Managing side effects of stomach & oesophageal cancer

Sunday 1 November, 2015

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On this page: Poor appetite and weight loss | Difficulty swallowing | Reflux and choking | Dumping syndrome | Anaemia | Key points


Oesophageal and stomach cancers and their treatment can cause many side effects. Many of these side effects are permanent and may affect your ability to eat, digest foods, and absorb essential nutrients. This section explains typical side effects and how to manage them.

After treatment, some foods you used to eat may cause digestive problems. You will need to try different foods and ways of eating to find out what works for you. You may need to change your eating habits, such as eating smaller meals more often throughout the day.

It’s important to make sure you are eating and drinking enough to maintain your weight. If you are eating less than usual it is often recommended that you choose high energy, high protein foods. Previous dietary restrictions and guidelines may be relaxed when you are recovery from surgery. Ask your doctor for a referral to a dietitian with experience in cancer care.

Some people find it difficult to cope emotionally with the changes to their eating habits. You may feel self-conscious or worry about eating in public or with friends. These reactions are natural. It may help to talk about how you feel with your family and friends, or speak with a counsellor or someone who has been through a similar experience. They may be able to give you advice on how to adjust. It may take time and support to adjust to your new way of eating.

See our Nutrition and Cancer section for more information or call Cancer Council 13 11 20 to ask to speak to a Cancer Connect volunteer who has had a similar cancer experience.

Poor appetite and weight loss

After surgery you may have a poor appetite caused by changes to your digestive system. Your stomach may be smaller and you might feel full more quickly. You may not feel like eating or you may have lost your sense of taste.

Chemotherapy and radiotherapy can also affect your appetite, due to nausea, irritation to the oesophagus or a sore mouth. To avoid malnutrition and weight loss, try the tips below.

  • Snack during the day – eat 5–6 small meals rather than three large ones each day.
  • Ask your family and friends to cook for you and offer you food throughout the day.
  • Keep a selection of snacks in handy locations, e.g. in your bag or car.
  • Test your ability to eat different foods. Experiment with recipes – your taste and tolerance for some foods may have changed and may continue to change.
  • Tell your doctor or dietitian if you have pain or discomfort when swallowing.
  • Ask your dietitian how you can increase your kilojoules.
  • Make the most of the times you feel hungry or when you crave certain foods but be careful not to become too full by eating too quickly.
  • Avoid filling up on liquids, unless it's a hearty, nourishing soup. Don't drink at mealtimes.
  • Prevent dehydration by drinking liquids between meals (e.g. 30–60 minutes before or after meals).
  • Don’t eat late at night. This may make you uncomfortable and disturb your sleep.
"Life changed as we knew it after my husband had surgery for oesophageal cancer. Reigniting his sense of wanting to eat again has taken time." – Leslee

Difficulty swallowing

Before or after surgery, radiotherapy or chemotherapy treatments, you may find it difficult to swallow solid foods. It is important to change your diet so that you can still get enough nutrition, and to prevent losing weight and strength.

The following tips may help you if you are having difficulty swallowing.

  • Make food softer, e.g. use a slow cooker to keep food moist or mash your food with a fork.
  • Snack on soft foods between meals, such as avocado, yoghurt, custard, ice-cream, diced tinned fruit, and milkshakes.
  • Try eating soft, nutritious foods, such as scrambled eggs, porridge, soup and casseroles.
  • Add extra gravy and sauce to your meals.
  • Consider adding nutritional supplements to your diet to meet your nutritional requirements.
  • Chew carefully and slowly, sitting still and upright. Try to avoid talking while you are eating.
  • Wash the food down with small sips of fluid.
  • Talk to your doctor or dietitian if you are losing weight, or if it is getting more difficult to swallow food.

Reflux and choking

Many people experience reflux following surgery. This can cause heartburn, nausea and discomfort in your chest. Medications to reduce stomach acid may improve these symptoms.

Some people who have had surgery or radiotherapy for oesophageal cancer choke or cough while eating. This may be due to scar tissue. It is important to see your doctor if this continues.

  • Limit spicy foods, fizzy drinks, alcohol and citrus fruits to prevent reflux.
  • Take small sips of liquid to reduce coughing or choking.
  • Sit up straight during meals and for at least 30 minutes after eating to help food digest.
  • Try eating your evening meal about four hours before going to bed. Or eat your main meal earlier in the day and have only a small snack in the evening.
  • Avoid bending over too far.
  • Chew foods well and eat slowly. Avoid talking while eating.
  • Keep your chest higher than your abdomen when sleeping – try using extra pillows or a foam wedge. Try to avoid lying on your left side, often reflux is worse in this position.
  • Avoid dry foods, e.g. tough meat or doughy bread. Or use sauces and spreads to assist swallowing.
  • Don’t overexert yourself, as this can cause reflux.
  • Ask your doctor for advice about medications that may help.
  • Wear loose-fitting clothing.
  • See your doctor if solid foods cause coughing or if food seems to be getting stuck.

