Nutrition for Patients with Esophageal Cancer

Patients with esophageal cancer don’t always get the nutrition they need. Nutrition issues can be worse during treatment. Your provider may want you to see a dietician to support you with your nutrition or a Speech Language Pathologist (SLP) to help you with issues swallowing.

Side Effects and Nutrition

The esophagus is a long tube that helps move food from the mouth to the stomach. Side effects of treatment that can impact your nutrition are:

• Loss of appetite.
• Taste changes.
• Esophagitis (esophagus sores).
• Xerostomia (dry mouth).
• Fatigue.
• Nausea and vomiting.
• Constipation.
• Swallowing Problems.

Managing side effects and treating nutrition problems early will help you feel better, improve your energy levels, and help you heal faster after treatment. Talk with your provider if you have any of the side effects listed above.

If your esophagus had to be removed to treat your cancer, there is an article about nutrition specifically for you.

Special Diets and Supplements

You may have to be on a special diet before, during, or after your treatment. Because of where your cancer is, your ability to swallow might change. You will be told which diet to follow and this may change throughout treatment. Special diets include:

Regular Diet as Tolerated

If you are on a regular diet as tolerated, try to eat a variety of foods from all of the food groups (vegetables, fresh fruits, whole grains, lean proteins, and low-fat dairy products). The USDA has more information about what a meal should look like to help have good nutrition. During cancer treatment, you may want to have some high calorie and high protein foods to maintain your weight. Dip dry, crisp foods, such as cookies, into milk, coffee or tea to make them softer if needed. Avoid hard and dry foods, such as potato chips or pretzels if these foods hurt to swallow.

Soft Diet

A soft diet means eating foods that can be easily mashed with a fork. These foods are easier to chew and swallow. Examples include:

• Tender-cooked chicken, turkey, or pork, cut into small pieces, or ground meat with gravy.
• Flaky fish or tuna in oil.
• Chicken or egg salad (finely chopped and well moistened).
• Mashed lentils or legumes, such as mashed chickpeas and soft tofu.
• Soft cooked or canned vegetables cut into small pieces.
• Ripened banana and avocado or soft canned/frozen fruit.
• Well cooked pasta with gravy or sauce.

Pureed or Blenderized Diet

Most foods can be pureed or put into a blender and made easier to swallow. After a food is pureed, it does not need to be chewed, only swallowed. The food should still be able to hold its shape on a spoon. Foods that you can puree or blenderize are: potatoes, fruit, vegetables, meat, eggs, egg substitute, tofu, tempeh, meat alternatives, soft cheeses, and nut butters. They should not be chunky and you can add liquids like gravy or milk to thin them out.

Full Liquid Diet

A full liquid diet consists of foods that are smooth, pourable liquids. Examples include:

• All beverages including water, milk, milk substitutes, juice, coffee, and tea.
• Smoothies and milkshakes, drinkable yogurt.
• Blended and strained soups, fruits, and vegetables. You can use broth, juice, yogurt, or milk to make it smoother or thinner.
• Oral nutrition supplement shakes. 

Feeding Tube

A feeding tube is a tube that is placed to provide liquid nutrition. You may need a feeding tube if you are not able to maintain proper nutrition with eating or you are not able to swallow. There are several types of tubes that can be placed and your provider will talk to you about which is best for you. These tubes can be temporary (used for a short time) or permanent (never come out). You will be prescribed liquid nutrition that can be given through the tube into your stomach either by a pump or manually. This liquid nutrition will replace the nutrients you are not able to eat and drink. In some cases, you can also eat normally along with getting nutrition from a feeding tube.

Keep in mind that these diets are likely temporary. It is important to be open and honest with your dietitian and providers so that together you can figure out the best plan to meet your nutritional needs.

Nutritional Supplements

Nutritional supplements can help you meet your nutritional needs. This might mean using a protein powder or high protein drink like Ensure® or Boost®. There are lower sugar, sugar-free, and non-dairy options. A dietitian can help you find foods that work for your diet and specific health needs and can recommend nutritional supplements if needed.

If supplements are your only form of food/nutrition, it can get costly. Ask your dietitian or social worker if samples and coupons are available. The Oley Foundation has an equipment and supply exchange that includes supplements and might be helpful.  

Calories and Protein

A calorie is a unit for measuring energy. All food and some drinks contain calories, which tells us how much energy is stored in it. When we eat, the food is broken down, releasing the stored energy for our body to use. It is important that we get enough calories because they provide the energy our bodies need to work

Proteins are large molecules made up of amino acids. Protein helps our cells, tissues, and organs work. It is needed to maintain, grow, and repair the body. Protein is found in some food and drinks and is measured in grams. Protein helps to ensure growth, to repair body tissue, and to maintain a healthy immune system. Without enough protein, the body takes longer to recover from illness, and you will have a lower resistance to infection.

If you are having chemotherapy, radiation, or surgery, the number of calories and grams of protein needed each day may be higher. Talk with your dietician or provider about your specific needs.

Hydration

Keeping your body hydrated helps it to work correctly. It helps regulate your body temperature and remove toxins from your body. Fluids that help keep you hydrated include water, decaffeinated tea and coffee, juices, popsicles, gelatin, and broths. You should be aware of how much sugar and salt are in the fluids you are drinking to help you make healthy choices. Ask your dietitian how much fluid you should be drinking each day.

Esophageal cancer and its treatments can affect your nutrition. Talk to your provider and dietitian about how to best manage your nutritional needs.