Discuss the risk factors of cancer and the dietary modifications for a cancer patient.

1. 1 · Open in two lines. Cancer is the uncontrolled growth of abnormal cells. Diet affects both the risk of cancer and the outcome of treatment.
2. 2 · Risk factors. Tobacco and areca nut, alcohol, obesity, processed and red meat, aflatoxin, salted and smoked foods, hot drinks, low plant foods, infections.
3. 3 · Draw the cachexia cycle. [Cycle: tumour → cytokines → anorexia and high energy use → muscle and fat loss → weakness → poor intake → more loss]
4. 4 · Diet principles.
   • Energy 25-30 kcal/kg; protein 1-1.5 g/kg (show a calculation).
   • Energy-dense fat, omega-3, RDA vitamins, 2-3 L fluid.
   • 6-8 small meals; supplements, then tube or parenteral feeding.
5. 5 · Foods to include and avoid. Enriched milk, eggs, paneer, fish, soft dal; avoid alcohol, tobacco, processed meat and fad diets.
6. 6 · Sample menu. A high-energy, high-protein one-day menu.
7. 7 · Close in one line. Good nutrition helps the patient complete treatment and recover.

Scoring tip: Use a risk-factor table with the cancer site in one column; it is quicker to write and scores more than a list.