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  • Managing side effects of treatment for stomach and oesophageal cancers

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    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 page explains common side effects and how to manage them.

    During and after treatment, it’s important to make sure you are eating and drinking enough to maintain your weight and avoid malnutrition or dehydration. If you are eating less than usual it is often recommended that you choose high energy, high protein foods and relax healthy eating guidelines. You may need a feeding tube during or after treatment if you are unable to eat and drink enough to meet your nutritional needs. Ask your doctor for a referral to a dietitian with experience in cancer care.

    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.

    Some people find it difficult to cope emotionally with the changes to how and what they can eat. 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.

    Poor appetite and weight loss

    After surgery, you may have a poor appetite caused by changes to your digestive system. Your stomach will be smaller (or completely removed) and you will feel full more quickly. You may not feel like eating or you may have lost your sense of taste. It is important to maintain your weight. Even a small drop in your weight (e.g. 3–4 kg), particularly over a short period of time, may put you at risk of malnutrition and affect your recovery.

    Chemotherapy and radiation therapy can also affect your appetite, due to nausea, irritation to the oesophagus or a sore mouth. If your oesophagus is very sore from radiation therapy, talk to your doctor about pain-relieving medicines and a referral to a dietitian.

    For more information about nutrition, call Cancer Council 13 11 20 or download our booklet Nutrition and Cancer.

    Difficulty swallowing

    You may have difficulty swallowing (dysphagia) before, during or after treatment. This may be because of where the tumour is located or 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. Some people find that food and fluid goes into the windpipe instead of the food pipe. This is called aspiration and it can block the airways and cause difficulty breathing.

    It is important to change your diet so that you can still get enough nutrition, and to prevent losing weight and strength. A speech pathologist can give you strategies to help you eat and drink safely.

    Reflux and choking

    Many people experience reflux 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. It is important to avoid eating or drinking before going to bed at night.

    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 after eating.


    Dumping syndrome

    If surgery has changed the normal structure of your stomach, partially digested food and/or fluid 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.

    Anaemia and osteoporosis

    Surgery to the stomach may reduce your ability 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. Talk to your doctor and dietitian about ways to look out for and treat osteoporosis.
    • vitamin B12 – This can cause a condition called pernicious anaemia. The most common early symptom of anaemia is tiredness. Your skin will look pale and you may feel breathless, get headaches, have a racing heart and lose your appetite. You will need regular vitamin B12 injections.
    • iron – This can cause iron deficiency anaemia. You may need iron supplements, which are usually given as a tablet or liquid you swallow.

    This website page was last reviewed and updated March 2020.

    Information last reviewed: Prof David Watson, Senior Consultant Surgeon, Oesophago-gastric Surgery Unit, Flinders Medical Centre, and Matthew Flinders Distinguished Professor of Surgery, Flinders University, SA; Kate Barber, 13 11 20 Consultant, Cancer Council Victoria; Katie Benton, Advanced Dietitian, Cancer Care, Sunshine Coast Hospital and Health Service, QLD; Alana Fitzgibbon, Clinical Nurse Consultant, Gastrointestinal Cancers, Royal Hobart Hospital, TAS; Christine Froude, Consumer; Dr Andrew Oar, Radiation Oncologist, Icon Cancer Centre, Gold Coast University Hospital, QLD; Dr Spiro Raftopoulos, Interventional Endoscopist and Consultant Gastroenterologist, Sir Charles Gairdner Hospital, WA; Grant Wilson, Consumer; Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT.

     

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