Importance of Nutrition

Many patients with cancer of the esophagus or stomach experience weight loss and inability to consume their usual amount of food. This may be due to appetite loss, difficulty swallowing or narrowing of the esophagus due to cancer growth.
Some patients also describe early satiety which is a feeling of fullness after a small amount of food.

When rapid or significant weight loss has occurred, it is important to make more of an effort to consume foods that are high in nutrient density. The priorities when attempting to regain lost weight or maintain weight are calories and protein.

Focus on foods with a high calorie density is important if you are unable to eat a large volume of food at one time. Foods high in calorie density provide more calories per bite than foods with a low calorie density. Protein rich foods are also important in maintaining strength, muscle mass and the ability to heal and fight off infection.

Some foods that are high in calories and protein include the following:

• Nuts
• Peanut butter
• Almond butter
• Cheese
• Eggs
• Flavored yogurt
• Meats
• Milkshakes
• Smoothies with protein powder
• Beans
• Premium ice cream
• Cheese
• Chocolate candy with lots of nuts

If swallowing is difficult it is important to choose foods that are high in calories and protein and have a moist or soft texture. Chopped or ground meats may be necessary with added broth or gravy to make swallowing easier.

Ideas for moist calorie and protein-rich foods include:

• Custard
• Pudding
• Ground meat with gravy
• Stew or soup with chopped or ground meat added
• Tuna salad
• Egg salad
• Hummus
• Pasta with cheese sauce
• Pasta with meat sauce
• Meatloaf with gravy
• Scrambled eggs

Eating small amounts frequently throughout the day is also important if you are unable to consume your usual quantity of food at each meal. Scheduling snacks and small meals every two or three hours throughout the day may be helpful to assure adequate nutritional intake.

Ideas for small meals or snacks that are high in calories include:

• Toast with butter and peanut butter
• Dried fruits and nuts
• Cereal with banana and whole milk
• Hummus and crackers
• Cheese and crackers
• Cream soup with ½ turkey sandwich
• Cheesecake
• Cookies and whole milk
• Greek-style yogurt with fruit and granola

Some other tips that can help to maintain nutrition when you are not able to eat much include the following:

• Try to eat small frequent meals and snacks every few hours instead of 2 or 3 large meals per day.
• Keep snacks visible, convenient and handy.
• Avoid carbonated beverages and high fiber/low calorie foods.
• Drink beverages after or between meals and snacks.
• Eat while watching TV or reading – we tend to eat more when distracted
• Add butter, margarine or oil to you food whenever practical
• Use whole milk or cream in recipes like oatmeal or pudding

It is important to realize that the size of your stomach is now much smaller than it was before surgery.  To get the nutrition that you need, it will be necessary to eat at least six times a day — three small meals with three snacks in between. Breakfast, lunch, and dinner should be about half the amount you were used to eating before your diagnosis and surgery.

Think Smaller. It may help to serve your meals on a salad plate to get used to eating small amounts.  To avoid filling up too fast, drink fluids in between meals, instead of with meals or snacks. Eating more than your “new stomach” is ready to handle may lead to discomfort and regurgitation of food or liquid. Sitting in an upright position for 30 – 45 minutes after a meal or snack can also help with prevention of reflux or back up of stomach contents. Most patients also benefit from antacid therapy after surgery if reflux is a problem. If this is bothersome to you, be sure to discuss it with your doctor.

J-Tube.Some people have a feeding tube placed in the small bowel or jejunum during surgery for esophageal cancer. This tube, called a jejunostomy feeding tube, can be very helpful in maintaining nutrition immediately after surgery when you are getting accustomed to a new way of eating. It is important to check with your doctor or health care provider to see if they want you to use this tube for feedings when you go home from the hospital. The dietitian and social worker can help to make arrangements for you to get these feedings at home and your nurse can show you how to do this. Some people use the tube for feedings during the night time to get supplemental nutrition while they are asleep. This allows them to go about their usual routine and eat their usual meals and snacks during the day. If you are not using the tube for feedings, be sure to find out about how to flush the tube with water and how often you are supposed to do this to keep it from getting clogged. Most people who use this feeding method find that they get stronger faster than trying to do it on their own with only meals and snacks during the day.

Many people who lose a significant amount of weight before surgery may find it difficult to return to their pre-illness weight, however, they do reach a new stable and comfortable weight. This is fine as long as you are feeling well and your quality of life is acceptable to you. If you are still feeling fatigued and cannot do your usual activities after you have healed from surgery, you may still need supplemental feedings with the jejunostomy tube to achieve a comfortable and “healthy” weight.