Diet and oesophageal cancer
This page is about how cancer of the food pipe (oesophagus) and its treatment can affect your diet. You can find the following information
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. If you are having problems swallowing, you may need to have softer foods.
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
- Your oesophagus is narrowed or blocked by the tumour
- 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
- You feel sick, have lost your appetite or have taste changes
- You are feeling tired and anxious, which makes it more difficult to eat
Swallowing is the passage of food from the mouth into the stomach, not just passing the back of the throat. 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
- Make fruit smoothies in a blender
- Try tinned fruit which is softer but is still nutritious, adding custard if you like it
- Try ice cream, yoghurts and mousse
A dietician can help you cope with any problems with eating. They will be able to support you with diet problems from diagnosis, through treatment and afterwards.
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. You can also make these supplement drinks or smoothies into ice lollies, which some people prefer. Ask your dietician for advice on what powders or supplements to use and what you can get on prescription.
If you are unable to eat and drink enough and are losing weight, you may need a feeding tube into part of your small bowel called the jejunum. This is called a jejunostomy tube. If you have had surgery to remove your food pipe, the surgeon may have put a feeding tube in during the operation. In some cases, you may have nutrition directly into a vein. This is called parenteral nutrition. There is information about drip or tube feeding in the section about managing diet problems.
It is common for eating difficulties to become a source of tension, particularly when family members are doing their best to help someone to eat well and they can't manage it. There are many pleasurable aspects of eating that we take for granted such as planning meals, shopping for food, eating out or eating with friends. Many of these can be lost when someone has swallowing problems. You may feel low in mood, irritable and lose confidence. Your doctors, nurses and dietician will be familiar with this so talk to them about ways of getting support.
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.
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.
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 happen 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 meals more often
• 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 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.
During radiotherapy treatment and for a short while after finishing, it is likely that you will have difficulty with swallowing and it will be painful. During this time you may need to eat a softer diet than usual until the swelling inside the food pipe has settled. Some people may need a feeding tube for a time to help get the nutrition they need.
Sometimes radiotherapy can cause longer term problems with swallowing. The inside of the oesophagus becomes hard and less stretchy. Your doctor can relieve this by stretching the oesophagus. They usually do this with an endoscopy, while you are under sedation.
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. You can show this to your dietician so that they can make suggestions to help.
There is information about soft diet and on boosting calories in the managing diet problems section.
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