Dumping syndrome

If your surgery has changed the normal structure of your stomach, partially digested food and or food containing high amounts of simple sugar, such as cordial, can go into the small bowel too quickly. This may cause cramps, nausea, racing heart, sweating, bloating, diarrhoea or dizziness. This is called dumping syndrome. Symptoms usually begin 15–30 minutes after eating.

Sometimes symptoms occur 1–2 hours after a meal. These are called late symptoms, which tend to cause weakness, light-headedness and sweating, and are usually worse after eating foods high in sugar.

Symptoms usually improve over time. If you experience these problems, talk to a dietitian, who can help you work out how to change your meals to reduce the symptoms. Your doctor may also prescribe medication to help.

Tips
  • Eat small meals slowly so your body can sense when it is full.
  • Take note of which foods cause problems – record and avoid them. Surgery may have impaired your ability to absorb or tolerate certain foods, such as those containing lactose, fructose or gluten.
  • Avoid foods and drinks high in sugar, e.g. cordial or soft drinks.
  • Eat starchy food (e.g. pasta, rice or potato) and meals high in protein.
  • Drink between meals rather than at mealtimes.

Anaemia

People who have had a total gastrectomy, and sometimes a subtotal gastrectomy, cannot absorb vitamin B12 from food or oral supplements. As a result, they may be unable to make enough red blood cells, which carry oxygen around the body. This can lead to a condition known as pernicious anaemia. The most common early symptom of anaemia is tiredness. Your skin will look pale and you may also feel breathless, get headaches, a racing heart and loss of appetite. You will need regular vitamin B12 injections.

Red blood cells carry oxygen around the body. If you don’t have enough red blood cells, it causes symptoms such as tiredness, breathlessness, headaches, a racing heart and appetite loss. You will need regular injections of vitamin B12, and you may also need to take iron supplements.

A gastrectomy may also reduce your ability to absorb iron, causing iron deficiency anaemia, and you may need iron supplements.

  • Talk to your doctor if you have symptoms of anaemia.
  • Rest when you need to and don’t overexert yourself.
  • Limit tea and coffee, as this can prevent iron absorption.
  • Find out what kind of anaemia you have and how it can be treated. Ask your GP or dietitian if you need vitamin B12 injections, iron or other supplements, and whether certain foods can help.
  • Eat foods rich in iron and B vitamins, such as meat, eggs and dark green leafy vegetables.
  • Eat foods high in vitamin C (e.g. red or orange fruits and vegetables) in the same meal as iron-rich foods, as vitamin C helps the body absorb iron.
  • If you smoke, talk to your GP about quitting, call Quitline on 13 7848, or visit quit.org.au. Tobacco can worsen your symptoms.

Key points

  • Surgery to the oesophagus and stomach can cause significant side effects and affect the way you eat. This can affect your physical and emotional wellbeing.
  • After treatment, you may have a poor appetite, find it difficult to eat certain foods, or feel full quickly. This can lead to weight loss and malnutrition.
  • Physical changes to the way you eat and digest food following treatment may include reflux (heartburn), coughing and choking. Dumping syndrome is less common. Eating several small meals a day slowly can help with these symptoms.
  • Sitting up during and after meals can help swallowing and digestion. It’s best to wait about four hours after a meal before going to bed and to avoid eating late meals.
  • To avoid dehydration, drink fluid throughout the day, in between meals. It is best not to drink much liquid at mealtimes.
  • Dietitians can help tailor eating plans to suit your individual needs. They can also give you advice on nutritional supplements if you need to increase your vitamin or mineral intake. You may need tablets, powdered supplements, injections or infusions. Making changes to your diet may also help.
  • Talk to your doctor or dietitian if you have ongoing trouble with eating and digestion, have symptoms of anaemia or if you keep losing weight.
  • Talking to a counsellor or someone who has been through a similar experience to you may help you cope with the changes.

Reviewed by: Prof Mark Smithers, Director, Upper GI/Soft Tissue Unit, Princess Alexandra Hospital, Professor, Discipline of Surgery, The University of Queensland; Katie Benton, Dietitian and Nutritionist, Upper Gastrointestinal Unit, Department of Nutrition and Dietetics, Princess Alexandra Hospital, QLD; Jeff Bull, Upper GI Cancer Clinical Practice Consultant, Cancer Services, Flinders Medical Centre, SA; Prof Bryan Burmeister, Senior Radiation Oncologist, Princess Alexandra Hospital, Dept Chair MSAC, Cancer Council Queensland; Frank Hughes, 13 11 20 Nurse, Cancer Council Queensland; June Leijon, Consumer; Dr Julia Maclean, Clinical Specialist, Speech Pathology, Cancer Care Centre, St George Hospital, NSW; A/Prof Euan Walpole, Medical Director, Cancer Services, Princess Alexandra Hospital & Southern Area Health Service, QLD.

Updated: 01 Nov, 2015