Overview of Nutrition in Cancer Care
Effect of Cancer on Nutrition
Effect of Cancer Treatment on Nutrition

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

Nutrition Therapy Overview

Nutrition Screening and Assessment Goals of Nutrition Therapy Methods of Nutrition Care         Enteral Nutrition         Parenteral Nutrition

Nutrition Suggestions for Symptom Relief

Anorexia Taste Changes Dry Mouth Mouth Sores and Infections Nausea Diarrhea Low White Blood Cell Count Hot Flashes Fluid Intake Constipation

Other Nutrition Issues

Advanced Cancer Drug-Nutrient Interactions Guidelines for Healthy Eating         The Food Guide Pyramid         Cancer Prevention Surviving Cancer and Preventing Second Cancers         Lung Cancer         Prostate Cancer         Breast Cancer         Colon Cancer         Esophageal and Gastric Cancer

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Overview of Nutrition in Cancer Care

Cancer and cancer treatments may cause nutrition-related side effects.

The diet is an important part of cancer treatment. Eating the right kinds of foods before, during, and after treatment can help the patient feel better and stay stronger. To ensure proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients (vitamins, minerals, protein, carbohydrates, fat, and water). For many patients, however, some side effects of cancer and cancer treatments make it difficult to eat well. Symptoms that interfere with eating include anorexia, nausea, vomiting, diarrhea, constipation, mouth sores, trouble with swallowing, and pain. Appetite, taste, smell, and the ability to eat enough food or absorb the nutrients from food may be affected. Malnutrition (lack of key nutrients) can result, causing the patient to be weak, tired, and unable to resist infections or withstand cancer therapies. Eating too little protein and calories is the most common nutrition problem facing many cancer patients. Protein and calories are important for healing, fighting infection, and providing energy.

Anorexia and cachexia are common causes of malnutrition in cancer patients.

Anorexia (the loss of appetite or desire to eat) is a common symptom in people with cancer. Anorexia may occur early in the disease or later, when the tumor grows and spreads. Some patients may have anorexia when they are diagnosed with cancer. Almost all patients who have widespread cancer will develop anorexia. Anorexia is the most common cause of malnutrition in cancer patients.

Cachexia is a wasting syndrome that causes weakness and a loss of weight, fat, and muscle. It commonly occurs in patients with tumors of the lung, pancreas, and upper gastrointestinal tract and less often in patients with breast cancer or lower gastrointestinal cancer. Anorexia and cachexia often occur together. Weight loss can be caused by eating fewer calories, using more calories, or a combination of the two. Cachexia can occur in people who are eating enough, but who cannot absorb the nutrients. Cachexia is not related to the tumor size, type, or extent. Cancer cachexia is not the same as starvation. A healthy person's body can adjust to starvation by slowing down its use of nutrients, but in cancer patients, the body does not make this adjustment.

Good eating habits during cancer care help the patient cope with the effects of the cancer and its treatment.

Nutrition therapy can help cancer patients get the nutrients needed to maintain body weight and strength, prevent body tissue from breaking down, rebuild tissue, and fight infection. Eating guidelines for cancer patients can be very different from the usual suggestions for healthful eating. Nutrition recommendations for cancer patients are designed to help the patient cope with the effects of the cancer and its treatment. Some cancer treatments are more effective if the patient is well nourished and getting enough calories and protein in the diet. People who eat well during cancer treatment may even be able to handle higher doses of certain treatments. Being well-nourished has been linked to a better prognosis (chance of recovery).

Reference citations in some PDQ Supportive Care information summaries may include links to external Web sites that are operated by individuals or organizations for the purpose of marketing or advocating the use of specific treatments or products. These reference citations are included for informational purposes only. Their inclusion should not be viewed as an endorsement of the content of the Web sites or of any treatment or product by the PDQ Supportive Care Editorial Board or the National Cancer Institute (NCI).

Effect of Cancer on Nutrition

Cancer can change the way the body uses food.

Tumors may produce chemicals that change the way the body uses certain nutrients. The body's use of protein, carbohydrates, and fat may be affected, especially by tumors of the stomach or intestines. A patient may appear to be eating enough, but the body may not be able to absorb all the nutrients from the food. Diets higher in protein and calories can help correct this and prevent the onset of cachexia. Drugs may also be helpful. It is important to monitor nutrition early, as cachexia is difficult to completely reverse.

