Effect of Surgery on Nutrition
Effect of Chemotherapy on Nutrition
Effect of Radiation Therapy on Nutrition
Effect of Immunotherapy on Nutrition
Effect of Bone Marrow and Stem Cell Transplantation on Nutrition

Effect of Surgery on Nutrition

Surgery increases the body's need for nutrients and energy.

The body needs extra energy and nutrients to heal wounds, fight infection, and recover from surgery. If the patient is malnourished before surgery, there may be complications during recovery, such as poor healing or infection. Patients with certain cancers, such as cancers of the head, neck, stomach, and intestines, may be malnourished at diagnosis. Nutrition care may therefore begin before surgery.

Nutrition-related side effects may occur as a result of surgery.

More than half of cancer patients have cancer-related surgery. Surgery may include the removal of all or parts of certain organs, which may affect a patient's ability to eat and digest food. The following are nutrition problems related to specific surgeries:

• Surgery to the head and neck may cause chewing and swallowing problems. Mental stress due to the amount of tissue removed during surgery may affect appetite.



• Surgery involving cancer of organs in the digestive system may lessen the ability of the digestive system to work properly and may slow the digestion of food. Removal of part of the stomach may cause a feeling of fullness before enough food has been eaten. Stomach surgery may also cause dumping syndrome (emptying of the stomach into the intestines before food is digested). Some of the organs in the digestive system normally produce important hormones and chemicals that are necessary for digestion. If surgery affects these organs, the protein, fat, vitamins, and minerals in the diet may not be absorbed normally by the body. Levels of sugar, salt, and fluid in the body may become unbalanced.

Nutrition therapy can treat these problems and help cancer patients get the nutrients they need.

Nutrition therapy can treat the nutrition-related side effects of surgery.

Nutrition therapy may include the following:

• Nutritional supplement drinks.
• Enteral nutrition (feeding liquid through a tube into the stomach or intestine).
• Parenteral nutrition (feeding through a catheter into the bloodstream).
• Medications to improve the appetite.

Surgery may cause fatigue, pain, and loss of appetite.

It is common for patients to experience pain, tiredness, and/or loss of appetite after surgery. For a short time, some patients may not be able to eat their regular diet because of these symptoms. The following eating tips may help:

• Avoid carbonated drinks (such as sodas) and gas-producing foods (such as beans, peas, broccoli, cabbage, brussel sprouts, green peppers, radishes, and cucumbers).



• If regularity is a problem, increase fiber by small amounts and drink lots of water. Good sources of fiber include whole-grain cereals (such as oatmeal and bran), beans, vegetables, fruit, and whole grain breads.



• Choose high-protein and high- calorie foods to help wounds heal. Good choices include eggs, cheese, whole milk, ice cream, nuts, peanut butter, meat, poultry, and fish. Increase calories by frying foods and using gravies, mayonnaise, and salad dressings. Supplements high in calories and protein are available.

Chemotherapy may affect the whole body.

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Because chemotherapy targets rapidly dividing cells, healthy cells that normally grow and divide rapidly may also be affected by the cancer treatments. These include cells in the mouth and digestive tract.

Nutrition-related side effects may occur during chemotherapy.

Side effects that interfere with eating and digestion may occur during chemotherapy. The following side effects are common:

• Anorexia.
• Nausea.
• Vomiting.
• Diarrhea or constipation.
• Inflammation and sores in the mouth.
• Changes in the way food tastes.
• Infections.

Nutrition therapy can treat the nutrition-related side effects of chemotherapy.

The side effects of chemotherapy may make it difficult for a patient to obtain the nutrients needed to regain healthy blood counts between chemotherapy treatments. Nutrition therapy can treat these side effects and help chemotherapy patients get the nutrients they need to tolerate and recover from treatment, prevent weight loss, and maintain general health. Nutrition therapy may include the following:

• Supplements high in calories and protein.



• Enteral nutrition (tube feedings).

Radiation therapy can affect healthy cells in the treatment area.

Radiation therapy is a cancer treatment that uses high energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Healthy cells that are near the cancer may be affected by the radiation treatments, and side effects may occur. The side effects depend mostly on the radiation dose and the part of the body that is treated.

Nutrition-related side effects may occur during radiation therapy.

