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DESCRIPTION
THE OVARIES: The ovaries are part of a woman's reproductive system. They are in the pelvis. Each ovary is about the size of an almond. The ovaries make the female hormones - estrogen and progesterone. They also release eggs. An egg travels from an ovary through a fallopian tube to the womb (uterus). When a woman goes through her "change of life" (menopause), her ovaries stop releasing eggs and make far lower levels of hormones.
Cancer is a malignant growth of the ovary that is likely to spread to other body parts and threaten life. It affects females of all ages, but is most common after age 50. There are many different types of ovarian cancer. Epithelial tumors account for the majority and are the most aggressive. Other ovarian cancers are slow growing, or metastasized from other cancer sites in the body.
UNDERSTANDING CANCER: Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body. Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place. Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor. Tumors can be benign or malignant:
Benign tumors are not cancer:
- Benign tumors are rarely life-threatening.
- Generally, benign tumors can be removed. They usually do not grow back.
- Benign tumors do not invade the tissues around them.
- Cells from benign tumors do not spread to other parts of the body.
Malignant tumors are cancer:
- Malignant tumors are generally more serious than benign tumors. They may be life-threatening. Malignant tumors often can be removed. But sometimes they grow back. Malignant tumors can invade and damage nearby tissues and organs. Cells from malignant tumors can spread to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the lymphatic system or bloodstream. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.
BENIGN & MALIGNANT CYSTS: An ovarian cyst may be found on the surface of an ovary or inside it. A cyst contains fluid. Sometimes it contains solid tissue too. Most ovarian cysts are benign (not cancer). Most ovarian cysts go away with time. Sometimes, a health care provider or midwife will find a cyst that does not go away or that gets larger. The health care provider/midwife may order tests to make sure that the cyst is not cancer or refer you to another practitioner for further evaluation.
Ovarian Cancer is a type of cancer that begins in the ovarian cells. The types of cells that are found in the ovaries include the following:
- Surface epithelial cells.
- Germ cells.
- And the sex cord-stromal cells.
Any cancer cells that invade the ovaries and begin to grow within the ovaries are not considered or referred to as Ovarian Cancer.
Many types of tumors can start to form within the ovary organs of a woman. A few of these types are considered to be benign or non-cancerous. In these cases the patient can be cured by surgically removing one ovary or the part of the ovary containing the tumor. Other types of Ovarian Cancer are malignant or cancerous. Treatment options and outcomes for patients that have contracted these types of Ovarian Cancer depend on the exact classification of the Ovarian Cancer and how far it has spread before it is diagnosed. Ovarian Tumors are named according to the category of cells from which the tumor originated and whether the tumor is classified as benign or cancerous. The three main classifications of Ovarian Tumors are:
- Epithelial Tumors.
- Germ Cell Tumors.
- Stromal Tumors.
OVARIAN CANCER
Ovarian cancer can invade, shed, or spread to other organs:
- Invade: A malignant ovarian tumor can grow and invade organs next to the ovaries, such as the fallopian tubes and uterus.
- Shed: Cancer cells can shed (break off) from the main ovarian tumor. Shedding into the abdomen may lead to new tumors forming on the surface of nearby organs and tissues. The doctor may call these seeds or implants.
- Spread: Cancer cells can spread through the lymphatic system to lymph nodes in the pelvis, abdomen, and chest. Cancer cells may also spread through the bloodstream to organs such as the liver and lungs.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original tumor. For example, if ovarian cancer spreads to the liver, the cancer cells in the liver are actually ovarian cancer cells. The disease is metastatic ovarian cancer, not liver cancer. For that reason, it is treated as ovarian cancer, not liver cancer. Doctors call the new tumor "distant" or metastatic disease.
MoonDragon's Obgyn Information: Ovarian Cysts
FREQUENT SIGNS & SYMPTOMS
Frequently no symptoms occur in early ovarian cancer until the tumor becomes large. But as the cancer grows, symptoms may become apparent.
The earliest symptoms include:
- Vague discomfort in the lower abdomen.
- Pressure or pain in the abdomen, pelvis, back or legs.
- A swollen or bloated abdomen.
- Gastrointestinal upsets, nausea, indigestion.
- Constipation or diarrhea.
- Irregular menstrual periods.
- Feeling very tired all the time.
Less Common symptoms include:
- Shortness of breath.
- Feeling the need to urinate often.
- Unusual vaginal bleeding (heavy periods, post-menopausal bleeding).
Later symptoms:
- Deep voice.
- Excessive hair growth.
- Unexplained weight loss.
- An enlarged, hard and sometimes tender mass in the lower abdomen.
- Pain with intercourse.
- Anemia.
Most often these symptoms are not due to cancer, but to other health issues. You need to visit your health care provider for an exam and possibly tests to rule out or confirm a cancer diagnosis. If you experience any of these symptoms, you should consult with your health care provider.
THE SILENT KILLER
Early detection of ovarian cancer offers a 90 percent cure rate. Sadly, a lack of symptoms from this silent disease means that about 75 percent of ovarian cancer cases will have spread to the abdomen by the time they are detected and, unfortunately, most patients die within five years. Thus, ovarian cancer has been dubbed The Silent Killer.
CAUSES
The exact causes of ovarian cancer are not known. However, studies show that the following risk factors for ovarian cancer may increase the chance of developing this disease (these are repeated again in Risk Factors section):
- The predominant type of ovarian cancer is believed to result from repetitive injury to the surface of the ovary.
- Family history or genetic disposition to ovarian cancer. First-degree relatives (mother, daughter, sister) of a woman who has had ovarian cancer are at increased risk of developing this type of cancer themselves. The likelihood is especially high if two or more first-degree relatives have had the disease. The risk is somewhat less, but still above average, if other relatives (grandmother, aunt, cousin) have had ovarian cancer. A family history of breast or colon cancer is also associated with an increased ovarian cancer risk factor
- Age. The likelihood of developing ovarian cancer increases as a woman gets older. Most ovarian cancers occur in women over the age of 50, with the highest ovarian cancer risk factor in women over 60.
- Childbearing. Women who have never had children are more likely to develop ovarian cancer than women who have had children. In fact, the more children a woman has had, the less likely she is to develop ovarian cancer.
- Personal history. Women who have had breast or colon cancer may have a greater chance of developing ovarian cancer than women who have not had breast or colon cancer.
- Fertility drugs. Drugs that cause a woman to ovulate may slightly increase a woman's chance of developing ovarian cancer. Researchers are studying this possible association.
- Hormone replacement therapy (HRT). Some evidence suggests that women who use HRT after menopause may have a slightly increased risk factor for ovarian cancer.
About 1 in every 57 women in the United States will develop ovarian cancer. Most cases occur in women over the age of 50, but this disease can also affect younger women.
RISK FACTORS
Health care providers cannot always explain why one woman develops ovarian cancer and another does not. However, women with certain risk factors may be more likely than others to develop ovarian cancer. A risk factor is something that may increase the chance of developing a disease. Studies have found the following risk factors for ovarian cancer:
- Family history of ovarian cancer. Women who have a mother, daughter, or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon, or rectum may also have an increased risk of ovarian cancer. If several women in a family have ovarian or breast cancer, especially at a young age, this is considered a strong family history. If you have a strong family history of ovarian or breast cancer, you may wish to talk to a genetic counselor. The counselor may suggest genetic testing for you and the women in your family. Genetic tests can sometimes show the presence of specific gene changes that increase the risk of ovarian cancer.
- Personal history of cancer. Women who have previously been diagnosed with cancers of the breast, uterus, colon or rectum have a higher risk of ovarian cancer.
- Late pregnancies (over age 30).
- Never pregnant. Older women who have never been pregnant have an increased risk of ovarian cancer.
- Age of 55. Most women are over the age of 55 when diagnosed with ovarian cancer.
- Menopausal hormone therapy. Some studies have suggested that women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer.
Studies have been done by scientists to study whether taking certain fertility drugs, using talcum powder, or being obese are risk factors. It is not clear whether these are risk factors, but if they are, they are not strong risk factors.
Having a risk factor does not mean that a woman will get ovarian cancer. Most women who have risk factors do not get ovarian cancer. On the other hand, women who do get the disease often have no known risk factors, except for growing older. Women who think they may be at risk of ovarian cancer should talk with their health care provider.
As we learn more about what causes ovarian cancer, we may also learn how to reduce the chance of getting this disease. Some studies have shown that breast feeding and taking birth control pills (oral contraceptives) may decrease a woman's likelihood of developing ovarian cancer. These factors decrease the number of times a woman ovulates, and studies suggest that reducing the number of ovulations during a woman's lifetime may lower the risk of ovarian cancer.
Women who have had an operation that prevents pregnancy (tubal ligation) or have had their uterus and cervix removed (hysterectomy) also have a lower risk of ovarian cancer. In addition, some evidence suggests that reducing the amount of fat in the diet may lower the risk of developing ovarian cancer.
Women who have higher risk factors for ovarian cancer due to a family history of the disease may consider having their ovaries removed before cancer develops (prophylactic oophorectomy). This procedure usually, but not always, protects women from developing ovarian cancer. The risks associated with this surgery and its side effects should be carefully considered. A woman should discuss the possible benefits and risks with her health care provider based on her unique situation.
Having one or more of the ovarian cancer risk factors mentioned here does not mean that a woman is sure to develop ovarian cancer, but their chance may be higher than average. Women who are concerned about ovarian cancer may want to talk with a health care provider who specializes in treating women with cancer: a gynecologist, a gynecologic oncologist, or a medical oncologist. The health care provider may be able to suggest ways to reduce the likelihood of developing ovarian cancer and can plan an appropriate schedule for checkups.
PREVENTIVE MEASURES
Have yearly pelvic examinations which may aid in earlier detection and treatment. If your mother or sister had ovarian cancer, additional screening tests, such as ultrasound, may be recommended.
Oral contraceptives may help with prevention. Women who use oral contraceptives for at least five years reduce their chance of developing ovarian cancer by half for the short-term following use and possibly for lifetime. The longer you use the pill, the lower your risk. However, carefully consider the negative side effects that may accompany the use of oral contraceptives.
Preventive surgery involving the removal of the ovaries has been suggested for some women who have a mother or sisters with ovarian cancer. An immediate (mother, sister, or daughter) family member who has had ovarian cancer increases your risk of developing this disease about three times, giving you a five to seven percent risk of future ovarian cancer.
When the cause is genetic, ovarian cancer usually shows up a decade earlier in each successive generation. (If your mother had ovarian cancer in her 60's, you stand a good chance that this disease will develop in you in your 50's.) Genetic counseling is a good idea for women with a family history of breast or ovarian cancers. Women with a family history may opt for oophorectomy (ovary removal), although this procedure does not offer absolute protection it does reduce risk by 75 to 90 percent.
