Importance of nutrition for recovery from stomach cancer

Dr Shyam Aggarwal emphasises on proper nutritional support from time of diagnosis and post treatment phase to help reduce disease complications, manage symptoms better, improve treatment outcomes and have a better quality of life

In 2016, there were an estimated 75,000 new cases of stomach (gastric) cancer.¹ Recent research ² studies have shown that patients with gastric cancer who are undergoing surgery or have advanced disease require nutritional support. This nutrition support is either provided directly through a vein (parenteral nutrition) or through a point of entry somewhere along the gastrointestinal tract (enteral nutrition) which includes food that is given through the mouth (oral nutrition). Oral nutrition involves both, the right diet and as well as supplements. Providing nutritional support from the time of diagnosis and well into the post treatment phase has helped patients reduce disease complications, manage their symptoms better, improve treatment outcomes and have a better quality of life after treatment. So, we need to understand what is meant by ‘nutritional support’ and how patients can get this during their treatment journey.

What happens in stomach cancer?

All cancers are a result of our cells going rogue. Every cell in our body has a distinct purpose and this determines when the cell should multiply, when it should stop doing this and when it should die. When cells begin to multiply uncontrollably, they grow into a tumour. When this happens in the inner lining of the stomach, it is the start of stomach cancer. Also known as ‘gastric cancer,’ stomach cancer usually develops slowly over many years.

Several risk factors may increase a person’s chance of developing stomach cancer, including being male; being over the age of 50 years; having a stomach infection with the bacterium ‘Helicobacter pylori’ and smoking.

The signs and symptoms of stomach cancer are not specific and could also be the result of a stomach ulcer or infection. So if any of the signs and symptoms we have identified here persist over two or three weeks, you must go to a gastroenterologist who will do a thorough investigation to investigate the cause and rule out or confirm stomach cancer.

The role of nutrition in stomach cancer

Treatment for stomach cancer ranges from surgery (gastrectomy) and chemotherapy to immunotherapy and targeted therapy. Some treatments try to cure the cancer while others keep the cancer under control. The oncologist will advise the most suitable type of treatment for you depending on the stage of your cancer and your overall health.

Most cancer treatments affect a patient’s appetite, cause nausea and vomiting, and lead to weight loss. This affects the patient’s nutritional status and weakens the immune system. Poor nutrition is an even bigger problem in the case of stomach cancer, since both the cancer and its treatment make it difficult for patients to eat and retain the food they consume.

Now that we know good nutrition improves stomach cancer outcomes, we must ensure that the quality of the diet does not suffer during the treatment journey. Patients with stomach cancer are usually referred to a nutritionist who advises on changes to be made and recommends food items that are both nourishing and easy to digest. The important dietary factors to keep in mind during and post treatment are:

• The diet should have a balanced mix of carbohydrates, protein, vitamins and minerals. These are the important food groups required on a daily basis to provide strength and help heal body tissue.
• Smaller meals about 6-8 times a day are ideal, as they do not ‘load’ the stomach with too much to digest at a given time and provide sustained energy through the day.
• Patients with stomach cancer often require supplements such as vitamin D, calcium, and iron or vitamin B12 shots, since the stomach may be unable to absorb these from food. Ask the doctor if you need vitamin and mineral supplements.
• Some patients experience nausea, diarrhoea, sweating and flushing after eating. This is called the ‘dumping syndrome’ and occurs when part or all of the stomach is removed, causing the swallowed food to pass directly into the intestine. These symptoms often get better with time. Report all discomfort and food-related problems to your doctor and nutritionist.

The goal of nutritional support and therapy ³ is to improve nutritional status, metabolism and help the patient better adhere to anti-cancer therapies. This not only improves treatment outcomes but also improves overall quality of life.

References: 

1. India State-Level Disease Burden Initiative Cancer Collaborators. The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Oncol. 2018 Oct;19(10):1289-1306.
2. Rosania R, Chiapponi C, Malfertheiner P, Venerito M. Nutrition in Patients with Gastric Cancer: An Update. Gastrointest Tumors. 2016;2(4):178-87.
3. Arends J, Bertz H, Bischoff SC, Fietkau R, Herrmann HJ, Holm E, Horneber M, Hütterer E, Körber J, Schmid I, DGEM Steering, Committee S3-Guideline of the German Society for Nutritional Medicine (DGEM) Aktuelle Ernahrungsmed. 2015; 40:1–74.