Diet and oesophageal cancer
This page is about how cancer of the food pipe (oesophagus) and its treatment can affect your diet. There is information about
Diet and oesophageal cancer
Having cancer of the food pipe (oesophagus) will affect your eating and drinking habits, whatever your stage or treatment. Many people with oesophageal cancer find it hard to eat well because they have difficulty swallowing. However it is important to eat well to ensure you are getting enough calories and protein to control weight loss and maintain your strength.
A dietician can help you to cope with any problems with eating or drinking. They can advise you about ways of maintaining weight by boosting calories in food and getting high calorie and high protein drinks or powders.
With everyday difficulties such as dietary problems, it often helps to get advice from people who are in the same situation as you. Try contacting a support group or one of the oesophageal cancer organisations.
It can help to keep a food diary if you are having problems that you think are related to your diet. Take a small notebook and draw a line down the centre of each page. Write down what you eat and when on the left of the page. Write down any symptoms you get and when on the other side of the page. After a few days, you may be able to spot which foods cause which symptoms.
You can view and print the quick guides for all the pages in the living with oesophageal cancer section.
Many people with oesophageal cancer find it hard to eat. This may be for a variety of reasons, for example
- Because your tumour is blocking part of your oesophagus
- During or after a course of radiotherapy
- After surgery to remove oesophageal cancer
- If you have had a tube (stent) put in to your oesophagus
If you have problems swallowing you will need to eat softer foods. You should avoid foods that may stick in your throat or which you have difficulty swallowing, like raw fruit and vegetables, tough meat or soft, doughy bread.
Make sure that you eat slowly and have plenty to drink during and after meals to soften your food and prevent blockages. It is best to avoid eating late in the day. It may be helpful to use a blender to process solid foods. You will find that you can eat most of your favourite foods with a few changes here and there. Here are some suggestions for a soft diet
- Use more sauces and gravies because moist food is easier to swallow than dry
- Long, slow cooking softens meat and vegetables
- Finely chop meat and vegetables in a food processor before or after cooking
- Blend or process meat or vegetable casseroles or curries to make tasty soups
If you have difficulty in maintaining your weight there are some ways of boosting the calorie content of everyday foods
- Porridge is a very nutritious breakfast – add syrup or sugar and cream
- Make up instant soups or gravies with milk instead of water
- Mix an egg, or grated cheese or cream with mashed potato
- Make instant coffee with all milk
You can increase the protein content of whole milk by adding a couple of tablespoons of dried milk powder per pint. Use it exactly like ordinary milk for drinking and cooking. You can also get protein powders and high energy powders from your dietician and sprinkle these on everyday foods or add them to recipes. Or you can have liquid food supplements such as Ensure plus and Fresubin on prescription from your doctor. Some of these come in 200ml cartons (the size of a small fruit juice carton). Keep one on hand and sip it throughout the day. You can really increase your calorie intake by doing this. Ask your dietician for advice on what to use and what you can get on prescription.
If you have had surgery, you will probably find that you have difficulty swallowing at first. Most people find it takes a few months to be able to eat fairly normally again. For some people it takes up to 2 years. This might be because your oesophagus is narrower or due to inflammation.
If your oesophagus and part of your stomach has been removed, you will need to adjust the amount you can eat at one time. The rest of your stomach will be moved up into the chest and so does not have as much room to store food. You may feel full more quickly. You may have to eat smaller, more frequent meals (about 6 to 8 a day) and eat slowly for quite a long time after the operation.
If you had surgery but did not have a major part of your stomach removed, you will be able to eat normally as soon as your doctor tells you that you can. But make sure you chew the food well. It is important to take good care of your teeth. Make sure there are no large lumps in the food that you swallow. This helps the joins in the food pipe to heal properly.
You may have some particular problems after surgery to remove the oesophagus. You may have
Dumping syndrome is a particular problem that can occur after oesophageal and stomach surgery. It is caused by food moving too fast into the small bowel. Dumping syndrome can occur just after you have eaten or some time afterwards.
Dumping syndrome just after a meal happens because the food is more highly concentrated than the fluids in the gut. So water is drawn into the gut to dilute the partly digested meal. This causes a sudden drop in your blood pressure, making you feel faint and dizzy. You may even have palpitations.
Dumping syndrome that comes on some time after you have eaten is due to a sudden rise in your blood sugar when the food passes into your small bowel and the sugar is absorbed. The body reacts by producing a sudden rush of the hormone, insulin. Insulin makes your blood sugar drop. When this happens, you will probably feel very faint and may need to sit or lie down.
You can reduce dumping syndrome by
• Eating slowly
• Reducing the amount of sugary foods you eat
• Adding fibre as you can manage it
• Increase the fat content of your food to replace the calories from sugary foods
• Eating smaller more regular meals (if that is possible)
• Avoid soup and very liquid foods
You can also try cutting down on the amount of liquids you drink and see if that helps. If you tend to get dumping syndrome some time after you have eaten, it may help to have glucose sweets between meals to keep your blood sugar up.
Diarrhoea can be a symptom of dumping syndrome. It can also happen because the vagus nerve is divided as part of your surgery to remove the tumour and lymph nodes. The vagus nerve controls the movement of the digestive system and the production of digestive juices. In a few people, this causes sudden urgent attacks of diarrhoea.
The diarrhoea happens occasionally and may last for about a day before your bowel habits go back to normal. Occasionally the diarrhoea can go on for longer. You may pass watery stools several times a day for several days out of each week. This can be difficult to treat. Sometimes taking anti diarrhoea medicine early each morning can help. If you have diarrhoea it is important to drink plenty of fluids so that you don't get dehydrated.
As the stomach is moved up into the chest after removal of the oesophagus, it doesn’t have as much room to stretch and store food, so you can feel full up quickly. Sometimes it can take a long time for the stomach to empty. This is often due to the vagus nerve being cut during surgery. This may mean you feel sick and bloated, particularly when you begin to eat larger meals. Your doctor may give you anti sickness drugs which help the stomach to empty, such as domperidone or metaclopramide (Maxalon).
Wind and pain can be a problem after this type of surgery. You may get it in bouts. Peppermint water can relieve trapped wind and so relieve pain. Put a few drops of peppermint oil in hot water and sip it slowly. You can buy peppermint oil at your chemist. Foods that might cause indigestion include fizzy drinks, alcohol, very spicy food, pickles, and citrus fruits.
To help avoid indigestion, you may find it helpful to eat slowly and stay sitting up for about 30 to 60 minutes after eating, and for a couple of hours before going to bed. You may also find it helpful not to lie completely flat. Extra pillows or raising the bed head by a few inches may help.
With everyday difficulties such as dietary problems, it often helps to get advice from people who are in the same situation as you. You can try contacting a support group. Look in the oesophageal cancer organisations section for organisations that can help.
Try keeping a food diary if you are having problems you think are related to your diet. Take a small notebook and draw a line down the centre of each page. Write down what you eat and the time on the left of the page. Write down any symptoms you get and when on the other side of the page. After a few days, you may be able to spot which foods cause which symptoms.
There is information about soft diet and on boosting calories in the managing diet problems section.
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