Research has determined that women who use powders to dust their genital areas have a 60 percent higher risk of ovarian cancer. Feminine deodorant sprays can almost double your risk!
Having two or three children can cut your risk by as much as 30 percent over women who never conceive or give birth. Having five or more children reduces the risk up to 50 percent, and breast-feeding your children can further reduce your risk.
Tubal ligation reduces a woman's risk up to 70 percent.
Remember, the best way to detect ovarian cancer is by regular pelvic examinations. See your health care provider for a Pap smear (screens for cervical cancer only) and pelvic/rectal exam yearly or as your health care provider determines best for you.
EXPECTED OUTCOME
Survival rates vary from 25% to 50% of women with ovarian cancer survive at least 5 years after treatment. The prognosis is related closely to the stage of the disease when it is first diagnosed. With aggressive treatment, the long-term survival rate is improving.
POSSIBLE COMPLICATIONS
Reaction to radiation and/or anti-cancer drug therapy.
Pleural effusion (excess of fluid in the lining of the lungs).
Ascites (excess fluid in the peritoneal cavity).
Fatal spread of cancer to other body parts.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
If you have a symptom or symptoms that suggests ovarian cancer, your health care provider must find out whether it is due to cancer or to some other cause. Your health care provider may ask about your personal and family medical history.
You may have one or more of the following tests. Your health care provider can explain more about each test. Diagnostic tests may include pelvic examination, laboratory blood studies, ultrasound of the abdomen, x-rays of the abdomen and CT or MRI. There are several blood tests (tumor markers) available, the most common being CA-125 and additional tests as needed to determine if the cancer has spread to other body parts.
- Physical exam: Your health care provider checks general signs of health. Your health care provider may press on your abdomen to check for tumors or an abnormal buildup of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells.
- Pelvic exam: Your health care provider feels the ovaries and nearby organs for lumps or other changes in their shape or size. A Pap test is part of a normal pelvic exam, but it is not used to collect ovarian cells. The Pap test detects cervical cancer. The Pap test is not used to diagnose ovarian cancer.
- Blood tests: Your health care provider may order blood tests. The lab may check the level of several substances, including CA-125. CA-125 is a substance found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration for monitoring a woman's response to ovarian cancer treatment and for detecting its return after treatment.
- Ultrasound: The ultrasound device uses sound waves that people cannot hear. The device aims sound waves at organs inside the pelvis. The waves bounce off the organs. A computer creates a picture from the echoes. The picture may show an ovarian tumor. For a better view of the ovaries, the device may be inserted into the vagina (transvaginal ultrasound).
- Biopsy: A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound, your health care provider may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose ovarian cancer. To learn more about surgery, see the Treatment section.
Although most women have a laparotomy for diagnosis, some women have a procedure known as laparoscopy. The practitioner inserts a thin, lighted tube (a laparoscope) through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread.
A pathologist uses a microscope to look for cancer cells in the tissue or fluid. If ovarian cancer cells are found, the pathologist describes the grade of the cells. Grades 1, 2, and 3 describe how abnormal the cancer cells look. Grade 1 cancer cells are not as likely as to grow and spread as Grade 3 cells.
STAGING
To plan the best treatment, your health care provider needs to know the grade of the tumor (see Diagnosis) and the extent (stage) of the disease. The stage is based on whether the tumor has invaded nearby tissues, whether the cancer has spread, and if so, to what parts of the body. Usually, surgery is needed before staging can be complete. The surgeon takes many samples of tissue from the pelvis and abdomen to look for cancer. Your health care provider may order tests to find out whether the cancer has spread:
- CT scan: Health care providers often use CT scans to make pictures of organs and tissues in the pelvis or abdomen. An x-ray machine linked to a computer takes several pictures. You may receive contrast material by mouth and by injection into your arm or hand. The contrast material helps the organs or tissues show up more clearly. Abdominal fluid or a tumor may show up on the CT scan.
- Chest x-ray: X-rays of the chest can show tumors or fluid.
- Barium enema x-ray: Your health care provider may order a series of x-rays of the lower intestine. You are given an enema with a barium solution. The barium outlines the intestine on the x-rays. Areas blocked by cancer may show up on the x-rays.
- Colonoscopy: Your health care provider inserts a long, lighted tube into the rectum and colon. This exam can help tell if cancer has spread to the colon or rectum.
These are the stages of ovarian cancer:
- Stage I: Cancer cells are found in one or both ovaries. Cancer cells may be found on the surface of the ovaries or in fluid collected from the abdomen.
- Stage II: Cancer cells have spread from one or both ovaries to other tissues in the pelvis. Cancer cells are found on the fallopian tubes, the uterus, or other tissues in the pelvis. Cancer cells may be found in fluid collected from the abdomen.
- Stage III: Cancer cells have spread to tissues outside the pelvis or to the regional lymph nodes. Cancer cells may be found on the outside of the liver.
- Stage IV: Cancer cells have spread to tissues outside the abdomen and pelvis. Cancer cells may be found inside the liver, in the lungs, or in other organs.
TREATMENT
Many women with ovarian cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. Knowing more about ovarian cancer helps many women cope.
Shock and stress after the diagnosis can make it hard to think of everything you want to ask your health care provider. It often helps to make a list of questions before an appointment. To help remember what your health care provider says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to your health care provider. They can help to take part in the discussion, to take notes, or just to listen.
You do not need to ask all your questions at once. You will have other chances to ask your health care provider or assistant to explain things that are not clear and to ask for more details. Your health care provider may refer you to a gynecologic oncologist, a surgeon who specializes in treating ovarian cancer. Or you may ask for a referral. Other types of health care providers who help treat women with ovarian cancer include gynecologists, medical oncologists, and radiation oncologists. You may have a team of health care providers and their staff to assist you.
A SECOND OPINION
Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your health care provider requests it. You may want to research treatment options and therapies before making a decision about how to progress with your health care plan. It may take some time and effort to gather medical records and arrange to see another health care practitioner. In most cases, a brief delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your health care provider. Sometimes women with ovarian cancer need treatment right away.
There are a number of ways to find a health practitioner for a second opinion:
- Your health care provider may refer you to one or more specialists. At cancer centers, several specialists often work together as a team. You may want to consider obtaining a second opinion outside of your current health care provider's team or group of associates for a more "unbiased" or "un-affiliated" opinion. Don't be afraid to shop around for a second opinion if you have the time before treatment needs to be started.
- The National Cancer Institute (NCI) has a Cancer Information Service, at 1-800-4-CANCER. They can tell you about nearby treatment centers. Information Specialists also can assist you online through LiveHelp at http://www.cancer.gov/help.
- A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists. For Massachusetts, the Massachusetts Medical Society provides health care provider profiles, referrals, and health care information for health care providers and citizens of Massachusetts.
- The American Board of Medical Specialties (ABMS) has a list of practitioners who have had training and passed exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. The Directory is in most public libraries. Also, ABMS offers this information at http://www.abms.org. You will need to click on "Who's Certified" and register for the search services.
TREATMENT METHODS
Specific treatment varies depending on the stage of the disease, the type of cancer cell and the patient's age. Your health care provider can describe your treatment choices and the expected results. Most women have surgery and chemotherapy. Rarely, radiation therapy is used. Cancer treatment can affect cancer cells in the pelvis, in the abdomen, or throughout the body.
Local Therapy: Surgery and radiation therapy are local therapies. They remove or destroy the ovarian cancer in the pelvis. When ovarian cancer has spread to other parts of the body, local therapy my be used to control the disease in those specific areas.
Intraperitoneal Chemotherapy: Chemotherapy can be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis.
Systemic Chemotherapy: When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body.
CANCER TREATMENT - WHAT TO EXPECT
You may want to know how treatment may change your normal activities. You and your health care provider can work together to develop a treatment plan that meets your medical and personal needs. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.
You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for women with all stages of ovarian cancer. See the NCI's article called The Promise of Cancer Research for more information about clinical trials.
QUESTIONS FOR YOUR HEALTH CARE PROVIDER
You may want to ask your health care provider these questions before your treatment begins:
- What is the stage of my disease? Has the cancer spread from the ovaries? If so, to where?
- What are my treatment choices? Do you recommend intraperitoneal chemotherapy for me? Why?
- Would a clinical trial be appropriate for me?
- Will I need more than one kind of treatment?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible side effects of each treatment? What can we do to control side effects? Will they go away after treatment ends?
- What can I do to prepare for treatment?
- Will I need to stay in the hospital? If so, for how long?
- What is the treatment likely to cost? Will my insurance cover the cost?
- How will treatment affect my normal activities?
- Will treatment cause me to go through an early menopause?
- Will I be able to get pregnant and have children after treatment?
- How often should I have checkups after treatment?
SURGERY
Surgery (cytoreductive) is usually performed to remove the cancerous ovary and other affected areas, including fallopian tubes, uterus and the other ovary (sometimes). The goal of surgery is to remove as many of the cancer cells as possible so chemotherapy will be more effective. In young patients who want to retain reproductive capacity, it may be possible to remove only the ovary and the tube. In some cases, follow up surgery is required to determine the effectiveness of the treatment.
The surgeon makes a long cut in the wall of the abdomen. This type of surgery is called a laparotomy. If ovarian cancer is found, the surgeon removes:
- Both ovaries and fallopian tubes (salpingo-oophoectomy).
- The uterus (hysterectomy).
- The omentum, which is the thin, fatty pad of tissue that covers the intestines.
- The nearby lymph nodes.
- Samples of tissue from the pelvis and abdomen.
If the cancer has spread, the surgeon removes as much cancer as possible. This is called "debulking" surgery. If you have early Stage I ovarian cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early ovarian cancer may decide with their health care provider to have only one ovary, one fallopian tube, and the omentum removed.
You may be uncomfortable for the first few days after surgery. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your health care provider or assistant. After surgery, your health care provider can adjust the plan if you need more pain relief.
The time it takes to heal after surgery is different for each woman. You will spend several days in the hospital. It may be several weeks before you return to normal activities.
If you haven't gone through menopause yet, surgery may cause menopausal symptoms such as hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Discuss with your health care provider about your symptoms so that you can develop a treatment plan together. There are drugs and lifestyle changes that can help, and most symptoms go away or lessen with time.
You may want to ask your health care provider these questions about surgery:
- What kind of surgery do you recommend for me? Will lymph nodes and other tissues be removed? Why?
