Diet in advanced cancer
This page tells you about diet changes that may happen in advanced cancer. There is information about
Advanced cancer means the cancer has
- Spread from where it started in the first place
- Come back some time after you were first treated
If you have advanced cancer it may not be possible to cure it. But even if your cancer can't be cured, there is usually treatment available to control your symptoms.
Problems with eating and drinking may get worse when your cancer gets more advanced. The causes may be the same as those in people with earlier stage cancer but a few problems are more common in the advanced stages. These are
- A blockage in the bowel
- Not having enough fluid in your body
- Wasting syndrome (cachexia)
Managing problems to do with your diet if you have advanced cancer needs a different approach than for people who have temporary problems related to their cancer treatment. The main aim is to improve quality of life by controlling the symptoms.
Sometimes a cancer in the abdominal area, such as ovarian cancer or stomach cancer, can grow so that it partly or completely blocks the bowel. Your doctor may call this a bowel obstruction. The waste from food you have digested cannot get past the blockage. This will cause quite a few symptoms such as
- Feeling bloated and full
- Colicky type pain
- Feeling sick
- Vomiting large amounts
- Hard abdomen
There are several ways of dealing with a blocked bowel. You may have
- A drip, and a tube into your nose
- Surgery to unblock the bowel
- A tube into your bowel to relieve the blockage
- Octreotide to help stop fluid build up
- Low fibre diet
If you have a completely blocked bowel you will need to be admitted to hospital and stop eating and drinking until your bowel is working normally again. This means you will need to have fluids through a drip into a vein (intravenously). This is to make sure that you don’t get dehydrated. You will also need to have a tube into your nose and down into your stomach (a nasogastric tube or NG tube) to drain fluids and stop you feeling sick. This treatment gives your bowel time to rest. Sometimes, with rest, swelling in the bowel can go down and this can fix the blockage, but not always.
To relieve all these symptoms for a longer time, it is sometimes possible to operate to unblock the bowel. It may be possible to close up the bowel again. Or you may have to have a stoma. This is an opening of the bowel onto the outside of the abdomen. Your bowel motions come out of the opening into a plastic bag that sticks over the stoma opening. There is more about bowel surgery and having a stoma in our surgery for bowel cancer section.
You may want to talk over having this operation with your close family and friends as well as your doctor and nurse. No one can say how much you will benefit from the operation. The cancer may not come back to block the bowel again. But it is likely to be quite a big operation just when you are feeling very low.
It may be possible to avoid such a big operation using a technique called ‘endoluminal stenting’. This means having a metal tube put through the blockage to help keep your bowel open. The tube is called a stent. The doctor puts it in using an instrument called a laparoscope. This is a long tube with an eye piece at one end - a bit like a telescope. First you have a small cut (incision) made in your abdominal wall. The doctor puts the laparoscope inside and moves it into position where the bowel is blocked. The doctor can see inside through the laparoscope and can position the stent in the right place. The stent can relieve the bowel obstruction and avoid the need for a big operation. But this technique may not be suitable for everyone, so you will have to talk to your own specialist about it.
Sometimes it is possible to use a drug called octreotide to help control the symptoms of a blocked bowel instead of an operation. Octreotide works by reducing the amount of fluid that builds up in your stomach and digestive system. It can help to stop you feeling and being sick. Unfortunately this type of treatment is only a temporary measure.
Lowering the amount of fibre in the diet seems to help some people with a blocked bowel, by reducing the amount of stools.
You can feel very sick if you are constipated. It is a good idea to talk this over in detail with a doctor or nurse. Don't be embarrassed to ask for help with constipation. The longer you leave it the more problems it can cause. Fibre in your diet and plenty of fluids can help, but you may also need to take a laxative. Your doctor can prescribe one. Many hospital and community nurses know about constipation. Ask them to tell you how to prevent or relieve it. Then, you can get the treatment you need. There are books and booklets about preventing constipation, some of which are free. Look in the books and links section. Here is more information about constipation.
Remember - if you have constipation with severe abdominal pain and vomiting, don't take laxatives or increase your fibre intake. Contact your doctor as soon as possible. Your bowel may be blocked and too much fibre will make it worse.
This is called dehydration. Being dehydrated can make you feel sick, confused and tired. If you feel quite ill, you may not feel like eating or drinking much so it can be difficult to prevent dehydration. But if possible, try to drink every hour or two, even if it is only sips. Your doctor may give you some fluids through a drip to help. But this is not always the best solution if you are in the final stage of your illness.
For people in the advanced stages of cancer, cachexia is a very serious problem and extremely difficult to control. You may be eating well but still be losing weight and your muscles may begin to waste away. The only real way to reverse cachexia is to get rid of the cancer, but this is almost impossible in the very advanced stages of the disease.
Doctors have tried to reverse the effects of cachexia using appetite stimulants, steroids and parenteral nutrition (PN). But any improvement has been temporary and has not increased how long people live.
Scientists are learning more about cachexia and how it affects the body in the advanced stages of cancer. They are developing and testing new drugs and supplements that may help to block the chemical causes of cachexia. We have more about new treatments for cachexia.
If you have cachexia it is important that you eat whenever you can face it. Eating may not reverse the problem but it may help to stabilise weight loss, make you to feel better emotionally, give you more energy and improve your quality of life. These things are very important for you and your loved ones when you are in the advanced stages of cancer
- Try eating in the mornings - people tend to feel more like eating in the morning than in the evenings
- Try small meals and snacks often
- Don't worry too much about what you eat - if you feel like it, have it
- Ask the hospital dietician for hints on how to prepare simple foods that are easy to digest
- If you really don't feel like eating, at least drink small amounts as often as you can. Or try drinking high energy supplements between meals.
We have more tips on how to manage loss of appetite and other symptoms that cause problems with eating.
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