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Stomach and oesophageal cancers

Managing side effects

Page last updated: March 2024

The information on this webpage was adapted from Understanding Stomach and Oesophageal Cancers - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in March 2024.

Expert content reviewers:

This information was developed based on international clinical practice guidelines, and with the help of a range of health professionals and people affected by these cancers:

  • Prof David I Watson, Matthew Flinders Distinguished Professor of Surgery, Flinders University, and Senior Consultant Surgeon, Oesophago-Gastric Surgery Unit, Flinders Medical Centre, SA
  • Prof Bryan Burmeister, Senior Radiation Oncologist, GenesisCare Fraser Coast and Hervey Bay Hospital, QLD
  • Kieran Cahill, Consumer;
  • Jessica Jong, Clinical Dietitian, Upper GI and Hepatobiliary Services, Peter MacCallum Cancer Centre, VIC
  • John Leung, Consumer
  • Prof Rajvinder Singh, Professor of Medicine, University of Adelaide, and Director, Gastroenterology Department and Head of Endoscopy, Lyell McEwin Hospital, SA
  • Dr Sarah Sutherland, Medical Oncologist, Chris O’Brien Lifehouse, NSW
  • Paula Swannock, Upper GI Cancer Nurse Consultant, St Vincent’s Hospital Melbourne, VIC
  • Rebecca Yeoh, 13 11 20 Consultant, Cancer Council Queensland

Stomach and oesophageal cancers and their treatment can cause side effects. Some of these side effects are permanent and may change what you can eat, and how you digest foods and absorb essential nutrients.

How treatment will affect eating

During and after treatment, you need to eat and drink enough to get the nutrition you need, maintain your weight and avoid dehydration. You may need a feeding tube.

Ask your doctor for a referral to a dietitian with experience in cancer care, who can give you more information.

After treatment, some foods may be uncomfortable to eat and may cause digestive problems.

You will need to try different foods and change your eating habits, such as eating smaller meals more often throughout the day.

It may take time and support to adapt to your new way of eating. It’s natural to feel self-conscious or worry about eating in public or with friends.

It may help to let your family and friends know how you feel, or to speak with a counsellor or someone who has been through a similar experience. 

Learn more

Poor appetite and weight loss

After surgery, your stomach will be smaller (or completely removed) and you will feel full more quickly after a meal. You may not feel like eating or you may have lost your sense of taste.

It is important to maintain your weight to avoid malnutrition. Even a small drop in your weight (e.g. 3–4 kg), particularly over a short period of time, can make your recovery slower.

Chemotherapy and radiation therapy can cause nausea, irritation to the oesophagus or a sore mouth. These side effects may make eating uncomfortable. 

Tips to prevent unplanned weight loss

  • Have a snack or small meal every 2–3 hours if you have lost your appetite and don’t feel hungry.
  • Keep a variety of snacks handy (e.g. in your bag or car).
  • Eat when you feel hungry or crave certain foods. Eat slowly and stop and rest when you are full.
  • Avoid filling up on liquids at mealtimes, unless it’s a hearty soup, so you have room for nourishing food.
  • Try eating different foods to see if your taste and tolerance for some foods have changed.
  • Try to drink fluids that add energy (kilojoules), such as milk, milkshakes, smoothies or nutritional supplement drinks recommended by your dietitian.
  • Prevent dehydration by drinking fluids between meals (30–60 minutes before or after meals).
  • Ask your dietitian how you can increase your energy and protein intake.
  • It may be helpful to use a food diary to keep a record of how you react to certain foods. Ask your dietitian about this.


Swallowing difficulties

You may have difficulty swallowing (dysphagia) before, during or after treatment. This may be because of where the tumour is or because of swelling in the oesophagus after surgery. Signs that swallowing is difficult include:

  • taking longer to chew and swallow
  • food getting caught in your mouth or throat, or
  • bringing up food or vomiting.

Some people find that food and fluid go into the windpipe instead of the food pipe. This is called aspiration and it can lead to chest infections like pneumonia. Talk to your doctor about these symptoms.

Tips to eat when it is hard to swallow

  • Make food softer by chopping, mashing, slow-cooking, mincing or puréeing.
  • Between meals, snack on soft foods that are high in energy and protein, such as avocado, yoghurt, ice-cream, diced tinned fruit and drink milkshakes.
  • Chew carefully and slowly, sitting still and upright. Try to avoid talking while eating.
  • Avoid dry foods – add extra gravy or sauce to your meals.
  • Wash food down with small sips of fluid.
  • See a speech pathologist for suggestions on the types of foods to include and ways to eat and drink safely.
  • Talk to your doctor or dietitian if you are losing weight. They can help you find foods that give you enough nutrition and help you maintain your weight.
  • Add nutritional supplement drinks to your diet to help maintain your strength. Examples include Sustagen, Resource and Ensure.