Radiation therapy to any part of the digestive system is likely to cause nutrition -related side effects. The following side effects may occur:

• Radiation therapy to the head and neck may cause anorexia, taste changes, dry mouth, inflammation of the mouth and gums, swallowing problems, jaw spasms, cavities, or infection.



• Radiation therapy to the chest may cause infection in the esophagus, swallowing problems, esophageal reflux (a backwards flow of the stomach contents into the esophagus), nausea, or vomiting.



• Radiation therapy to the abdomen or pelvis may cause diarrhea, nausea and vomiting, inflammation of the intestine or rectum, and fistula (holes) in the stomach or intestines. Long-term effects can include narrowing of the intestine, chronic inflamed intestines, poor absorption, or blockage in the stomach or intestine.



• Radiation therapy may also cause tiredness, which can lead to a decrease in appetite and a reduced desire to eat.

Nutrition therapy can treat the nutrition-related side effects of radiation therapy.

Nutrition therapy during radiation treatment can provide the patient with enough protein and calories to tolerate the treatment, prevent weight loss, and maintain general health. Nutrition therapy may include the following:

• Nutritional supplement drinks between meals.



• Enteral nutrition (tube feedings).



• Other changes in the diet, such as eating small meals throughout the day and choosing certain kinds of foods.

Nutrition-related side effects may occur during immunotherapy.

Immunotherapy is treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biologic therapy or biotherapy.

The following nutrition -related side effects are common during immunotherapy:

• Fever.
• Nausea.
• Vomiting.
• Diarrhea.
• Anorexia.
• Tiredness.

Nutrition therapy can treat the nutrition-related side effects of immunotherapy.

If the side effects of immunotherapy are not treated, weight loss and malnutrition may occur. These conditions can cause complications during recovery, such as poor healing or infection. Nutrition therapy can treat side effects from immunotherapy and help patients get the nutrients they need to tolerate treatment, prevent weight loss, and maintain general health.

Bone marrow and stem cell transplant patients have special nutritional needs.

Bone marrow and stem cell transplantation are methods of replacing blood -forming cells destroyed by cancer treatment with high doses of chemotherapy or radiation therapy. Stem cells (immature blood cells) are removed from the bone marrow of the patient or a donor and are frozen for storage. After the chemotherapy and radiation therapy are completed, the stored stem cells are thawed and given back to the patient through an infusion. Over a short time, these reinfused stem cells grow into (and restore) the body’s blood cells.

Chemotherapy, radiation therapy, and medications used in the transplant process may cause side effects that prevent a patient from eating and digesting food as usual. These side effects include the following:

• Taste changes.
• Dry mouth.
• Thick saliva.
• Mouth and throat sores.
• Nausea and vomiting.
• Diarrhea.
• Constipation.
• Lack of appetite.
• Weight gain.

Transplant patients also have a very high risk of infection. The high doses of chemotherapy and radiation therapy reduce the number of white blood cells, the cells that fight infection. Cancer patients should be especially careful to avoid infections and food-borne illnesses. Patients are advised to avoid eating certain foods that may carry harmful bacteria.

Nutrition therapy can treat the nutrition-related side effects of bone marrow and stem cell transplantation.

Patients undergoing the transplant process need adequate protein and calories to tolerate and recover from the treatment, prevent weight loss, fight infection, and maintain general health. Nutrition therapy is also designed to avoid possible infection from bacteria in food. Nutrition therapy during the transplant process may include the following:

• A diet of only cooked and processed foods, avoiding raw vegetables and fresh fruit.



• Instruction on safe food handling.



• Specific diet guidelines based on the type of transplant and the cancer site.



• Parenteral nutrition (feeding through the bloodstream) during the first few weeks after the transplant is complete, to ensure the patient gets the calories, protein, vitamins, minerals and fluids needed for good health.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

An abnormal loss of the appetite for food. Anorexia can be caused by cancer, AIDS, a mental disorder (i.e., anorexia nervosa), or other diseases.

A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Also called CBC and complete blood count.

The soft, sponge-like tissue in the center of most bones. It produces white blood cells, red blood cells, and platelets.

A procedure to replace bone marrow that has been destroyed by treatment with high doses of anticancer drugs or radiation. Transplantation may be autologous (an individual's own marrow saved before treatment), allogeneic (marrow donated by someone else), or syngeneic (marrow donated by an identical twin).