- How soon will I know the results from the pathology report? Who will explain them to me?
- How will I feel after surgery?
- If I have pain, how will it be controlled?
- How long will I be in the hospital?
- Will I have any long-term effects because of this surgery?
- Will the surgery affect my sex life?
CHEMOTHERAPY
Chemotherapy, depending on cell type and stage of disease, is usually recommended along with surgery for the best outcome. Chemotherapy uses anti-cancer drugs to kill cancer cells. Most women have chemotherapy for ovarian cancer after surgery. Some women have chemotherapy before surgery. Usually, more than one drug is given. Drugs for ovarian cancer can be given in different ways:
- By vein (IV): The drugs can be given through a thin tube inserted into a vein.
- By vein and directly into the abdomen: Some women get IV chemotherapy along with intraperitoneal (IP) chemotherapy. For IP chemotherapy, the drugs are given through a thin tube inserted into the abdomen.
- By mouth: Some drugs for ovarian cancer can be given by mouth.
Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anti-cancer drugs used. You may have your treatment in a clinic, at your health care provider's office, or at home. Some women may need to stay in the hospital during treatment.
The side effects of chemotherapy depend mainly on which drugs are given and how much. The drugs can harm normal cells that divide rapidly:
- Blood cells: These cells fight infection, help blood to clot, and carry oxygen to all parts of your body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team checks you for low levels of blood cells. If blood tests show low levels, your health care team can suggest medicines that can help your body make new blood cells.
- Cells in hair roots: Some drugs can cause hair loss. Your hair will grow back, but it may be somewhat different in color and texture.
- Cells that line the digestive tract: Some drugs can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Ask your health care team about medicines that help with these problems.
Some drugs used to treat ovarian cancer can cause hearing loss, kidney damage, joint pain, and tingling or numbness in the hands or feet. Most of these side effects usually go away after treatment ends. You may find it helpful to read NCI's booklet Chemotherapy and You: A Guide to Self-Help During Cancer Treatment.
You may want to ask your health care provider these questions about chemotherapy:
- When will treatment start? When will it end? How often will I have treatment?
- Which drug or drugs will I have?
- How do the drugs work?
- Do you recommend both IV and IP (intraperitoneal) chemotherapy for me? Why?
- What are the expected benefits of the treatment?
- What are the risks of the treatment? What side effects might I have?
- Can I prevent or treat any of these side effects? How?
- How much will it cost? Will my health insurance pay for all of the treatment?
RADIATION THERAPY
Radiation therapy is used less often than chemotherapy for treatment of ovarian cancer. Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. A large machine directs radiation at the body. Radiation therapy is rarely used in the initial treatment of ovarian cancer, but it may be used to relieve pain and other problems caused by the disease. The treatment is given at a hospital or clinic. Each treatment takes only a few minutes.
Side effects depend mainly on the amount of radiation given and the part of your body that is treated. Radiation therapy to your abdomen and pelvis may cause nausea, vomiting, diarrhea, or bloody stools. Also, your skin in the treated area may become red, dry, and tender. Although the side effects can be distressing, your health care provider can usually treat or control them. Also, they gradually go away after treatment ends.
SUPPORTIVE CARE
Ovarian cancer and its treatment can lead to other health problems. You may receive supportive care to prevent or control these problems and to improve your comfort and quality of life. Your health care team can help you with the following problems:
- Pain: Your health care provider or a specialist in pain control can suggest ways to relieve or reduce pain. More information about pain control can be found in the NCI booklets Pain Control:
- A Guide for People with Cancer and Their Families
- Get Relief from Cancer Pain
- Understanding Cancer Pain
- Swollen abdomen (from abnormal fluid buildup called ascites): The swelling can be uncomfortable. Your health care team can remove the fluid whenever it builds up.
- Blocked intestine: Cancer can block the intestine. Your health care provider may be able to open the blockage with surgery.
- Swollen legs (from lymphedema): Swollen legs can be uncomfortable and hard to bend. You may find exercises, massages, or compression bandages helpful. Physical therapists trained to manage lymphedema can also help.
- Shortness of breath: Advanced cancer can cause fluid to collect around the lungs. The fluid can make it hard to breathe. Your health care team can remove the fluid whenever it builds up.
- Sadness: It is normal to feel sad after a diagnosis of a serious illness. Some people find it helpful to talk about their feelings. Counseling and joining in a support group are recommended to learn to accept and cope with cancer.
SUPPORT HELP
You can get information about supportive care on NCI's Web site at www.cancer.gov/cancerinfo/coping and from NCI's Cancer Information Service at 1-800-4-CANCER or LiveHelp (http://www.cancer.gov/help).
Learning you have ovarian cancer can change your life and the lives of those close to you. These changes can be hard to handle. It is normal for you, your family, and your friends to have many different and sometimes confusing feelings. You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Your health care providers and other members of your health care team can answer questions about treatment, working, and other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.
Counseling and joining in a support group are recommended to learn to accept and cope with cancer. Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.
It is natural for you to be worried about the effects of ovarian health care provider about possible sexual side effects and whether these effects will be permanent. Whatever happens, it may be helpful for you and your partner to talk about your feelings and help one another find ways to share intimacy during and after treatment.
Additional information available from: The American Cancer Society
(800) ACS-2345
Website: www.cancer.org
or
The National Cancer Institute
(800) 4-CANCER
Website: www.nci.nih.gov
FOLLOW-UP CARE
You will need regular checkups after treatment for ovarian cancer. Even when there are no longer any signs of cancer, the disease sometimes returns because undetected cancer cells remained somewhere in your body after treatment. Checkups help ensure that any changes in your health are noted and treated if needed. Checkups may include a pelvic exam, a CA-125 test, other blood tests, and imaging exams. If you have any health problems between checkups, you should contact your health care provider.
You may wish to read the NCI booklet Facing Forward Series: Life After Cancer Treatment. It answers questions about follow-up care and other concerns. It also suggests ways to talk with your doctor about making a plan of action for recovery and future health. Life-After-Treatment Booklet
MEDICATION
Anti-cancer drugs (chemotherapy); usually a combination of drugs is recommended.
Pain relievers, as needed.
ACTIVITY
After surgery, you will want to follow your health care provider's guidelines about after-care. There should be no restrictions after you recover from surgery.
DIET
Eat a normal, well-balanced diet that is high in protein to promote repair of body tissues. However, I have included dietary recommendations for women diagnosed with cancer and will decide to go through standard medical treatments after surgery. These recommendations cover dietary suggestions before surgery and after starting post-surgery radiation and/or chemotherapy treatments and cover building your immune system and dealing with side effects of treatment. For more information, consult with your health care provider and/or nutritionist regarding your personal needs and requirements.
A diagnosis of ovarian cancer tends to cause a re-evaluation of dietary and health practices. Many women wonder about what caused the cancer to occur and want to know about making changes in their lifestyle to help recover and prevent reoccurrence. Most women believe they must make significant dietary changes to ensure a good outcome. However, diet is only one of several factors that can affect the immune system. Exercise is as important as the diet. Both of these factors along with stress management will increase overall health and well-being. There are no food or dietary supplements that will act as magic bullets to prevent ovarian cancer from returning. National Cancer Institute guidelines for cancer prevention can be used to decrease the chance of a recurrence. These guidelines include:
- Increase intake of fruits, vegetables and whole grains.
- Decrease fat intake to under 30% of calories
- Minimize intake of cured, pickled and smoked foods.
- Achieve and maintain a healthy weight.
- Consume alcoholic beverages in moderation, if at all.
Fruits, vegetable and whole grains are known to contain phytochemicals with antioxidant, anti-estrogen and chemopreventive properties that may prevent cancer. We recommend five or more serving of fruit and vegetables daily. Cruciferous vegetables (broccoli, cauliflower, kale, cabbage and Brussels sprouts) are especially rich in phytochemicals. Whole grains are unprocessed foods that are high in complex carbohydrates, fiber, vitamins, minerals and phytochemicals. High fiber intakes may have a positive benefit by altering hormonal actions of ovarian and other hormonal-dependent cancers. Daily fiber intake should be 25-35 grams of insoluble and soluble fiber.
Important Plant Sources for Good Health:
- Grains - Wheat, rye, oats, rice, corn, bulgur, barley
- Green leafy vegetables - Lettuce, spinach, Swiss chard, endives, beet greens, romaine
- Cruciferous vegetables - Broccoli, cabbage, turnip, Brussels sprouts, cauliflower, kohlrabi, bok choy, watercress, collards, kale, mustard greens, rutabaga
- Umbelliferous vegetables - Celery, parsley, fennel, carrots, parsnip
- Allium vegetables - Garlic, onion, shallots, chives, leek
- Legumes - Soybeans, peas, chickpeas, lima beans, peanut, carob, dried beans (kidney, mung, pinto, black-eyed), lentils
- Solanaceous vegetables, Nightshade family - eggplant, tomatoes
- Cucurbitaceous vegetables, Gourd family - pumpkin, squash, cucumber, muskmelon, watermelon
POTENTIAL CANCER FIGHTERS IN FOOD - Phytochemical Food Source:
- Isothiocyanates - Cruciferous vegetables, mustard, horseradish
- Phenolic compounds - Garlic, green tea, soybeans, cereal grains, cruciferous, umbelliferous, solanaceous, cucurbitaceous vegetables, licorice root, flax seed
- Flavonoids - Most fruits and vegetables (cruciferous, umbelliferous, solanaceous, cucurbitaceous), citrus fruits, wine, green tea, onions, cereal grains, soybeans, flax seed
- Mono-terpenes - Garlic, citrus fruits, caraway seeds, umbelliferous, solanaceous, Cucurbitaceous vegetables, sage, camphor, dill, basil, mint
- Organo-sulfides - Garlic, onion, leeks, shallots, cruciferous vegetables
- Isoflavones - Soybeans, legumes, flax seed
- Indoles - Cruciferous vegetables
- Carotenoids - Dark yellow/orange/green vegetables and fruits
The Department of Nutrition can provide nutritional counseling at the Nutrition Clinic located at your hospital to set up an appointment with one of the qualified Registered Dietitians on staff.
NUTRITION AND PHYSICAL ACTIVITY:
It's important for women with ovarian cancer to take care of themselves. Taking care of yourself includes eating well and staying as active as you can. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy. Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your health care provider, a registered dietitian, or another health practitioner can suggest ways to deal with these problems.
Many women find they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Whatever physical activity you choose, be sure to talk to your health care provider before you start. Also, if your activity causes you pain or other problems, be sure to let your practitioner know about it.
