Find out about diet problems that can happen in advanced cancer, including information on treatments available to control your symptoms.
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.
Diet problems in advanced cancer
Problems with eating and drinking may get worse when your cancer gets more advanced.
Managing diet problems in advanced cancer is different to managing temporary problems related to cancer treatment. The main aim is to improve quality of life by controlling the symptoms.
A blockage in the bowel
About bowel obstruction
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 causes quite a few symptoms such as:
- feeling bloated and full
- colicky type pain
- feeling sick
- vomiting large amounts
- hard abdomen
Below are several ways of dealing with a blocked bowel.
A drip and a tube into your nose
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.
Surgery to unblock the bowel
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.
You may want to talk over having this operation with your close family and friends as well as your doctor and nurse. This is quite a big operation, when you are already feeling low. No one can say how much you will benefit from the operation. The cancer may not come back to block the bowel again.
A tube into your bowel to relieve the blockage
It may be possible to avoid such a big operation using a technique called ‘endoluminal stenting’.
You have a metal tube (stent) put through the blockage to help keep your bowel open. 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.
Octreotide to help stop fluid build up
Instead of an operation it is sometimes possible to use a drug called octreotide to help control the symptoms of a blocked bowel.
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.
Low fibre diet
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. Don't be embarrassed to ask for help with constipation. Many hospital and community nurses know about constipation. Ask them to tell you how to prevent or relieve it.
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.
Increasing fluid in your body
Not having enough fluid in your body is called dehydration.
Being dehydrated can make you feel sick, confused and tired. You might 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 might 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.
Coping with cachexia (wasting syndrome)
For people in the advanced stages of cancer, cachexia is a very serious problem and extremely difficult to control.
You might be eating well but still be losing weight. 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 improvements are only temporary and don’t increase how long you 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 might help to block the chemical causes of cachexia.
If you have cachexia it is important that you eat whenever you can face it. Eating might not reverse the problem but can help to stabilise weight loss. This will help you feel better emotionally, give you more energy and improve your quality of life.
The following 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.