A measurement of the energy content of food. The body needs calories as to perform its functions, such as breathing, circulating the blood, and physical activity. When a person is sick, their body may need extra calories to fight fever or other problems.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A flexible tube used to deliver fluids into or withdraw fluids from the body.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

Treatment with drugs that kill cancer cells.

A disease or condition that persists or progresses over a long period of time.

A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.

The process of identifying a disease, such as cancer, from its signs and symptoms.

Frequent and watery bowel movements.

The things a person eats and drinks.

A product that is added to the diet. A dietary supplement is taken by mouth, and usually contains one or more dietary ingredient (such as vitamin, mineral, herb, amino acid, and enzyme). Also called nutritional supplement.

The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum.

The organs through which food and liquids pass when they are swallowed, digested, and eliminated. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum and anus.

The amount of medicine taken, or radiation given, at one time.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A condition that occurs when food or liquid moves too fast into the small intestine. Symptoms include cramps, nausea, diarrhea, sweating, weakness, and dizziness. Dumping syndrome sometimes occurs in people who have had part or all of their stomach removed.

A form of nutrition that is delivered into the digestive system as a liquid. Drinking nutrition beverages or formulas and tubefeeding are forms of enteral nutrition. People who are unable to meet their needs with food and beverages alone, and who do not have vomiting or uncontrollable diarrhea may be given tubefeedings. Tubefeeding can be used to add to what a person is able to eat or can be the only source of nutrition. A small feeding tube may be placed through the nose into the stomach or the small intestine, or it may be surgically placed into the stomach or the intestinal tract through an opening made on the outside of the abdomen, depending on how long it will be used.

The backward flow of stomach acid contents into the esophagus (the tube that connects the mouth to the stomach). Also called gastric reflux and gastroesophageal reflux.

The muscular tube through which food passes from the throat to the stomach.

A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.

In food, fiber is the part of fruits, vegetables, legumes, and whole grains that cannot be digested. The fiber in food may help prevent cancer. In the body, fiber refers to tissue made of long threadlike cells, such as muscle fiber or nerve fiber.

Liquid.

An intensive drug treatment to kill cancer cells, but that also destroys the bone marrow and can cause other severe side effects. High-dose chemotherapy is usually followed by bone marrow or stem cell transplantation to rebuild the bone marrow.

One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.

The complex group of organs and cells that defends the body against infections and other diseases.

Treatment to boost or restore the ability of the immune system to fight cancer, infections, and other diseases. Also used to lessen certain side effects that may be caused by some cancer treatments. Agents used in immunotherapy include monoclonal antibodies, growth factors, and vaccines. These agents may also have a direct antitumor effect. Also called biological response modifier therapy, biological therapy, biotherapy, and BRM therapy.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.

A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion.

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called bowel.

A disorder caused by a lack of proper nutrition or an inability to absorb nutrients from food.

A nutrient required to maintain health.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.

The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.

A part of the body that performs a specific function. For example, the heart is an organ.

A form of nutrition that is delivered into a vein. Parenteral nutrition does not use the digestive system. It may be given to people who are unable to absorb nutrients through the intestinal tract because of vomiting that won't stop, severe diarrhea, or intestinal disease. It may also be given to those undergoing high-dose chemotherapy or radiation and bone marrow transplantation. It is possible to give all of the protein, calories, vitamins and minerals a person needs using parenteral nutrition. Also called hyperalimentation, total parenteral nutrition, and TPN.

The lower part of the abdomen, located between the hip bones.

A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

Giving off radiation.

A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material breaks down and becomes more stable.

The last several inches of the large intestine closest to the anus.

The watery fluid in the mouth made by the salivary glands. Saliva moistens food to help digestion and it helps protect the mouth against infections.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.

A method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

Adding nutrients to the diet.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

A group or layer of cells that work together to perform a specific function.

The replacement of tissue with tissue from the person’s own body or from another person.

A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.

To eject some or all of the contents of the stomach through the mouth.

Refers to a blood cell that does not contain hemoglobin. White blood cells include lymphocytes, neutrophils, eosinophils, macrophages, and mast cells. These cells are made by bone marrow and help the body fight infections and other diseases. Also called WBC.

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.