Managing eating problems caused by surgery, radiation, and chemotherapy

Different cancer treatments can cause different kinds of problems that may make it hard for you to eat or drink. Here are some tips on how to manage nutrition problems depending on the type of treatment you receive.

Surgery

Surgery is done to remove cancer cells and nearby tissue. It is often used with radiation therapy and chemotherapy.

After surgery, the body needs extra calories and protein for wound healing and recovery. This is when many people have pain and feel tired. They also may be unable to eat a normal diet because of surgery-related side effects. The body’s ability to use nutrients may also be changed by surgery that involves any part of the mouth, esophagus, stomach, small intestine, pancreas, colon, or rectum.

Nutrition tips for people having cancer surgery

If you’ve had surgery, remember that many side effects will go away within a few days of the operation. Certain drugs, self-care practices, and changes in diet can help lessen some side effects. If they last, be sure to tell your doctor, nurse, dietitian, or other member of your health care team.

Eat as well as you can on days when your appetite is good. Try to eat regular meals and snacks, but don’t be too hard on yourself if side effects make it hard to eat. It may be easier to eat small, frequent meals or snacks.

Don’t hesitate to ask for help with shopping for groceries and preparing meals.

Keep in mind that foods and drinks that are low in fat are easier to digest and tolerate than high-fat items, like fried or greasy foods.

As you recover, make sure to take in plenty of fluids (at least eight 8-ounce glasses each day unless directed otherwise by your doctor). Try to sip water, juices, and other clear liquids throughout the day.

Talk with your health care team about how soon you can return to your normal, day-to-day activities. Ask your surgeon for guidelines to increase physical activity,

The day or night before surgery, you may not be allowed to eat or drink anything. After the operation, it may be several hours or even 1 or 2 days before you can eat normal foods and liquids. If you haven’t eaten for more than a day or 2, your doctor may let you eat only easy-to-digest foods and drinks at first. Here is a typical example of the steps a person may take to start eating again after surgery:

1st step: Clear liquids
Plain gelatin	Clear, carbonated drinks
Sports drinks	Weak tea
Juices	Clear, fat free broth
Strained citrus juices	Bouillon
Fruit ices	Consommé
Popsicles	Strained vegetable broth
Strained lemonade	Water

2nd step: Easy-to-digest foods (add to the clear liquids in 1st step)
Plain crackers	White bread, rolls
“Instant” hot cereal	White rice, noodles, and potatoes
Angel food cake	Fruit nectars
All juices	Soft or baked custard
Canned, peeled fruits and vegetables	Plain puddings
Lean beef, fish, skinless chicken or turkey	Plain milk shakes
Strained, blenderized broth-based or cream soups	Smooth ice cream or ice milk
Refined cereals	Carton or frozen yogurt
Milk, all types	Pasteurized eggnog

3rd step: Regular diet

Try to eat smaller, more frequent meals, and add foods as tolerated.

Be careful of foods that cause gas, like beans, melons, cruciferous vegetables (broccoli, cauliflower, and cabbage), milk, and milk products.

You may not do well with high-fat, greasy, or deep-fat-fried foods.

Side effects of cancer surgery that can affect eating

After surgery, the type of side effects you might have and how long they last depend on the type of surgery and your overall health. There are many possible side effects after surgery for cancer of different parts of the body that can change your ability to eat. For instance, you may have:

Trouble chewing and swallowing

Taste changes

Dry mouth

Sore mouth

Loss of appetite

Fatigue

Heartburn/indigestion

Feeling of fullness when eating

Fat intolerance

Milk intolerance

Decreased absorption of nutrients from food

Food may pass through your system more quickly.

Dehydration

Gas and bloating

Cramping

Constipation

Shortness of breath

These side effects can be treated so you can take in the nutrients you need to heal. Be sure to talk to your health care team about any problems you are having so they can help you manage them.

Radiation therapy

In radiation therapy, radiation is directed at the tumor to kill the cancer cells. While all cells are affected by radiation, most normal cells can usually recover over time. The type of side effects radiation causes depends on the area of the body being treated, the size of the area being treated, the type and total dose of radiation, and the number of treatments. The following chart shows possible eating-related side effects of radiation, according to the area of body being treated. Some of these side effects can happen during treatment while others may not happen until after treatment.

Area of body being treated	Eating-related side effects that might happen during treatment	Eating-related side effects that might happen more than 90 days after treatment
Brain, spinal column	Nausea, vomiting	Headache, tiredness
Head or neck: tongue, voice box, tonsils, salivary glands, nasal cavity, pharynx	Sore mouth, hard to swallow or pain with swallowing, change in taste or loss of taste, sore throat, dry mouth, thick saliva	Dry mouth, damage to jaw bone, lockjaw, changes in taste and smell
Chest: lungs, esophagus, breast	Trouble swallowing, heartburn, tiredness, loss of appetite	Narrowing of the esophagus, chest pain with activity, enlarged heart, inflammation of the pericardium (the membrane around the heart), lung scarring or inflammation
Belly (abdomen): large or small intestine, prostate, cervix, uterus, rectum, pancreas	Loss of appetite, nausea, vomiting, diarrhea, gas, bloating, difficulty tolerating milk products, changes in urination, tiredness	Diarrhea, blood in urine or bladder irritation

Side effects usually start around the second or third week of treatment and peak about two-thirds of the way through treatment. After radiation therapy ends, most side effects last 3 or 4 weeks, but some may last much longer.