EATING HINTS FOR CANCER RECOVERY
Your Diet Is an Important Part of Your Treatment for cancer. Eating the right kinds of foods before, during, and after your treatment can help you feel better and stay stronger. This information will help you learn about your diet needs during treatment and to help you cope with side effects that may affect eating. It is designed for cancer patients and their families and other caregivers. The information here has been gathered from many sources and reflects the tried-and-true experience of cancer patients and the health care providers and dietitians who work with them.
A registered dietitian is your best source of information about your diet. The information here will add to what the dietitian can tell you. Feel free to ask for help or advice when you need it. Writing down your questions in advance will help you make sure you get the information you need. Ask the dietitian to repeat or explain anything that is not clear. She or he can also explain anything in this book if you have a question and can give you more detailed information. Your health care provider can also give you helpful advice and can refer you to a registered dietitian. If you cannot get a referral, call the American Dietetic Association's (ADA) toll-free nutrition hotline (see below). The information specialist you talk to can help you find a registered dietitian in your area.
BEFORE TREATMENT BEGINS
Nutrition Recommendations Can Be Different for Cancer Patients - Preparing Yourself for Cancer Treatment:
When your cancer was first diagnosed, your health care provider talked to you about a treatment plan. This may have involved surgery, radiation therapy, chemotherapy, hormone therapy, and biologic immunotherapy or some combination of those treatments. All of these methods of treating cancer kill cells. In the process of killing the cancer cells, some healthy cells are also damaged. That is what causes the side effects of cancer treatment. Side effects that can affect your ability to eat include:
- Loss of appetite.
- Changes in weight (either losing or gaining weight).
- Sore mouth or throat.
- Dry mouth.
- Dental and gum problems.
- Changes in sense of taste or smell.
- Nausea/vomiting.
- Diarrhea.
- Lactose intolerance.
- Constipation.
- Fatigue and/or depression.
You may or may not have any of these side effects. Many factors determine whether you will have any and how severe they will be. These factors include the type of cancer you have, the part of your body being treated, the type and length of treatment, and the dose of treatment. The good news is that if you do have side effects they can often be well-controlled. Most side effects also go away after treatment ends. Your health care provider can tell you more about your chances of having side effects and what they might be like.
NUTRITION RECOMMENDATIONS CAN BE DIFFERENT FOR CANCER PATIENTS
Recommendations about food and eating for cancer patients can be very different from the usual suggestions for healthful eating. This can be confusing for many patients because these new suggestions may seem to be the opposite of what they've always heard. Nutrition recommendations usually stress eating lots of fruits, vegetables, and whole grain breads and cereals; including a moderate amount of meat and dairy products; and cutting back on fat, sugar, alcohol, and salt.
Nutrition recommendations for cancer patients may focus on helping you eat more higher calorie foods that emphasize protein. Recommendations might include eating or drinking more milk, cream, cheese, and cooked eggs. Other suggestions might include increasing your use of sauces and gravies, or changing your cooking methods to include more butter, margarine, or oil. Sometimes, nutrition recommendations for cancer patients suggest that you eat less of certain high-fiber foods because these foods can aggravate problems such as diarrhea or a sore mouth.
Nutrition recommendations for cancer patients are different because they are designed to help build up your strength and help you withstand the effects of your cancer and its treatment. When you are healthy, eating enough food to get the nutrients you need is usually not a problem. During cancer treatment, however, this can become a challenge, especially if you have side effects or simply don't feel well.
PREPARING YOURSELF FOR CANCER TREATMENT
Until your treatment actually starts, you won't know exactly what, if any, side effects you may have or how you'll feel. One way to prepare is to think of your treatment as a time for you to concentrate on yourself and on getting well. Here are some other ways to get ready:
- Think Positively. Many people have few or no eating-related side effects. Even if you do, they may be mild, and most go away after cancer treatment ends. Also, there are new drugs now that can work well to control side effects. Having a positive attitude, talking out your feelings, becoming well-informed about your cancer and treatment, and planning ways to cope can all help reduce worry and anxiety, make you feel more in control, and help you keep your appetite. Give food a chance. Even if you do have eating problems, you'll have days when eating is a pleasure.
- Eat a Healthy Diet. A healthy diet is vital for a person's body to work its best. This is even more important for cancer patients. If you've been eating a healthy diet, you'll go into treatment with reserves to help keep up your strength, prevent body tissue from breaking down, rebuild tissue, and maintain your defenses against infection. People who eat well are better able to cope with side effects. You may even be able to handle higher doses of certain treatments. For example, we know that some cancer treatments are actually much more effective if the patient is well-nourished and getting enough calories and protein in his or her diet. Don't be afraid to try new foods. Some things you may never have liked before may taste good to you during treatment.
- Plan Ahead. Stock the pantry and freezer with favorite foods so that you won't need to shop as often. Include foods you know you can eat even when you are sick. Keep foods handy that need little or no preparation, for example, pudding, peanut butter, tuna fish, cheese, and eggs. Do some cooking in advance and freeze in meal-sized portions. Talk to friends or family members about helping with shopping and cooking. Or, ask a friend or family member to manage that job for you. Talk to a registered dietitian about your concerns and what you might expect. She or he can give you ideas and help you plan meals. Ask for help in developing a grocery list with foods that might help with potential side effects, such as constipation or nausea. Ask about what has worked for other patients.
MANAGING EATING PROBLEMS DURING TREATMENT
All the methods of treating cancer - surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy (immunotherapy) - are very powerful. Although these treatments target the fast-growing cancer cells in your body, healthy cells can also be damaged. Healthy cells that normally grow and divide rapidly, such as those in the mouth, digestive tract, and hair, are often affected by cancer treatments. The damage to healthy cells is what produces the unpleasant side effects that cause eating problems.
Side effects of cancer treatment vary from patient to patient. The part of the body being treated, the type and length of treatment, and the dose of treatment determine whether side effects will occur.
The good news is that not everyone has side effects during treatment, and most side effects go away when treatment ends. Side effects can also be well-controlled with new drugs. Talk to your health care provider about possible side effects from your treatment and what can be done about them.
Some eating problems are caused by the treatment itself. Other times, patients may have trouble eating because they are upset, worried, or afraid. Losing your appetite and nausea are two normal responses to feeling nervous or fearful. Once you get into your treatment period and have a better sense of what to expect and how you will react, these anxiety-related eating problems should get better.
While you are in the hospital or undergoing treatment, talk to your health care provider, medical staff, or a registered dietitian. They can answer your questions and give you suggestions for specific meals, snacks, and foods, and for dealing with any eating problems you may have. They can also help with dietary preferences that reflect various cultural and ethnic backgrounds. Feel free to talk to them if problems arise during your recovery as well. Ask them what has worked for other patients.
Remember, there aren't any hard and fast nutrition rules during cancer treatment. Some patients may continue to enjoy eating and have a normal appetite throughout most of their cancer treatment. Others may have days when they don't feel like eating at all; even the thought of food may make them feel sick. Here are some things to keep in mind:
- When you can eat, try to eat meals and snacks with sufficient protein and calories; they will help you keep up your strength, prevent body tissues from breaking down, and rebuild tissues that cancer treatment may harm.
- Many people find their appetite is better in the morning. Take advantage of this and eat more then. Consider having your main meal of the day early, and have liquid meal replacements later on if you don't feel so interested in eating. You can purchase liquid supplements, such as Ensure, at most pharmacies and drug stores. They come in a variety of flavors and nutritional needs.
- If you don't feel well and can eat only one or two things, stick with them until you are able to eat other foods. Try a liquid meal replacement for extra calories and protein.
- On those days when you can't eat at all, don't worry about it. Do what you can to make yourself feel better. Come back to eating as soon as you can, and let your health care provider know if this problem doesn't get better within a couple of days.
- Try to drink plenty of fluids, especially on those days when you don't feel like eating. Water is essential to your body's proper functioning, so getting enough fluids will ensure that your body has the water it needs. For most adults, 6-8 cups of fluid a day are a good target. Try carrying a water bottle with you during the day. That may help you get into the habit of drinking plenty of fluids.
COPING WITH SIDE EFFECTS
This section offers practical hints for coping with treatment side effects that may affect your eating. These suggestions have helped other patients manage the same eating problems that you may have. Try all the ideas to find what works best for you. Share your needs and concerns with your family and friends, particularly those who prepare meals for you. Let them know that you appreciate their support.
Keep a journal to keep track of how you are feeling as you go through treatment. Write down any questions or concerns in it that you may want to discuss with your health care provider or nutritionist. Keep track of all your side effects and when they are occurring.
LOSS OF APPETITE
Loss of appetite or poor appetite is one of the most common problems that occurs with cancer and its treatment. No one knows exactly what causes loss of appetite. It may be caused by the treatments or by the cancer itself. Emotions such as fear or depression can also take away a person's appetite. Ask a health care provider or social worker about ways to lessen these emotional difficulties. Sometimes it is the side effects of treatment such as nausea, vomiting, or changes in food's taste or smell that make a person feel like not eating. If this is the cause, work with your health care provider to get the side effects under better control.
For some people, loss of appetite happens for just a day or two; for others, it's an ongoing concern. Whatever the reason, here are some suggestions that might help:
- Try liquid or powdered meal replacements, such as "instant breakfast," during times when it is hard for you to eat food.
- Try frequent small meals throughout the day, rather than fewer big ones. It may be easier to eat more that way, and you won't get so full.
- Keep snacks within easy reach so you can have something whenever you feel like it. Cheese and crackers, muffins, ice cream, peanut butter, fruit, and pudding are good possibilities. Take a portable snack with you when you go out, such as peanut butter crackers or small boxes of raisins.
- Even if you don't feel like eating solid foods, try to drink beverages during the day. Juice, soup, and other fluids like them can give you important calories and nutrients. Milk-based drinks also provide protein.
- If possible, try having something at bedtime. It won't affect your appetite for the next meal.
- Sometimes, changing the form of a food will make it more appetizing and help you eat better. For example, if eating whole, fresh fruit is a problem, try mixing fruit into a milkshake.
- Try softer, cool, or frozen foods, such as yogurt, milkshakes, or popsicles.
- Take advantage of times when you do feel well, and have a larger meal then. Many people have a better appetite first thing in the morning, when they are well rested.
- During meals, sip only small amounts because drinking may make you feel full. If you want to have more than just a small amount to drink, have it 30-60 minutes before or after a meal.
- Make meal times as relaxed and pleasant as possible. Presenting food or meals in an attractive way may also help.
- If your health care provider allows, have a small glass of wine or beer during a meal. It may help to stimulate your appetite.
- Regular exercise may help your appetite. Check with your health care provider to see what options are open to you.