Reflux and choking

Stomach acid going back into the oesophagus (reflux) is common after surgery for oesophageal cancer.

This can cause heartburn, chest discomfort, or your stomach contents to flow up your oesophagus, particularly when lying flat or bending over.

Taking medicines to reduce stomach acid generally helps.

After surgery or radiation therapy for oesophageal cancer, scar tissue may cause choking or swallowing problems while eating or drinking. 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 or bring up food after eating.

Tips to reduce reflux and choking

  • Avoid spicy foods, fatty foods, fizzy drinks, alcohol and citrus fruits if you find they trigger reflux.
  • Take small sips of liquid to reduce coughing or choking.
  • Chew foods well, eat slowly, and don’t talk while eating.
  • To help food digest, sit up straight when eating and for at least 30 minutes after.
  • Have your main meal earlier in the day and eat a small snack in the evening.
  • After an oesophagectomy, sit up for 2–4 hours after eating. Eat your evening meal more than four hours before going to bed.
  • Avoid positions where your head is below your stomach (e.g. when bending over too far), particularly after eating.
  • Keep your chest higher than your stomach when sleeping by lifting the head of your bed with blocks about the thickness of a house brick. The whole bed should be tilted slightly.
  • Ask your doctor how much physical activity you can do, as this can sometimes cause reflux.


Dumping syndrome

If surgery has changed the structure of your stomach, partially digested food can go into the small bowel too quickly. This can especially be a problem with sugary fluids, such as soft drinks, juices and cordial.

You may have cramps, nausea, racing heart, sweating, bloating, diarrhoea or dizziness. This combination of symptoms is called dumping syndrome, and it usually begins 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.

Tips to manage dumping syndrome

  • Have smaller meals throughout the day.
  • Chew your food well and eat slowly so your body can sense when it is full.
  • Surgery may affect how you tolerate certain foods. Keep a record of foods that cause problems and talk to a dietitian for suggestions on what to eat to reduce the symptoms.
  • Include sources of fibre with your meals (e.g. lentils, baked beans, fruits and vegetables with skins on, wholegrain breads).
  • Eat meals high in protein (e.g. lean meats and poultry, fish, eggs, milk, yoghurt, nuts, seeds and beans).
  • Eat starchy foods (e.g. pasta, rice or potato).
  • Avoid foods and drinks high in sugar (e.g. cordial, soft drinks, cakes and biscuits). 
  • Avoid drinking liquids with your meals; after drinking, wait at least 30 minutes before eating.
  • Symptoms usually improve over time. If they don’t, ask your doctor for advice about medicines that may help.


Anaemia and osteoporosis

Surgery to remove the stomach will mean you will be unable to absorb some vitamins and minerals from food. This may lead to low levels of:

  • calcium – over time, your bones may become weak and brittle, and break more easily (osteoporosis), which may cause pain.
  • vitamin B12 – low B12 levels can cause a condition called pernicious anaemia. The most common symptom is tiredness. Other symptoms include pale skin, breathlessness, headaches, a racing heart and appetite loss. You will need regular vitamin B12 injections.
  • iron – low iron levels can cause iron deficiency anaemia. You may need an iron infusion, in which iron is given as a liquid through a drip inserted into a vein. Iron taken by mouth can’t be absorbed easily.

Tips for managing anaemia

  • Talk to your doctor about what type of anaemia you have and how to treat it.
  • Eat foods rich in iron, such as meat, eggs and softened dark green leafy vegetables.
  • Eat foods high in vitamin C (e.g. red or orange fruits and vegetables) to help your body absorb iron.
  • Avoid drinking tea and coffee with meals, as they can prevent your body absorbing iron.
  • Rest when you need to.
  • If you smoke, talk to your GP about quitting or call the Quitline on 13 7848. Smoking tobacco can increase the risk of developing anaemia.
  • See your GP for regular blood tests to check on nutrient levels for at least two years after treatment.


Life after treatment

After treatment ends, you will have regular appointments to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread.

You will also be able to discuss how you’re feeling and any concerns you have. You may have blood tests, imaging scans or an endoscopy if necessary.

How often you will need to see your doctor will depend on the level of monitoring needed for the type and stage of the cancer.

You should also see a dietitian for advice about good nutrition. Check-ups will become less frequent if you have no further problems.

For some people, stomach or oesophageal cancer does come back after treatment, which is known as a recurrence. If the cancer returns, you may have further treatment.

Talk to a cancer nurse

Understanding Stomach and Oesophageal Cancers

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