If you have side effects, ask your doctor, nurse, or other health care professional whether medicines, a change in diet, or anything else can help you manage them.

Nutrition tips for people getting radiation therapy

Eating well while getting radiation may be hard to do, especially if you must travel to a treatment center far from your home. Remember these tips:

Try to eat something at least an hour before treatment rather than going in with an empty stomach, unless otherwise instructed by your radiation center.

Bring snacks or nutrition supplements with you to eat or drink on the ride to and from treatment if you are traveling a long distance. Easy-to-carry foods include single-serving size bowls of fruit, gelatin, or pudding; cheese or peanut butter and crackers; granola bars; or cereal.

Make sure to drink liquids with your small, frequent meals if food does not taste good, hurts going down, or causes diarrhea.

Be sure to drink plenty of water and other liquids.

Ask friends and family to help by shopping for groceries and preparing meals.

Do not expect to have the same side effects as someone else being treated for cancer in another area of the body. Even people with the exact same treatment may have different side effects.

Try to eat small, frequent snacks rather than 3 large meals. If your appetite is better at certain times of the day, plan on having your largest meal then. You may also have been told to add extra calories and protein to your foods. If so, see the section called “Tips to increase calories and protein.”

Nutrition supplements, such as liquid meal replacements, may help. Your doctor, nurse, or dietitian may have samples for you to try.

If you are having appetite problems, nausea or vomiting, diarrhea, sore mouth or throat, dry mouth, thick saliva, trouble swallowing, or changes in the taste or smell of food, please refer to these specific sections in this guide for information on how to help manage these side effects.

If you are having trouble eating and have been following a special eating plan for diabetes or some other chronic health condition, some of these general tips may not work for you. Talk to your doctor, nurse, or dietitian about how best to change your eating habits while you are getting radiation treatments.

Tell your doctor or nurse about any side effects you have so they can prescribe any needed medicines. For example, there are medicines to control nausea and vomiting or to treat diarrhea. For more information on how to manage the side effects of radiation therapy, call us for a free copy of Understanding Radiation Therapy: A Guide for Patients and Families or read it on our Web site.

Other patients can also be a great source of information and support. Get to know and talk with other patients about their experiences, or join a support group. If you would like information on support programs, contact your local American Cancer Society office or call 1-800-227-2345.

Chemotherapy

Chemotherapy (chemo) is the use of strong drugs to kill cancer cells. The drugs are most often taken by mouth or put into the bloodstream. Chemo drugs can damage both healthy cells and cancer cells. Cells most likely to be injured are bone marrow, hair, and the lining of the digestive tract, including the mouth, esophagus, stomach, and intestines. Side effects depend on what kind of chemo drugs you take and how you take them. The common side effects of chemo that can cause eating problems are:

Appetite changes

Changes in bowel habits

Changes in taste and smell

Fatigue

Mouth tenderness or sores

Nausea

Vomiting

You may not have these side effects, but if you do, be sure to tell your doctor or nurse. They may suggest medicines, daily self-care practices, and changes in diet to lessen eating-related side effects.

Nutrition tips for people getting chemo

Most people get chemo at an outpatient center. It may take anywhere from a few minutes to many hours. Make sure you eat something before getting your treatment. Most people find that a light meal or snack an hour or so before chemo works best. If you will be there several hours, plan ahead and bring a small meal or snack in an insulated bag or cooler. Find out if there is a refrigerator or microwave you can use.

Don’t be too hard on yourself if side effects make it hard to eat. Try eating small, frequent meals or snacks. Go easy on fried or greasy foods, which can be hard to digest. On days when you are feeling well and your appetite is good, try to eat regular meals and snacks. Be sure to drink plenty of water or liquids (eight to ten 8-ounce glasses) each day.

Ask for help with grocery shopping and fixing meals. If you have no one to help you, think about having meals delivered to your home or eating at a community or senior center. To learn more about meal delivery and other services, click on the “Contact Us” button at www.cancer.org or call us at 1-800-227-2345 for resources in your area.

Some side effects of chemo go away within hours of getting treatment. If your side effects persist, tell your health care team. Prompt attention to nutrition-related side effects can help keep up your weight and energy level and help you feel better.

If you are having trouble with poor appetite, nausea or vomiting, diarrhea or constipation, sore mouth or throat, dry mouth, trouble swallowing, or changes in the taste or smell of food, please refer to these specific sections in this guide for information on how to help manage these side effects. Be sure that your doctor or nurse knows about your side effects so they can help you manage them.

If you are having trouble eating and have been following a special eating plan for diabetes or some other chronic health condition, talk to your doctor, nurse, or dietitian about how best to change your eating habits while you are getting chemo.

For more information on managing side effects of chemo, call for a copy of Understanding Chemotherapy: A Guide for Patients and Families or read it on our Web site.