COMMERCIAL PRODUCTS TO IMPROVE NUTRITION
If you cannot get enough calories and protein from your diet, commercial meal replacements such as drinks, "shakes," and "instant breakfast" powders may help. Other products also can be added to any food or beverage. These supplements are high in protein and calories and have extra vitamins and minerals. They come in liquid, pudding, and powder forms. Most commercial meal replacements contain little or no lactose. However, it is important to check the label if you are sensitive to lactose. Your health care provider or a registered dietitian can tell you which products are best for you and which ones are available in your area.
Most of these products need no refrigeration until you open them. That means you can carry them with you and have them whenever you feel hungry or thirsty. They are also good chilled as between-meal or bedtime snacks. You may want to take a can with you when you go for treatments or other times when you may have a long wait.
Many supermarkets and drugstores carry a variety of commercial liquid meal replacements. If you don't see these products on the shelf, ask the store manager if they can be ordered.
WEIGHT LOSS
Many cancer patients lose weight during their cancer treatment. This is partly due to the effects of the cancer itself on the body. Also, if you've lost your appetite and are eating less than usual because of your treatment or emotional worries, you may lose weight. See the sections on "How to Increase Calories" and "How to Increase Protein". These will give you some ideas for slowing weight loss or even gaining a few pounds. The tips under "Loss of Appetite" may help, too. In the recipe section there are three simple recipes that show you how to increase the calories and protein of familiar foods:
- Fortified Milk
- High-Protein Milkshake
- Peanut Butter Snack Spread
Instant Dry Milk as a Protein Powder can be used for extra protein in dishes, consider adding a little nonfat instant dry milk to scrambled eggs, soup, cereal, sauces, and gravies.
Some patients find their weight does not change during treatment. They may even gain weight. This is particularly true for breast, prostate, and ovarian cancer patients taking certain medications or who are on hormone therapy or chemotherapy.
It is important not to go on a diet right away if you notice weight gain. Instead, tell your health care provider so you can find out what may be causing this change. Sometimes, weight gain happens because certain anti-cancer drugs can cause your body to hold on to excess fluid. This condition is called edema. The weight comes from the extra water. If this is the case, your health care provider may ask you to talk with a registered dietitian for guidelines on limiting the amount of salt you eat. This is important because salt causes your body to hold extra water. Your health care provider may also want to prescribe a diuretic. This is a medication that causes your body to get rid of excess fluid.
Breast cancer patients with a primary diagnosis of cancer may be different. Over half of them may actually gain weight rather than lose during treatment. Because of this, many of the recommendations for breast cancer patients do emphasize a lower fat, reduced calorie diet similar to those provided to patients after cancer treatment has been completed.
Weight gain may also be the result of increased appetite and eating extra food and calories. If this is the case and you want to stop gaining weight, here are some tips that can help. Talk to a registered dietitian for more guidance:
- Emphasize fruits, vegetables, and breads and cereals.
- Choose lean meats (lean beef or pork trimmed of fat, chicken without skin) and low-fat dairy products (skim or 1% milk, light yogurt).
- Cut back on added butter, mayonnaise, sweets, and other extras.
- Choose low-fat and low-calorie cooking methods (broiling, steaming).
- Avoid eating high-calorie snacks between meals.
- If you feel up to it, increase the amount of exercise you get.
SORE THROAT OR MOUTH
Mouth sores, tender gums, and a sore throat or esophagus often result from radiation therapy, chemotherapy, or infection. If you have a sore mouth or gums, see your health care provider to be sure the soreness is a treatment side effect and not an unrelated dental problem. Your health care provider may be able to give you medicine that will control mouth and throat pain. Your dentist also can give you tips for the care of your mouth. Certain foods will irritate an already tender mouth and make chewing and swallowing difficult. By carefully choosing the foods you eat and by taking good care of your mouth, teeth, and gums, you can usually make eating easier. Here are some suggestions that may help:
Try soft foods that are easy to chew and swallow, such as:
- Milkshakes
- Bananas, applesauce, and other soft fruits
- Peach, pear, and apricot nectars
- Watermelon
- Cottage cheese, yogurt
- Mashed potatoes, noodles
- Macaroni and cheese
- Custards, puddings, and gelatin
- Scrambled eggs
- Oatmeal or other cooked cereals
- Pureed or mashed vegetables, such as peas and carrots
- Pureed meats
A simple blender recipe found in the recipe section that's easy on a sore mouth is the "Fruit and Cream" recipe.
Avoid foods or liquids that can irritate your mouth. These include:
- Oranges, grapefruits, lemons, or other citrus fruit or juice
- Tomato sauces or juice
- spicy or salty foods
- Raw vegetables, granola, toast, crackers, or other rough, coarse, or dry foods
- Commercial mouthwashes that contain alcohol
Other suggestions for preparing food when a patient has an irritated mouth:
- Cook foods until they are soft and tender.
- Cut foods into small pieces.
- Use a blender or food processor to puree your food.
- Mix food with butter, margarine, thin gravy, or sauce to make it easier to swallow.
- Use a straw to drink liquids.
- Use a smaller-than-usual spoon, such as a baby spoon.
- Try foods cold or at room temperature. Hot foods can irritate a tender mouth and throat.
- Try drinking warm bouillon or salty broth; it can soothe throat pain.
- Try sucking on ice chips.
- If swallowing is hard, tilting your head back or moving it forward may help.
- If your teeth and gums are sore, your dentist may be able to recommend a special product for cleaning your teeth.
- Rinse your mouth often with water to remove food and bacteria and to promote healing.
- Ask your health care provider about anesthetic lozenges and sprays that can numb your mouth and throat long enough for you to eat meals.
DRY MOUTH
Chemotherapy and radiation therapy in the head or neck area can reduce the flow of saliva and cause dry mouth. When this happens, foods are harder to chew and swallow. Dry mouth also can change the way foods taste. Some of the ideas for sore mouth and throat may help. The suggestions below also may help you deal with dry mouth.
- Have a sip of water every few minutes to help you swallow and talk more easily. Consider carrying a water bottle with you so you always have some handy.
- Try very sweet or tart foods and beverages, such as lemonade; these foods may help your mouth make more saliva. (Do not try this if you also have a tender mouth or sore throat and the sweet or tart foods make it worse.)
- Suck on hard candy or popsicles or chew gum. These can help make more saliva.
- Eat soft and pureed foods, which may be easier to swallow.
- Keep your lips moist with lip salves.
- Moisten food with sauces, gravies, and salad dressings to make it easier to swallow.
- If your dry mouth problem is severe, ask your health care provider or dentist about products that coat, protect, and moisten your mouth and throat. These are sometimes called "artificial saliva."
DENTAL AND GUM PROBLEMS
Cancer and cancer treatment can cause tooth decay and other problems for your teeth and gums. For example, radiation to the mouth can affect your salivary glands, making your mouth dry and increasing your risk of cavities. Changes in eating habits also may add to the problem. Your health care provider and dentist should work closely together to fix any problems with your teeth before you start treatment. If you eat often or eat a lot of sweets, you may need to brush your teeth more often. Brushing after each meal or snack is a good idea. Here are some other ideas for preventing dental problems:
- Be sure to let your health care provider know about any dental problems you are having.
- Be sure to see your dentist regularly. Patients who are receiving treatment that affects the mouth - for example, radiation to the head and neck - may need to see the dentist more often than usual.
- Use a soft toothbrush. Ask your health care provider or dentist to suggest a special kind of toothbrush and/or toothpaste if your gums are very sensitive.
- Rinse your mouth with warm water when your gums and mouth are sore.
- If you are eating foods high in sugar or foods that stick to your teeth, be sure to brush or rinse your mouth afterward so that the sugar won't damage your teeth, or use sugar-free varieties. (Sorbitol, a sugar substitute that is contained in many sugar-free foods, can cause diarrhea in many people. If diarrhea is a problem for you, check the labels of sugar-free foods before you buy them and limit your use of them.)
CHANGED SENSE OF TASTE AND SMELL
Your sense of taste or smell may change during your illness or treatment. Foods, especially meat or other high-protein foods, can begin to have a bitter or metallic taste. Many foods will have less taste. Chemotherapy, radiation therapy, or the cancer itself may cause these problems. Dental problems also can change the way foods taste. For most people, changes in taste and smell go away when their treatment is finished.
There is no foolproof way to prevent changes to your sense of taste or smell because each person is affected differently by illness and treatments. However, the tips below should help if you have this problem. (If you also have a sore mouth, sore gums, or a sore throat, talk to your health care provider or registered dietitian. They can suggest ways to help you without hurting the sore areas.)
- Choose and prepare foods that look and smell good to you.
- If red meat, such as beef, tastes or smells strange, try chicken, turkey, eggs, dairy products, or mild-tasting fish instead.
- Help the flavor of meat, chicken, or fish by marinating it in sweet fruit juices, sweet wine, Italian dressing, or sweet-and-sour sauce.
- Try using small amounts of flavorful seasonings, such as basil, oregano, or rosemary.
- Try tart foods, such as oranges or lemonade, that may have more taste. A tart lemon custard might taste good and will also provide needed protein and calories. (If you have a sore mouth or throat, tart or citrus foods might cause pain or discomfort.)
- If smells bother you, try serving foods at room temperature, turning on a kitchen fan, covering foods when cooking, and cooking outdoors in good weather.
- Try using bacon, ham, or onion to add flavor to vegetables.
- Visit your dentist to rule out dental problems that may affect the taste or smell of food.
- Ask your dentist or health care provider about special mouthwashes and good mouth care.
NAUSEA
Nausea, with or without vomiting, is a common side effect of surgery, chemotherapy, radiation therapy, and biological therapy. The disease itself, or other conditions unrelated to your cancer or treatment, may also cause nausea. Some people have nausea or vomiting right after treatment; others don't have it until two or three days after a treatment. Many people never experience nausea. For those who do, nausea often goes away once the treatment is completed. Also, there are now drugs that can effectively control this side effect. These medications, called anti-emetics, are often given at the beginning of a chemo-therapy session to prevent nausea.
Whatever the cause, nausea can keep you from getting enough food and needed nutrients. Here are some ideas that can help:
- Ask your health care provider about anti-emetics that might help you control nausea and vomiting.
- Try foods that are easy on your stomach, such as:
- Toast, crackers, and pretzels
- Yogurt
- Sherbet
- Angel food cake
- Cream of wheat, rice, or oatmeal
- Boiled potatoes, rice, or noodles
- Skinned chicken that is baked or broiled, not fried
- Canned peaches or other soft, bland fruits and vegetables
- Clear liquids.
