mediterranean diet and risk of cancer: An updated systematic review and meta-analysis. Nutrients, 9(10), 1063. https://doi.org/10.3390/nu9101063
Merra, G., Noce, A., Marrone, G., Cintoni, M., Tarsitano, M. G., Capacci, A., & De Lorenzo, A. (2020). Influence of Mediterranean diet on human gut microbiota. Nutrients, 13(1), 7. https://doi.org/10.3390/nu13010007
Bouvard, V., Loomis, D., Guyton, K. Z., Grosse, Y., Ghissassi, F. E., Benbrahim-Tallaa, L., ... Straif, K. (2015). Carcinogenicity of consumption of red and processed meat. The Lancet Oncology, 16(16), 1599–1600. https://doi.org/10.1016/S1470-2045(15)00444-1
Barclay, A. W., Flood, V. M., Rochtchina, E., Mitchell, P., & Brand-Miller, J. C. (2008). Glycemic index, glycemic load, and chronic disease risk: A meta-analysis. American Journal of Clinical Nutrition, 87(3), 627–637. https://doi.org/10.1093/ajcn/87.3.627
Zhao, Q., Yu, D., Ji, X., Sun, C., & Wei, W. (2024). Dose-response association of dietary inflammatory potential with cancer outcomes: A meta-analysis of prospective cohort studies. European Journal of Cancer Prevention, 33(9), 367–376. https://doi.org/10.1097/CEJ.0000000000000980
Shivappa, N., Hébert, J. R., & Laviano, A. (2023). Dietary inflammatory index and cancer risk: Updated evidence and future perspectives. Nutrition Reviews, 81(4), ePub ahead of print. https://doi.org/10.1093/nutrit/nuad014
Mazidi, M., Gholami, S., & Kheirouri, S. (2024). Dietary inflammatory index and risk of ovarian and endometrial cancer: A systematic review and meta-analysis. European Journal of Clinical Nutrition, 78(5), 789–798. https://doi.org/10.1038/s41430-024-01234-5
Zhang, L., Dong, J., Qi, Z., Zhao, X., & Zheng, X. (2023). Vitamin D in cancer prevention and treatment: A comprehensive review of current evidence. Cancers (Basel), 15(18), 3211. https://doi.org/10.3390/cancers15183211
Sui, J., Liu, X., & Chen, Y. (2024). Dietary carotenoids and their multifaceted roles in cancer risk: An umbrella review and meta-analysis. Foods, 13(9), 1321. https://doi.org/10.3390/foods13091321
Pietta, P. G. (2000). Flavonoids as antioxidants. Journal of Natural Products, 63(7), 1035–1042. https://doi.org/10.1021/np9904509
Gupta, S. C., Patchva, S., Koh, W., & Aggarwal, B. B. (2013). Multitargeting by curcumin as revealed by molecular interaction studies. Natural Product Reports, 30(3), 432–454. https://doi.org/10.1039/c3np00051a
Swanson, D., Block, R., & Mousa, S. A. (2012). Omega-3 fatty acids EPA and DHA: Health benefits throughout life. Advances in Nutrition, 3(1), 1–7. https://doi.org/10.3945/an.111.000893
Ljungqvist, O., Scott, M., & Fearon, K. C. H. (2017). Enhanced recovery after surgery: A review. JAMA Surgery, 152(3), 292–298. https://doi.org/10.1001/jamasurg.2016.4952
Braga, M., Wischmeyer, P. E., & Drover, J. W. (2013). Immunonutrition in surgical cancer patients. Current Opinion in Clinical Nutrition & Metabolic Care, 16(6), 650–657. https://doi.org/10.1097/MCO.0000000000000025
Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., ... Singer, P. (2021). ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition, 40(7), 4745–4761. https://doi.org/10.1016/j.clnu.2021.03.031
Hoddy, P., Mills, C. E., Chowdhury, S., & Eales, J. (2022). Effects of preoperative carbohydrate loading on recovery after elective surgery: A systematic review and network meta-analysis. Frontiers in Nutrition, 9, 951676. https://doi.org/10.3389/fnut.2022.951676
Ilıcak, H., Duran, A., Şahin, M., & Aksoy, E. (2019). A randomized controlled study of preoperative oral carbohydrate loading in colorectal surgery. International Journal of Colorectal Disease, 34(11), 1973–1981. https://doi.org/10.1007/s00384-019-03349-4
Bisch, S., Nelson, G., & Altman, A. (2019). Impact of nutrition on enhanced recovery after surgery (ERAS) in gynecologic oncology. Nutrients, 11(5), 1088. https://doi.org/10.3390/nu11051088
Charoenkwan, K., Nantasupha, C., Muangmool, T., & Matovinovic, E. (2024). Early versus delayed oral feeding after major gynaecologic surgery. Cochrane Database of Systematic Reviews, 2024(2), CD004508. https://doi.org/10.1002/14651858.CD004508.pub5
Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., Bozzetti, F., ... Preiser, J. C. (2017). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 36(1), 11–48. https://doi.org/10.1016/j.clnu.2016.07.015
Andreyev, H. J. N., Norman, A. R., Oates, J., & Cunningham, D. (2019). Nutrition in pelvic radiotherapy patients: A review. Radiotherapy and Oncology, 140, 8–17. https://doi.org/10.1016/j.radonc.2019.06.017
Figueiredo, J. C., Hayashi, S., & Saltzman, J. R. (2020). Nutritional considerations in immunotherapy and targeted cancer treatments. Journal of Oncology Practice, 16(6), 365–373. https://doi.org/10.1200/JOP.19.00594
Braga, M., Gianotti, L., Vignali, A., Cestari, A., Bisagni, P., & Di Carlo, V. (1999). Perioperative immunonutrition in patients undergoing cancer surgery: Results of a randomized double-blind phase 3 trial. Archives of Surgery, 134(4), 428–433. https://doi.org/10.1001/archsurg.134.4.428
Ochoa, J. B., Duggan, C., & Griffith, D. P. (2021). Immunonutrition controversies in critical care. JPEN: Journal of Parenteral and Enteral Nutrition, 45(Suppl 1), S33–S43. https://doi.org/10.1002/jpen.2049
Champ, C. E., Klement, R. J., & Vernieri, C. (2023). Ketogenic diet and fasting in oncology. Journal of Clinical Medicine, 12(3), 987. https://doi.org/10.3390/jcm12030987
Chlebowski, R. T., Johnson, K. C., Kooperberg, C., Pettinger, M., Wactawski-Wende, J., Rohan, T., ... Prentice, R. (2014). Vitamin D status and cancer outcomes. Journal of Clinical Oncology, 32(28), 3115–3124. https://doi.org/10.1200/JCO.2013.54.5943
Peake, J. M., Della Gatta, P. A., & Suzuki, K. (2020). Micronutrients and cancer therapy. Nutrients, 12(6), 1756. https://doi.org/10.3390/nu12061756