Drugs may help relieve cancer symptoms and side effects that cause weight loss.

Early treatment of cancer symptoms and side effects that affect eating and cause weight loss is important. Both nutrition therapy and drugs can help the patient maintain a healthy weight. The types of drugs commonly used to relieve these symptoms and side effects include the following:

• Medicines to prevent nausea and vomiting.
• Medicines to prevent diarrhea.
• Pancreatic enzymes.
• Laxatives (to promote bowel movements).
• Medicines for mouth problems (to clean the mouth, stimulate saliva, prevent infections, relieve pain, and heal sores).
• Pain medications.

(Refer to the Nutrition Screening and Assessment ¹ section and the Nutrition Suggestions for Symptom Relief ² section for more information.)

Effect of Cancer Treatment on Nutrition

Effect of Surgery on Nutrition

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

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

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

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

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



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

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

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

Nutrition therapy may include the following:

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

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

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

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



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



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

Chemotherapy may affect the whole body.

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

Nutrition-related side effects may occur during chemotherapy.

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

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

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

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

• Supplements high in calories and protein.



• Enteral nutrition (tube feedings).

Radiation therapy can affect healthy cells in the treatment area.

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

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

Nutrition-related side effects may occur during radiation therapy.

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

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



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



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



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

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

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

• Nutritional supplement drinks between meals.



• Enteral nutrition (tube feedings).



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

Nutrition-related side effects may occur during immunotherapy.

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

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

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

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

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

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

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

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

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

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

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

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

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



• Instruction on safe food handling.



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



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

Nutrition Therapy Overview

Nutrition Screening and Assessment

Finding and treating nutrition problems early may improve the patient's prognosis (chance of recovery).

Early nutrition screening and assessment can identify problems that affect the success of anticancer therapy. Patients who are underweight or malnourished may not respond well to cancer treatments. Malnutrition may be caused by the cancer or made worse as the cancer progresses. Finding and treating nutrition problems early may help the patient gain or maintain weight, improve the patient's response to therapy, and reduce complications of treatment.

Screening and assessment are done before beginning anticancer therapy, and assessment continues throughout treatment.

Because the ability to tolerate treatment is better for the well-nourished patient, screening and assessment are done before beginning anticancer therapy. Appropriate nutrition management is begun early, and nutritional status is checked often during treatment.

Screening is used to identify patients who may be at nutritional risk. Assessment determines the complete nutritional status of the patient and identifies if nutrition therapy is needed. The patient or caregiver may be asked for the following information:

• Weight changes over the past 6 months.



• Changes in the amount and type of food eaten compared to what is usual for the patient.



• Problems that have affected eating, such as nausea, vomiting, diarrhea, constipation, dry mouth, changes in taste and smell, mouth sores, pain, or loss of appetite.



• Ability to walk and perform the activities of daily living.

A physical exam is part of the assessment. The physical exam will check the body for general health and signs of disease, such as lumps or growths. The physician will look for loss of weight, fat and muscle, and fluid buildup in the body.

Ongoing assessment is completed by a healthcare team with expertise in nutritional management.

A nutrition support team will monitor the patient's nutritional status during cancer treatment and recovery. The team may include the following specialists:

• Physician.



• Nurse.



• Registered dietitian.



• Social worker.



• Psychologist.

The goals of nutrition therapy for cancer patients in active treatment and recovery are designed to restore nutrient shortages, maintain nutritional health, and prevent complications.

The goals of nutrition therapy for patients in active treatment and recovery are to do the following:

• Prevent or correct malnutrition.



• Prevent wasting of muscle, bone, blood, organs, and other lean body mass.



• Help the patient tolerate treatment.



• Reduce nutrition-related side effects and complications.



• Maintain strength and energy.



• Protect ability to fight infection.



• Help recovery and healing.



• Maintain or improve quality of life.

A patient whose religion forbids eating certain foods may consider speaking with a religious leader about waiving the restriction during cancer treatment and recovery.

Good nutrition continues to be important for patients who are in remission or whose cancer has been cured.

The goals of nutrition therapy for patients who have advanced cancer are designed to improve the quality of life.