- Ice chips
- Carbonated drinks
- Avoid foods that:
- Are fatty, greasy, or fried
- Are very sweet, such as candy, cookies, or cake
- Are spicy or hot
- Have strong odors
- Eat small amounts, often and slowly. Eat before you get hungry, because hunger can make feelings of nausea stronger.
- If nausea makes certain foods unappealing, then eat more of the foods you find easier to handle.
- Avoid eating in a room that's stuffy, too warm, or has cooking odors that might disagree with you.
- Drink fewer liquids with meals. Drinking liquids can cause a full, bloated feeling.
- Slowly drink or sip liquids throughout the day. A straw may help.
- Have foods and drinks at room temperature or cooler; hot foods may add to nausea.
- Don't force yourself to eat favorite foods when you feel nauseated. This may cause a permanent dislike for those foods.
- Rest after meals, because activity may slow digestion. It's best to rest sitting up for about an hour after meals.
- If nausea is a problem in the morning, try eating dry toast or crackers before getting up.
- Wear loose-fitting clothes.
- If nausea occurs during radiation therapy or chemotherapy, avoid eating for 1 to 2 hours before treatment.
- Try to keep track of when your nausea occurs and what causes it (specific foods, events, surroundings). If possible and if it helps, change your diet or schedule. Share the information with your health care provider or nurse.
VOMITING
Vomiting may follow nausea and may be brought on by treatment, food odors, gas in the stomach or bowel, or motion. In some people, certain associations or surroundings, such as the hospital, may cause vomiting. As with nausea, some people have vomiting right after treatment, while others don't have it until a day or more after treatment.
If vomiting is severe or lasts for more than a day or two, contact your health care provider. He/she may give you an anti-emetic medication to control nausea and vomiting.
Very often, if you can control nausea, you can prevent vomiting. At times, though, you may not be able to prevent either. Relaxation exercises or meditation may help you. These usually involve deep rhythmic breathing and quiet concentration, and can be done almost anywhere. If vomiting does occur, try these suggestions to help prevent further episodes:
- Do not eat or drink anything until you have the vomiting under control.
- Once the vomiting is under control, try small amounts of clear liquids, such as water or bouillon. Begin with 1 teaspoonful every 10 minutes, gradually increasing the amount to 1 tablespoon every 20 minutes. Finally, try 2 tablespoons every 30 minutes.
- When you are able to keep down clear liquids, try a full-liquid diet or a soft diet. MoonDragon's Nutrition Information: Diets - Soft Diet gives examples of foods and a soft diet program. Continue taking small amounts as often as you can keep them down. If you feel okay, gradually work up to your regular diet. If you have a hard time digesting milk, you may want to try a soft diet instead of a full-liquid diet, because a full-liquid diet includes a lot of milk products. Ask a registered dietitian for information about a soft diet.
DIARRHEA
Diarrhea may have several causes, including chemotherapy, radiation therapy to the abdomen, infection, food sensitivities, and emotional upset. Work with your doctor to identify the cause of your diarrhea so that it can be successfully treated.
During diarrhea, food passes quickly through the bowel before your body has a chance to absorb enough vitamins, minerals, and water. This may cause dehydration, which means that your body does not have enough water to work well. Long-term or severe diarrhea may cause problems, so contact your health care provider if the diarrhea is severe or lasts for more than a couple of days. Here are some ideas for coping with diarrhea:
- Drink plenty of fluids to replenish what you lose with the diarrhea.
- Eat small amounts of food throughout the day instead of three large meals.
- Eat plenty of foods and liquids that contain sodium and potassium, two important minerals that help your body work properly. These minerals are often lost during diarrhea. Good high-sodium liquids include bouillon or fat-free broth. Foods high in potassium that don't cause diarrhea include bananas, peach and apricot nectar, and boiled or mashed potatoes. Sports drinks contain both sodium and potassium and have easily absorbable forms of carbohydrates.
- Try these foods:
- Yogurt, cottage cheese
- Rice, noodles, or potatoes
- Farina or cream of wheat
- Eggs (cooked until the whites are solid; not fried)
- Smooth peanut butter
- White bread
- Canned, peeled fruits and well-cooked vegetables
- Skinned chicken or turkey, lean beef, or fish (broiled or baked, not fried)
- Avoid:
- Greasy, fatty, or fried foods if they make your diarrhea worse
- Raw vegetables and the skins, seeds, and stringy fibers of unpeeled fruits
- High-fiber vegetables, such as broccoli, corn, dried beans, cabbage, peas, and cauliflower
- Avoid very hot or cold food or beverages. Drink liquids that are at room temperature.
- Limit foods and drinks that contain caffeine, such as coffee, some sodas, and chocolate.
- If you have a sudden, short-term attack of diarrhea, try having nothing but clear liquids for the next 12 to 14 hours. This lets your bowel rest and replaces the important fluids lost during the diarrhea. Make sure your health care provider knows about this problem.
- Be careful when using milk and milk products. The lactose they contain can make diarrhea worse. Most people, though, can handle small amounts (about 1-1/2 cups) of milk or milk products.
Special Diets for Special Needs
When you have special needs because of your cancer or treatment, your health care provider or registered dietitian may prescribe a special diet. For example, a soft diet may be best if your mouth, throat, esophagus, or stomach is sore. Or, if your treatment makes it difficult for you to digest dairy products, you may need to follow a low-lactose diet. Other special diets include a clear-liquid diet, a full-liquid diet, and a fiber-restricted diet.
Some special diets are well balanced and can be followed for long periods of time. Others, however, should be followed for only a few days because they may not provide enough nutrients for the long term. If you think you need a special diet, talk with your health care provider and a registered dietitian. Together, you can work out a plan. You also should work with your health care provider and dietitian if you are already on a special diet for a disease such as diabetes, kidney, or heart disease.
LACTOSE INTOLERANCE
Lactose intolerance means that your body can't digest or absorb the milk sugar called lactose. Milk, other milk-based dairy products (such as cheese and ice cream), and foods to which milk has been added (such as pudding) may contain lactose.
Lactose intolerance may occur after treatment with some antibiotics, with radiation to the stomach or with any treatment that affects the digestive tract. The part of your intestines that digests lactose may not work properly during treatment. For some people, the symptoms of lactose intolerance (gas, cramps, diarrhea) disappear a few weeks or months after the treatments end or when the intestine heals. For others, a permanent change in eating habits may be needed.
If you have this problem, your health care provider may advise you to follow a diet that is low in foods that contain lactose. Talk to a registered dietitian to get advice and specific tips about how to follow a low-lactose diet. Your supermarket should carry milk and other products that have been modified to reduce or eliminate the lactose. You can also make your own low-lactose or lactose free foods. See RECIPES below for a simple recipe for a lactose-free pudding called "Lactose-Free Double Chocolate Pudding."
CONSTIPATION
Some anti-cancer drugs and other drugs, such as pain medications, may cause constipation. This problem also can occur if your diet lacks enough fluid or fiber, or if you've been in bed for a long time. Here are some suggestions for preventing and treating constipation:
- Drink plenty of liquids - at least eight 8-ounce glasses every day. This will help to keep your stools soft. Another way to think about fluids is to try to drink at least 1/2 oz. per pound of your body weight.
- Have a hot drink about one-half hour before your usual time for a bowel movement.
- Check with your health care provider to see if you can increase the fiber in your diet (there are certain types of cancer for which a high-fiber diet is not recommended). If you can, try foods such as whole-grain breads and cereals, dried fruits, wheat bran, wheat germ; fresh fruits and vegetables; dried beans and peas. Eat the skin on potatoes. Make sure you also drink plenty of fluids to help the fiber work. Here's is an easy recipe that might help relieve constipation in the RECIPE section, below: Apple/Prune Sauce.
- Get some exercise every day. Talk to your health care providers or a physical therapist about the amount and type of exercise that's right for you.
If these suggestions don't work, ask your health care provider about medicine to ease constipation. Be sure to check with your health care provider before taking any laxatives or stool softeners.
FATIGUE & DEPRESSION
All the methods of treating cancer treatment are powerful. Treatment may go on for weeks or months. It may even cause more illness or discomfort than the initial disease. Many patients say they feel exhausted and depressed, and unable to concentrate. Fatigue during cancer treatment can be related to a number of causes: not eating, inactivity, low blood counts, depression, poor sleep, and side effects of medicine. It is important for you to raise the issue with your health care team if you are having fatigue. Together, you can decide what is causing the problem, since many of the causes can be treated.
Fatigue and depression aren't eating problems in and of themselves, but they can affect your interest in food and your ability to shop and prepare healthy meals. Here are some suggestions that may help:
- Talk about your feelings and your fears. Being open about your emotions can make them seem more manageable. Consider talking with your health care provider or social worker, who can help you find ways to lessen your worries and fears.
- Become familiar with your treatment, possible side effects, and ways of coping. Being knowledgeable and acting on that knowledge will help you feel more in control. Don't be afraid to talk with your health care provider and ask questions.
- Make sure you get enough rest:
- Take several naps or rest breaks during the day, rather than one long rest
- Plan your day to include rest breaks
- Make rest time special with a good book in a comfortable chair or a favorite video with a friend
- Try easier or shorter versions of your usual activities; don't push yourself to do more than you can manage.
- Save your favorite foods for times that aren't associated with treatment sessions. That way, they won't be linked to an uncomfortable or distressing event.
- Take short walks or get regular exercise, if possible. Some people find this helps to lessen their fatigue and raise their spirits.
PREVENTING FOOD-BORNE ILLNESS
Cancer patients undergoing treatment can develop a weakened immune system because most anti-cancer drugs decrease the body's ability to make white blood cells, the cells that fight infection. That's why cancer patients should be especially careful to avoid infections and food-borne illnesses. Here are some tips to help you prevent food-borne illness:
- Wash all raw fruits and vegetables well. If it can't be well washed (as with raspberries), avoid it. Scrub rough surfaces, like the skin of melons, prior to cutting.
- Carefully wash your hands and food preparation surfaces (knives, cutting boards) before and after preparing food, especially after handling raw meat.
- Thaw meat in the refrigerator, not on the kitchen counter.
- Be sure to cook meat and eggs thoroughly.
- Avoid raw shellfish and use only pasteurized or processed ciders and juices and pasteurized milk and cheese.
The Food and Drug Administration has published a booklet that includes these and other tips for preventing food-borne illness.
