Malnutrition in stomach cancer is common to most people with stage 4 disease.
It’s a complex area and causes many different issues, but early intervention has been shown to make a difference in some patients.
If not addressed, cachexia (going off food) and weight loss occur, resulting in loss of your muscle mass and fat reserves.
Your family will worry about this and your doctor too.
It is all about making sure your body has the required amount of vitamins, minerals, fats, proteins and carbohydrates.
In order to achieve this, you need to experience hunger, eat and gain satiety from having a decent meal.
However, in stomach cancer the opposite happens, hunger is lost and you might experience difficulty with eating.
Early satiety is a common issue as your stomach is less compliant and taken up by the tumor
A similar problem can occur after gastrectomy and malnutrition in stomach cancer can result.
If you go off your food and lose weight, certain things problems can arise including:
If you don't get the required nutrition, you will eventually become malnourished.
We know from studies that trying to maintain feed is associated with:
So, it would seem sensible to address malnutrition in stomach cancer whatever the circumstances, but there are issues with this.
Cancers can change the way the body handles some constituents of food and in stomach cancer, digestion may be affected too.
In most patients (>85%), in the latter stages of the disease, cachexia (going off food) and malnutrition in stomach cancer patients occurs.
The tumor in some way affects appetite, a problem that can occur in other illnesses too.
Weight loss is due to an increased 'catabolic state'. Catabolism occurs because your body burns more energy as the tumor grows.
If you are having treatment, whether chemotherapy, radiotherapy or surgery your catabolism increases.
In stomach cancer, food is more difficult to digest and the volume you eat is reduced due to early satiety, poor stomach retention and vomiting.
Chemotherapy and radiotherapy can cause also cause side effects including sore mouth, diarrhea and vomiting which can all contribute to weight loss.
We know trying to maintain your nutrition, at an early stage, you are more likely to benefit from its effects.
So, how can you maintain your nutrients?
Well, the simple answer is to eat more or at least eat high calorie foods containing a lot of fat, protein and carbohydrate.
Ice cream, cream, sugary drinks, milk puddings, custard, biscuits and yoghurt's will give you the fats and carbohydrates plus some protein too.
Mince your meat, perhaps liquidise it and add to mashed potato with gravy.
Taking high calorie nutrient drinks and supplements might improve your bodies intake as well.
Specialist nutritionists or dieticians will help find the right diet plan which, in turn, will help to prevent malnutrition in stomach cancer patients.
If you can’t maintain your nutrition, some surgeons and oncologist's may look at artificial ways of feeding you.
The 3 main ways to prevent malnutrition in stomach cancer patients are:
A nasogastric tube is a thin tube, inserted through your nose and fed down to your stomach. The it is then fixed to the side of your cheek with tape.
Liquid nutrition can be passed through this as a supplement to what you are already managing.
The advantage of having such as tube is that it is usually easily placed or removed.
However some people can’t tolerate the tube and pull it out or have issues with retching.
There are also risks of inserting the tube in to the lung as well as causing perforation (putting a hole in the gut wall), but thankfully this is rare if performed by suitably trained staff.
An alternative is a nasojejunal (NJ) tube. This is placed endoscopically or through radiological (x-ray) guidance.
An NJ tube is passed through the stomach in to the duodenum and then jejunum.
The advantage of this is you bypass your vomiting mechanism and pass liquid food directly in to your small bowel.
Special liquid feed to treat malnutrition in stomach cancer is sometimes given via either a peripheral cannula/PICC line or needle.
It is known as PPN when given this way or TPN when given through a central line.
It is not without risk, but does totally bypass the gut so is generally used when gut feeding or 'enteral' feeding is not an option.
It is also reserved for those before, during or after cancer treatment whether this is surgery or chemotherapy.
The main risks of parenteral nutrition include:
There is an increased risk of developing blood clots on the central line which can the throw of clots in to the lungs.
The condition is referred to as PE’s or Pulmonary Emboli, a potentially life threatening condition.
Any foreign body in the vein increases your risk of introducing infection in to your blood stream and subsequent septicaemia.
This risk is reduced by sterile placement of your line and good care of it too.
There is an increased risk of liver failure from TPN due to steatosis or fat deposits in the liver.
When malnutrition in stomach cancer occurs, it is dangerous to overfeed in the early stages.
It can cause massive changes in your blood phosphate levels (phosphate is required for energy production), electrolytes including Sodium and Potassium as well as fluid handling.
Fluid can build up in the tissues of your limbs and cause edema.
Imbalances of the above can cause breathing difficulties, nerve damage, blood issues as well as damage to your heart.
Replacement therapy needs to be closely monitored with blood tests to make sure your nutrients including phosphate, electrolytes, Calcium and Magnesium are replaced appropriately.