Diet problems can happen when you have advanced cancer.
What is advanced cancer?
Advanced cancer means cancer has:
- spread from where it started in the first place
- come back some time after you were first treated
A cure may not be possible if you have advanced cancer. Your doctor will offer treatments that can help to control your symptoms.
Diet problems in advanced cancer
Problems with eating and drinking may get worse when your cancer gets more advanced.
Diet problems in advanced cancer are different from those related to cancer treatment. Your doctor and dietitian will manage it differently.
The main aim is for you to have a better quality of life by controlling the symptoms you have.
Some of the common diet problems in advanced cancer are:
- a blockage in the bowel
- not enough fluid in your body (dehydration)
- wasting syndrome (
A blockage in the bowel
Sometimes cancer in the tummy (abdominal) area can grow so that it partly or completely blocks the bowel. This can happen with ovarian, bowel or stomach cancer.
Other causes of a blocked bowel are:
- tissues that stick to the bowel after previous surgery (adhesions)
- thickening of tissue around the bowel that is a late side effect of radiotherapy
Your doctor may call this a bowel obstruction. The waste from the food you have digested can't get past the blockage.
This causes symptoms such as:
- feeling bloated and full
- tummy (abdominal) pain which can be crampy
- feeling sick
- vomiting large amounts
- a hard tummy (abdomen)
- bleeding from the back passage when the blockage is in the large bowel
Below are several ways of dealing with a blocked bowel.
A drip and a tube into your nose
Your doctor will admit you to the hospital if you have a completely blocked bowel. You stop eating and drinking until your bowel is working normally again.
This means you have fluids through a drip into a vein (intravenously). It prevents you from getting dehydrated.
You will also need to have a tube into your nose and down into your stomach. This is called a nasogastric tube (NG tube). It drains fluids and stops 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
It is sometimes possible to have an operation to unblock the bowel. This relieves symptoms for a longer time.
Your surgeon might be able to close up the bowel after removing the blockage. Or the bowel may open onto the outside of your tummy (abdomen). This is called a stoma. Your stools come out of the opening into a plastic bag that sticks over the stoma opening.
This is quite a big operation to go through if you have an advanced cancer. It's not easy to say how much you will benefit from the operation. Speak to your doctor and family before having this operation to help you weigh up the possible risks and benefits.
A tube into your bowel to relieve the blockage
Avoiding a big operation might be possible. Sometimes you can have a metal tube (stent) through the blockage. This is called an endoluminal stent.
The stent helps to keep your bowel open. The surgeon puts it in using an instrument called a laparoscope. This is a long tube with a light and a camera at one end.
First, you have a small cut made in your tummy (abdominal) wall. The surgeon puts the laparoscope inside and moves it into the position of the blocked bowel. They can see inside through the laparoscope and can position the stent in the right place.
The stent can relieve the blocked bowel and avoid the need for a big operation. This procedure might not be suitable for everyone. Talk to your specialist about it.
Octreotide to help stop fluid build up
Instead of an operation, you can sometimes have a drug called octreotide. It helps to control the symptoms of a blocked bowel.
Octreotide reduces the build up of fluid 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 doing this, you reduce the amount of stool.
- cereals: low fibre breakfast cereals such as Cornflakes, Rice Crispies, Coco Pops and Frosties
- bread and flour: bread made with white flour, including pitta, naan bread, wraps, Crumpets, pikelets, Cream crackers and rice cakes
- potatoes: peeled, cooked potatoes, mashed, chipped or roasted without skins, inside of jacket potato
- rice and pasta: white rice, white and tricolore pasta and spaghetti, white noodles, couscous and rice noodles
- cake and biscuits: cakes, plain or cheese scones, biscuits and pastries made with white flour (no nuts, seeds or dried fruits added), crumpets, white muffins, croissants or pancakes
- fruit: all pips, pith and skin removed - ripe banana, apple, pear, peach, mango, melon, lychees, tinned fruit and smooth fruit juice
- vegetables: peeled and cooked with stringy or tough bits removed – turnip, carrot, butternut squash, pumpkin, sweet potato, parsnip, courgette, cucumber, aubergine, tomatoes (skinned and deseeded, puree or passata), florets of cauliflower and broccoli (well cooked and stalks removed)
- meat, fish and other proteins: meat, poultry, ham, bacon, sausages, fish, eggs, Tofu, sausage rolls and meat pies.
- milk and dairy products: milk (fresh, evaporated or condensed), cheese, cottage cheese, cream cheese, cheese spreads, cream, plain smooth yoghurt fromage frais and ice cream
- other foods: plain or milk chocolate, boiled sweets, toffee, fudges, wine gums, mints, crisps, honey, lemon curd, treacle, syrup, marmite, shredless marmalade, seedless jam, tomato sauce, brown sauce, soya sauce, mayonnaise, stock cubes, smooth nut butter
Constipation is a common problem in advanced cancer. Some causes are:
- not being physically active
- a low fibre diet
- the side effects of some pain, anti sickness and chemotherapy drugs
- spinal cord compression
You can feel very sick with constipation. You might feel embarrassed about it too. But do ask for help. Hospital and community nurses know how to deal with constipation. They can tell you how to prevent or relieve it.
The longer you leave it, the more problems it can cause.
Adding fibre to your diet and plenty of fluids can help, but you may also need to take a laxative. Your doctor can prescribe one.
Not enough fluid in your body (dehydration)
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 when you have advanced cancer. So it can be hard to prevent dehydration.
But if possible, try to drink every hour or two, even if it is only sips of your favourite fluid. 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 late stage of your cancer.
Wasting syndrome (cachexia)
Cachexia is a problem for many people with advanced cancer. Cachexia is also called wasting syndrome or anorexia cachexia syndrome. Anorexia means loss of appetite.
Cachexia is more than only loss of appetite. It is a complex problem and difficult to control. It involves changes in the way your body uses proteins, carbohydrates, and fat. You may also burn up calories faster than usual.
Cachexia in advanced cancer can be very upsetting. You can feel very weak and less able to do things. Doctors try to reverse the effects of cachexia. They use appetite stimulants, steroids and in some people, tube feeding. But improvements are only temporary and don't increase how long you live.
If you have cachexia, it might be helpful to 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. It can also give you more energy and improve your quality of life.
You and your loved ones can try the following suggestions to help with cachexia:
- Try eating in the mornings. People tend to feel more like eating in the morning than in the evenings.
- Try to regularly eat small meals and snacks that are high in energy.
- Don't worry too much about what you eat. If you feel like it, have it.
- Ask the hospital dietitian for hints on how to prepare simple foods that are easy to digest.
- Drink small amounts as often as you can if you don't feel like eating. Or try drinking high energy supplements between meals.
- Try to still eat with your family or friends at the table. The social gathering with loved ones and the support they offer can help you to cope better.