EXTRA VITAMINS & MINERALS
Many cancer patients want to know whether vitamins, minerals, or other dietary supplements (such as phytochemicals) will help "build them up" or help fight their cancer. We know that patients who eat well during cancer treatment are better able to cope with their disease and any side effects of treatment. Consult with a dietician or holistic health care provider knowledgeable in dietary supplements about your particular dietary needs. You should try to depend on traditional, healthy foods for vitamins, minerals, and other nutrients. Talk to your health care provider registered dietitian, or a pharmacist before taking any vitamin or mineral supplements. Too much of some vitamins or minerals can be just as dangerous as too little. Large doses of some vitamins may even stop your cancer treatment from working the way it should. To avoid problems, don't take these products on your own. Follow your health care provider's guidance.
ALTERNATIVE THERAPIES
You may hear or read about many different kinds of treatments people have tried to cure their disease. A therapy is called complementary when it is used in addition to conventional treatments; it is often called alternative when it is used instead of conventional treatment. A number of medical centers are evaluating the scientific aspects of complementary and alternative therapies and developing studies to test them. Some complementary therapies work better than others. Do research on them and find a skilled practitioner. It is important to discuss with your health care provider if you are considering trying any of these treatments, because some therapies may interfere with your standard treatment or may be harmful when used with conventional treatment. He/she can talk to you about any research that has been done and whether or not the treatment is safe or would interfere with your treatment. People who depend upon unconventional treatments alone may lose valuable treatment time if they eventually decide to use conventional treatments and may reduce their chances of controlling their cancer and getting well. Some centers will use complementary therapies with conventional treatment. See Cancer Treatment Centers of America for centers that use both therapies designed for each individual's care. Their phone number is 800-615-3055. It never hurts to talk to them if you have Cancer problems.
RECIPES
BANANA MILKSHAKE
1 whole ripe banana, sliced
Vanilla extract (few drops)
1 cup milk
Place all ingredients into a blender.
Blend at high speed until smooth.
Yield: 1 serving
Serving size: Approximately 2 cups
If made with whole milk:
Calories per serving: 255 calories
Protein per serving: 9 grams
If made with 2% milk:
Calories per serving: 226 calories
Protein per serving: 9 grams
If made with skim milk:
Calories per serving: 190 calories
Protein per serving: 9 grams
FORTIFIED MILK
1 quart whole milk
1 cup nonfat instant dry milk
Pour liquid milk into a deep bowl. Add dry milk and beat slowly with beater until dry milk is dissolved (usually less than five minutes). Refrigerate and serve cold. Note: If it tastes too strong, start with 1/2 cup of dry milk powder and gradually work up to 1 cup.
Yield: 1 quart
Serving size: 1 cup
Calories per serving: 211 calories
Protein per serving: 14 grams
Use fortified milk when making: macaroni and cheese, puddings and custards, cream sauces for vegetables, mashed potatoes, cocoa, French toast or pancake batter, soup.
HIGH-PROTEIN MILKSHAKE
1 cup fortified milk
2 tbsp butterscotch, chocolate, or your favorite fruit syrup or sauce
1/2 cup ice cream
1/2 tsp vanilla extract
Put all ingredients in a blender. Blend at low speed for 10 seconds.
Yield: 1 serving
Serving size: Approximately 1-1/2 cups
Calories per serving: 425 calories
Protein per serving: 17 grams
PEANUT BUTTER SNACK SPREAD
1 tbsp nonfat instant dry milk
1 tbsp honey
1 tsp water
5 tbsp smooth peanut butter
1 tsp vanilla extract
Combine dry milk, water, and vanilla, stirring to moisten. Add honey and peanut butter, stirring slowly until liquid blends with peanut butter. Spread on crackers. Mixture also can be formed into balls, chilled, and eaten as candy. Keeps well in refrigerator but is difficult to spread when cold.
Yield: 6 tbsp
Serving size: 3 tbsp
Calories per serving: 279 calories
Protein per serving: 11 grams
FRUIT AND CREAM
1 cup whole milk
1 cup vanilla ice cream or frozen yogurt
1 cup canned fruit (heavy syrup), including juice (peaches, apricots, pears)
Almond or vanilla extract to taste
Blend ingredients and chill well before serving.
Yield: 2 servings
Serving size: 1-1/2 cups
If made with ice cream:
Calories per serving: 302 calories
Protein per serving: 7 grams
If made with frozen yogurt:
Calories per serving: 268 calories
Protein per serving: 9 grams
LACTOSE-FREE DOUBLE CHOCOLATE PUDDING
2 squares baking chocolate (1 oz each)
1 cup non dairy creamer, soy formula or lactose-free milk
1 tbsp cornstarch
1/4 cup granulated sugar
1 tsp vanilla extract
Melt chocolate in small pan or on foil. Measure cornstarch and sugar into saucepan. Add part of the liquid and stir until cornstarch dissolves. Add the remainder of the liquid. Cook over medium heat until warm. Stir in chocolate until mixture is thick and comes to a boil. Remove from heat. Blend in vanilla and cool.
Yield: 2 servings
Serving size: 3/4 cup
Calories per serving: 382 calories
Protein per serving: 1 gram
APPLE-PRUNE SAUCE
1/3 cup unprocessed bran
1/3 cup applesauce
1/3 cup mashed stewed prunes
Blend all ingredients and store in refrigerator. Take 1-2 tablespoons of this mixture before bedtime, then drink 8 oz. of water. Note: Make sure you drink the water, or else it will not work to relieve constipation.
Yield: 16 servings
Serving size: 1 tbsp
Calories per serving: 10 calories
SPECIAL NOTES FOR CAREGIVERS
There is much that you can do to help your friend or loved one through the period of cancer treatment. Read over the tips and suggestions in Managing Eating Problems During Cancer Treatment. Many may be useful to you as you prepare food or meals for the patient. In addition, here are some other things to remember that will help you cope:Be prepared for the patient's tastes to change from day to day. Some days he or she won't want favorite foods because they don't taste good. Other times, he or she will be able to eat a dish that couldn't be tolerated just the day before. Have food within easy reach at home. For example:
- A snack-pack of applesauce or pudding and a spoon on the bedside table if the patient isn't feeling well that day.
- A bag of cut-up carrots on the top shelf of the refrigerator.
- Have meals and snacks ready so the patient can have something to eat when he or she is ready.
- Be prepared for times when the patient is able to eat only one or two foods for a few days in a row, until side effects diminish. Even if he or she can't eat at all, still encourage plenty of fluids. Tables 2 and 3 contain a variety of examples of fluids, and the section on "Coping with Side Effects" has lots of ideas for getting enough fluids.
- Talk to the patient about needs and concerns, and about ideas that might work best. A willingness to be flexible and supportive no matter what will help the patient feel in control of the situation.
- Try not to push the patient into eating and drinking. Encourage and support without being overwhelming.
AFTER TREATMENT ENDS - WAYS TO GET BACK INTO EATING
Most eating-related side effects associated with radiation, chemotherapy, or other treatments go away after cancer treatment ends. If you have had side effects, you should gradually begin to feel better, and your interest in food and mealtimes will come back. Sometimes, though, side effects persist, especially weight loss. If this happens to you, talk to your health care provider and work out a plan together for how to address the problem.
After cancer treatment ends and you're feeling better, you may want to think again about the traditional guidelines for healthy eating. Just as you wanted to go into treatment with all the reserves that such a diet could give you, you'll want to do the best for yourself at this important time. There is no guarantee that the foods you eat will prevent your cancer from recurring. But, we do know that eating right will help you regain your strength, rebuild tissue, and help you feel well. Here are the fundamentals:
- Focus on eating a variety of foods every day. No one food contains all the nutrients you need.
- Emphasize fruits and vegetables. Raw or cooked vegetables, fruits, and fruit juices provide the vitamins, minerals, and fiber you need.
- Emphasize breads and cereals, especially the whole grain varieties, such as whole wheat bread, oats, and brown rice. These foods are good sources of complex carbohydrates, vitamins and minerals, and fiber.
- Go easy on fat, salt, sugar, alcohol, and smoked or pickled foods. Choose low-fat milk products, and small portions (no more than 6-7 oz. a day) of lean meat and poultry without skin. Try lower-fat cooking methods, such as broiling, steaming, and poaching.
The U.S. Department of Agriculture and U.S. Department of Health and Human Services have published materials to help Americans learn how to choose a healthy diet. The Resources section at the end of this booklet gives you information on how to get these materials. If you have any questions about guidelines for healthy eating, or whether such guidelines are right for you at this time, talk to a registered dietitian. For a list of diets and sample menus, facts about foods and dietary supplements, including a food index giving nutritional values found in various foods, see our Nutrition Index:
Some patients need to have treatments that last a long time. Others may have surgery to remove part of their stomach or intestines. These patients may have ongoing eating-related concerns. If this is your situation, talk to your health care provider and a registered dietitian. He/she can give you more information about the long-term issues that you will deal with and can help you develop an individual diet plan.
Even if your treatment is over and you're feeling much better, you still may not feel completely back to your old self. Here are some ways to help you ease back to regular meals and mealtimes, without overdoing it:
- Make simple meals using familiar, easy-to-prepare recipes.
- Cook enough for two or three meals, then freeze the remainder for a later meal.
- Take advantage of the supermarket's salad bar and prepared foods to make cooking easier.
- Think about ways you used to make mealtime special and try them again.
- Don't be afraid to ask a friend or family member for help with cooking or shopping.
Figure and Tables Table 1. How Cancer Treatments Can Affect Eating
Table 2. Examples of Clear Liquids
Table 3. Examples of Full-Liquid Foods
Table 4. Quick & Easy Snacks
Table 5. How to Increase Calories
Table 6. How to Increase Protein
Keeping Track of Side Effects
Table 1. How Cancer Treatments Can Affect Eating
Cancer Treatment How it Can Affect Eating What Sometimes Happens: Side Effects Surgery Increases the need for good nutrition. May slow digestion. May lessen the ability of the mouth, throat, and stomach to work properly. Adequate nutrition helps wound-healing and recovery. Before surgery, a high-protein, high-calorie diet may be prescribed if a patient is underweight or weak. After surgery, some patients may not be able to eat normally at first. They may receive nutrients through a needle in their vein (such as in total parenteral nutrition), or through a tube in their nose or stomach. Radiation Therapy As it damages cancer cells, it also may affect healthy cells and healthy parts of the body. Treatment of head, neck, chest, or breast may cause:
- Dry mouth
- Sore mouth
- Sore throat
- Difficulty swallowing (dysphagia)
- Change in taste of food
- Dental problems
- Increased phlegm Treatment of stomach or pelvis may cause:
- Nausea and vomiting
- Diarrhea
- Cramps, bloating
Chemotherapy As it destroys cancer cells, it also may affect the digestive system and the desire or ability to eat.
