Managing side effects of stomach and oesophageal cancer


Stomach and oesophageal cancers and their treatment can cause many side effects. Some 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 and avoid malnutrition. 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 recovering from treatment. 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 to 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 adapt to your new way of eating.

See Nutrition and Cancer or call Cancer Council 13 11 20 to arrange 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. If your oesophagus is very sore from radiotherapy, your doctor may prescribe pain-relieving medicines.

How to prevent unplanned weight loss

  • 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 handy, e.g. in your bag or car.
  • Test your ability to eat different foods. Your taste and tolerance for some foods may have changed and may continue to change.
  • Ask your dietitian how you can increase your energy and protein intake.
  • Make the most of the times you feel hungry or crave certain foods, but be careful not to become too full by eating too quickly.
  • Ensure you have room for nourishing food – avoid filling up on liquids at mealtimes, unless it's a hearty soup.
  • 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.

Difficulty swallowing

Many people with stomach or oesophageal cancer have difficulty swallowing (dysphagia) before, during or after treatment. This may be because of where the tumour is located or as a side effect of treatment. Signs that swallowing is difficult include taking longer to chew and swallow, coughing or choking while eating or drinking, or food sticking in your mouth or throat like a ball.

It is important to change your diet so that you can still get enough nutrition, and to prevent losing weight and strength.

How to manage swallowing difficulties

  • Change the consistency of your food by chopping, mincing or pureeing.
  • 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.
  • Avoid dry foods – add extra gravy or sauce to your meals.
  • Chew carefully and slowly, sitting still and upright. Try to avoid talking while eating.
  • Wash the food down with small sips of fluid.
  • Talk to your doctor or dietitian if you are losing weight, or if you have pain or discomfort when swallowing.
  • You may need to consider adding supplements to your diet to meet your nutritional needs, e.g. a ready-to-use nutritional supplement drink.

Reflux and choking

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

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

After an oesophagectomy, the stomach can take longer to empty. You may feel full more quickly or be more likely to vomit after eating.

How to relieve reflux and choking

  • Limit spicy foods, fatty foods, fizzy drinks, alcohol and citrus fruits to prevent reflux.
  • Take small sips of liquid to reduce coughing or choking.
  • Chew foods well, eat slowly, and avoid talking while eating.
  • To help food digest, sit up straight when eating and for at least another 30 minutes.
  • After an oesophagectomy, you should remain upright for four hours after eating. Try eating your evening meal about four hours before going to bed.
  • Consider eating your main meal earlier in the day and having a small snack in the evening.
  • Avoid bending over too far.
  • Keep your chest higher than your abdomen when sleeping by using extra pillows or a foam wedge. Try to avoid lying on your left side, as reflux is often worse in this position.
  • Don't overexert yourself, as this can cause reflux.
  • See your doctor if solid foods cause coughing or get stuck.

Dumping syndrome

If 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.

How to manage dumping syndrome

  • Eat small meals throughout the day. Chew your food well.
  • Eat slowly so your body can sense when it is full.
  • Keep a record of foods that cause problems and avoid them. Surgery may have impaired your ability to absorb or tolerate certain foods, such as those containing lactose, fructose or gluten.
  • Talk to a dietitian, who can help you work out how to change your meals to reduce the symptoms.
  • Avoid foods and drinks high in sugar, e.g. cordial, soft drinks, cakes and biscuits.
  • Eat starchy food, e.g. pasta, rice or potato.
  • Eat meals high in protein, e.g. lean meats and poultry, fish, eggs, milk, yoghurt, nuts, seeds, and legumes/beans.
  • Drink between meals rather than at mealtimes.
  • Symptoms usually improve over time. If they don't, ask your doctor for advice about medicines that may help.

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, have a racing heart and lose your appetite. You will need regular vitamin B12 injections.

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

Tips for managing anaemia

  • Talk to your doctor if you have symptoms of anaemia.
  • Find out what kind of anaemia you have and how it can be treated.
  • Rest when you need to and don't overexert yourself.
  • Limit tea and coffee, as these can prevent iron absorption.
  • 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 softened 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. Vitamin C helps the body absorb iron.
  • If you smoke, talk to your GP about quitting, call Quitline on 13 7848, or visit quitnow.gov.au. Tobacco can worsen your symptoms.

Key points

  • Surgery to the stomach and oesophagus can cause significant side effects. 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 avoid eating late meals and to wait about four hours after a meal before going to bed.
  • To avoid dehydration, try to drink fluid in small amounts throughout the day. 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.
  • 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.
  • You may feel self-conscious when eating. Talking to a counsellor or someone who has been through a similar experience to you may help you cope with the changes.

Expert content reviewers:

Prof David Watson, Head, Flinders University Department of Surgery, Flinders Medical Centre, SA; Prof Bryan Burmeister, Senior Staff Specialist, Cancer Services, Princess Alexandra Hospital, QLD; Dr Fiona Day, Medical Oncologist, Calvary Mater Hospital, Newcastle, and Conjoint Senior Lecturer, University of Newcastle, NSW; Mark Diggle, Consumer; Merran Findlay, Executive Research Lead – Cancer Nutrition and Oncology Specialist Dietitian, Royal Prince Alfred Hospital, NSW; Rosie Newth, 13 11 20 Consultant, Cancer Council NSW; Dr David Ransom, Medical Oncologist, Fiona Stanley Hospital, WA; Megan Rogers, Specialist Nurse, Upper Gastrointestinal Cancer Service, Peter MacCallum Cancer Centre, VIC. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.

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