Nutrition During Gastric Cancer Treatment

Stomach cancer consists of uncontrolled, abnormal growth of some stomach cells and can occur in any part of the stomach. The stomach is the largest part of the digestive tract and is located in the upper abdomen, between the oesophagus and the small intestine, close to the diaphragm and other abdominal organs, such as the liver, pancreas and spleen. It is an essential organ in food digestion. When food is chewed and lubricated with saliva, it travels down the throat to the stomach through the oesophagus. In the stomach, food is mixed with gastric juices and begins to be digested. The digested food, together with the gastric juice, is emptied into the first section of the small intestine through the pylorus, thanks to the contraction and relaxation of the stomach muscles.

Both the diagnosis and the treatment decision are made in a multidisciplinary fashion. The main treatments are based on surgery, chemotherapy, immunotherapy and radiation therapy. The choice of treatment is based on different factors related to the patient (overall condition, clinical and nutritional status, associated diseases, patient’s decision), the tumour (symptoms caused, type and stage of tumour) and the treatment (intention, tolerance and efficacy, previous treatments, etc.).

Surgery is the treatment of choice in localised stomach cancer and may be accompanied by additional prior and/or subsequent chemotherapy, and sometimes radiation therapy. The purpose of treatment prior to surgery is to shrink the tumour to allow the surgery to be more effective, while the purpose after surgery is to ensure the tumour cells are eliminated. In non-surgical stomach cancer, the treatment of choice is usually chemotherapy, sometimes also combined with immunotherapy and/or radiation therapy.

Gastric and oesophageal-gastric junction cancer is considered a high nutritional risk and can lead to malnutrition as early as the diagnosis of the disease, and especially in the more advanced stages. There are many causes that interact with each other:

• Inadequate oral intake due to the symptoms and location of the disease and treatment-related side effects, such as difficulty swallowing, feelings of fullness, abdominal pain, nausea, vomiting, diarrhoea or lack of appetite, which may lead to reduced food intake and weight loss.

• A decrease in muscle mass due to low food intake, a decrease in mobility and/or the effect of the tumour or treatment.

Deterioration of the nutritional state influences the efficacy and tolerance and response to treatment, as well as the patient’s functional capacity and quality of life. For all these reasons, a proper nutritional state can favour recovery, palliate complications from treatment and lead to a shorter hospital stay and a better prognosis.

The nutritional needs of the person undergoing treatment for stomach cancer can be classified according to the treatment and the stage. Therefore, patients can go directly to the different sections:

Whatever the stage of treatment the patient is in, they should check with their medical team to find out if there are interactions between any food and the medication received. It is also important not to take any vitamin, mineral, antioxidant, herbal or other supplement without first checking with a specialist.

In addition to a proper diet, it is important to perform physical activity that includes both movement (walking, strolling, cycling, stationary bike, swimming, etc.) and strength exercises, adapted to each situation, as they help to optimise the patient’s muscle mass and functional capacity.