- Nausea and vomiting
- Loss of appetite
- Diarrhea
- Constipation
- Sore mouth or throat
- Weight gain or loss
- Change in taste of food
Biological Therapy (Immunotherapy) As it stimulates your immune system to fight cancer cells, it can affect the desire or ability to eat.
- Nausea and vomiting
- Diarrhea
- Sore mouth
- Severe weight loss
- Dry mouth
- Change in taste of food
- Muscle aches, fatigue, fever
Hormonal Therapy Some types can increase appetite and change how the body handles fluids.
- Changes in appetite
- Fluid retention
Table 2. Examples of Clear Liquids
- Bouillon
- Clear, fat-free broth
- Clear carbonated beverages
- Consomme
- Cranberry/grape juice
- Fruit-flavored drinks
- Fruit ices without fruit pieces
- Fruit ices without milk
- Fruit punch
- Honey
- Jelly
- Plain gelatin dessert
- Popsicles
- Sports drinks
- Strained citrus juice
- Strained lemonade/limeade
- Strained vegetable broth
- Tea
- Water
Table 3. Examples of Full-Liquid Foods
- All fruit juices and nectars
- Bouillon, broth
- Butter/cream/oil/margarine
- Carbonated beverages
- Cheese soup
- Coffee/Tea
- Fresh or frozen plain yogurt
- Fruit drinks
- Fruit punch
- Honey/jelly/syrup
- Ice milk
- Liquid meal replacements
- Milk, all types
- Milkshakes
- Pasteurized eggnog
- Plain cornstarch pudding
- Plain gelatin desserts
- Potatoes pureed in soup
- Refined/strained cooked cereal
- Small amounts of strained meat in broth or gelatin
- Smooth ice cream
- Soft or baked custard
- Strained lemonade/limeade
- Strained or blenderized soup
- Thin fruit purees
- Tomato juice
- Tomato puree for cream soup
- Vegetable juice
- Water
Table 4. Quick & Easy Snacks
- Applesauce
- Bread, muffins, and crackers
- Buttered popcorn
- Cakes and cookies made with whole grains, fruits, nuts, wheat germ, or granola
- Cereal
- Cheese, hard or semi-soft
- Cheesecake
- Chocolate milk
- Crackers
- Cream soups
- Dips made with cheese, beans, or sour cream
- Fruit (fresh, canned, dried)
- Gelatin salads and desserts
- Granola
- Hard-boiled and deviled eggs
- Ice cream frozen yogurt, popsicles
- Juices
- Milkshakes, "instant breakfast" drinks
- Nuts
- Peanut butter
- Pita bread and hummus
- Pizza
- Puddings and custards
- Sandwiches
- Vegetables (raw or cooked)
- Whole or 2% milk
- Yogurt
Table 5. How to Increase Calories
Butter and Margarine
- Add to soups, mashed and baked potatoes, hot cereals, grits, rice, noodles, and cooked vegetables.
- Stir into cream soups, sauces, and gravies.
- Combine with herbs and seasonings, and spread on cooked meats, hamburgers, and fish and egg dishes.
- Use melted butter or margarine as a dip for seafoods and raw vegetables, such as shrimp, scallops, crab, and lobster.
Whipped Cream
- Use sweetened on hot chocolate, desserts, gelatin, puddings, fruits, pancakes, and waffles.
- Fold unsweetened into mashed potatoes or vegetable purees.
Milk and Cream
- Use in cream soups, sauces, egg dishes, batters, puddings, and custards.
- Put on hot or cold cereal.
- Mix with noodles, pasta, rice, and mashed potatoes.
- Pour on chicken and fish while baking.
- Use as a binder in hamburgers, meatloaf, and croquettes.
- Use whole milk instead of low-fat.
- Use cream instead of milk in recipes.
- Make hot chocolate with cream and add marshmallows.
Cheese
- Melt on top of casseroles, potatoes, and vegetables.
- Add to omelets.
- Add to sandwiches.
Cream Cheese
- Spread on breads, muffins, fruit slices, and crackers.
- Add to vegetables.
- Roll into balls and coat with chopped nuts, wheat germ, or granola.
Sour Cream
- Add to cream soups, baked potatoes, macaroni and cheese, vegetables, sauces, salad dressings, stews, baked meat, and fish.
- Use as a topping for cakes, fruit, gelatin desserts, breads, and muffins.
- Use as a dip for fresh fruits and vegetables.
- For a good dessert, scoop it on fresh fruit, add brown sugar, and refrigerate until cold before eating.
Salad Dressings and Mayonnaise
- Use with sandwiches.
- Combine with meat, fish, and egg or vegetable salads.
- Use as a binder in croquettes.
- Use in sauces and gelatin dishes.
Honey, Jam, and Sugar
- Add to bread, cereal, milk drinks, and fruit and yogurt desserts.
- Use as a glaze for meats, such as chicken.
Granola
- Use in cookie, muffin, and bread batters.
- Sprinkle on vegetables, yogurt, ice cream, pudding, custard, and fruit.
- Layer with fruits and bake.
- Mix with dry fruits and nuts for a snack.
- Substitute for bread or rice in pudding recipes.
Dried Fruits
(raisins, prunes, apricots, dates, figs)
- Try cooking dried fruits; serve for breakfast or as a dessert or snack.
- Add to muffins, cookies, breads, cakes, rice and grain dishes, cereals, puddings, and stuffings.
- Bake in pies and turnovers.
- Combine with cooked vegetables, such as carrots, sweet potatoes, yams, and acorn and butternut squash.
- Combine with nuts or granola for snacks.
Eggs
- Add chopped, hard-cooked eggs to salads and dressings, vegetables, casseroles, and creamed meats.
- Make a rich custard with eggs, milk, and sugar.
- Add extra hard-cooked yolks to deviled-egg filling and sandwich spread.
- Beat eggs into mashed potatoes, vegetable purees, and sauces. (Be sure to keep cooking these dishes after adding the eggs because raw eggs may contain harmful bacteria.)
- Add extra eggs or egg whites to custards, puddings, quiches, scrambled eggs, omelets, and to pancake and French toast batter before cooking.
Food Preparation
- Bread meat and vegetables.
- If tolerated, sauté and fry foods when possible, because these methods add more calories than do baking or broiling.
- Add sauces or gravies.
Table 6. How to Increase Protein
Hard or Semi-soft Cheese
- Melt on sandwiches, bread, muffins, tortillas, hamburgers, hot dogs, other meats or fish, vegetables, eggs, desserts, stewed fruit, or pies.
- Grate and add to soups, sauces, casseroles, vegetable dishes, mashed potatoes, rice, noodles, or meatloaf.
Cottage Cheese/
Ricotta Cheese
- Mix with or use to stuff fruits and vegetables.
- Add to casseroles, spaghetti, noodles, and egg dishes, such as omelets, scrambled eggs, and souffles.
- Use in gelatin, pudding-type desserts, cheesecake, and pancake batter.
- Use to stuff crepes and pasta shells or manicotti.
Milk
- Use milk instead of water in beverages and in cooking when possible.
- Use in preparing hot cereal, soups, cocoa, and pudding.
- Add cream sauces to vegetables and other dishes.
Nonfat Instant Dry Milk
- Add to regular milk and milk drinks, such as pasteurized eggnog and milkshakes.
- Use in casseroles, meatloaf, breads, muffins, sauces, cream soups, mashed potatoes, puddings and custards, and milk-based desserts.
Commercial Products
- See the section on "Commercial Products to Improve Nutrition".
- Use "instant breakfast" powder in milk drinks and desserts.
- Mix with ice cream, milk, and fruit or flavorings for a high-protein milkshake.
Ice Cream, Yogurt, and Frozen Yogurt
- Add to carbonated beverages, such as ginger ale or cola.
- Add to milk drinks, such as milkshakes.
- Add to cereal, fruit, gelatin desserts, and pies; blend or whip with soft or cooked fruits.
- Sandwich ice cream or frozen yogurt between cake slices, cookies, or graham crackers.
- Make breakfast drinks with fruit and bananas.
Eggs
- Add chopped, hard-cooked eggs to salads and dressings, vegetables, casseroles, and creamed meats.
- Add extra eggs or egg whites to quiches and to pancake and French toast batter.
- Add extra egg whites to scrambled eggs and omelets.
- Make a rich custard with eggs, high-protein milk, and sugar.
- Add extra hard-cooked yolks to deviled-egg filling and sandwich spreads.
- Avoid raw eggs, which may contain harmful bacteria, because your treatment may make you susceptible to infection. Make sure all eggs you eat are well cooked or baked; avoid eggs that are under cooked.
Nuts, Seeds, and Wheat Germ
- Add to casseroles, breads, muffins, pancakes, cookies, and waffles.
- Sprinkle on fruit, cereal, ice cream, yogurt, vegetables, salads, and toast as a crunchy topping; use in place of bread crumbs.
- Blend with parsley or spinach, herbs, and cream for a noodle, pasta, or vegetable sauce.
- Roll banana in chopped nuts.
Peanut Butter
- Spread on sandwiches, toast, muffins, crackers, waffles, pancakes, and fruit slices.
- Use as a dip for raw vegetables, such as carrots, cauliflower, and celery.
- Blend with milk drinks and beverages.
- Swirl through soft ice cream and yogurt.
Meat and Fish
- Add chopped, cooked meat or fish to vegetables, salads, casseroles, soups, sauces, and biscuit dough.
- Use in omelets, souffles, quiches, sandwich fillings, and chicken and turkey stuffings.
- Wrap in pie crust or biscuit dough as turnovers.
- Add to stuffed baked potatoes.
Beans/Legumes
- Cook and use peas, legumes, beans, and tofu in soups or add to casseroles, pastas, and grain dishes that also contain cheese or meat. Mash cooked beans with cheese and milk.
Keeping Track of Side Effects
Here's a form to help you keep track of eating-related side effects you may experience while you are undergoing cancer treatment. Feel free to copy this form and keep your own record. You can also share it with the health professional who is keeping track of side effects with you during this time.
Your Name:
Week of:Write the type and date of your last treatments(s):
Type of Treatment:
Date:
Type of Treatment:
Date:Your Weight (lbs):
(measure once a week)Below you will find a list of some eating-related side effects that cancer patients may experience. Check the box next to any side effect listed below that you experience in the week you have listed above. Next to each one you have checked, write a number from 1 to 3 indicating how severe you think each side effect was for you, where:
1= mild; 2= moderate; and 3= severe.Side Effect M T W Th F S Sun Sore/Dry Mouth o o o o o o o Nausea o o o o o o o