The goals of nutrition therapy for patients who have advanced cancer are to do the following:

• Reduce side effects.



• Reduce risk of infection.



• Maintain strength and energy.



• Improve quality of life.

Nutrition support provides nutrition to patients who cannot eat normally.

Eating by mouth is the preferred method and should be used whenever possible, but some patients may not be able to take any or enough food by mouth due to complications from cancer or cancer treatment. This may include patients with cancer of the head, neck, esophagus, or stomach. A patient may be fed using enteral nutrition (through a tube inserted into the stomach or intestine) or parenteral nutrition infused into the bloodstream directly). The nutrients are delivered in formulas, liquids that contain water, protein, fats, carbohydrates, vitamins, and/or minerals. The content of the formula depends on the needs of the patient and the method of feeding.

Nutritional support can improve a patient's quality of life during cancer, but there are risks and disadvantages that should be considered before making the decision to use it. The effect of nutritional support on tumor growth is not known. Also, each form of nutrition therapy has its own benefits and disadvantages. For example, enteral nutrition keeps the stomach and intestines working normally and has fewer complications than parenteral nutrition; nutrients are used more easily by the body in enteral feeding. These and other issues should be discussed with the patient's health care providers so that an informed decision can be made. (See the Advanced Cancer section below ³ for more information on deciding whether to use nutritional support.)

Patients with certain conditions are most appropriate for treatment with nutrition support.

Nutrition support may be helpful for patients who have one or more of the following characteristics:

• Low body weight.



• Inability to absorb nutrients.



• Holes or draining abscesses in the esophagus or stomach.



• Inability to eat or drink by mouth for more than 5 days.



• Moderate or high nutritional risk.



• Ability, along with the caregiver, to handle tube feedings at home.

Enteral nutrition is also called tube feeding.

Enteral nutrition is food (in liquid form) given to the patient through a tube that is inserted into the stomach or the small intestine. The following types of tube feeding may be used:

• A tube inserted through the nose and throat down into the stomach or small intestine. This kind of tube is usually used for short-term use.



• A tube inserted into the stomach or small intestine through a stoma (an opening made on the outside of the abdomen). This kind of tube is usually chosen for long-term use or for patients who cannot tolerate a tube in the nose and throat.

If the tube is placed in the stomach, food may be given through the tube continuously or in batches several times a day. If the tube is placed in the small intestine, the food is delivered continuously. Different formulas are available. Some provide complete nutrition and others provide certain nutrients. Formulas that meet the patient's specific needs are selected. Formulas are available for patients who have other health conditions, such as diabetes.

Enteral nutrition is sometimes used when the patient is able to eat small amounts by mouth but cannot obtain enough food that way. The patient may continue to eat or drink as able, and the tube feeding provides the balance of calories and nutrients that are needed.

Enteral nutrition may be appropriate for patients whose gastrointestinal tract is still working.

Enteral nutrition continues to use the stomach and/or intestines to digest food. Enteral nutrition may be used for patients who have cancer of the head, neck, or digestive system and whose treatment with chemotherapy and radiation therapy causes side effects that limit eating or drinking.

Enteral nutrition is not appropriate for the following patients:

• Patients whose stomach and intestines are not working or have been removed.



• Patients who have a blockage in the bowel.



• Patients who have severe nausea, vomiting, and/or diarrhea.



• Patients whose platelet count is low. Platelets are blood cells that help prevent bleeding by causing blood clots to form.



• Patients who have low levels of all blood cells (white blood cells, red blood cells, and platelets).

Enteral nutrition may continue after a patient leaves the hospital.

If enteral nutrition is to be part of the patient's care after leaving the hospital, the patient and caregiver will be trained in use of the tube and pump, and in care of the patient. The home must be clean and the patient must be monitored often by the nutrition support team.

Parenteral nutrition provides the patient with nutrients delivered into the blood stream.

Parenteral nutrition is used when the patient cannot take food by mouth or by enteral feeding. Parenteral feeding bypasses the normal digestive system. Nutrients are delivered to the patient directly into the blood, through a catheter (thin tube) inserted into a vein. Patients with the following problems may benefit from parenteral nutrition:

• Stomach and intestines that are not working or have been removed.



• Severe nausea, diarrhea, or vomiting.



• Severe sores in the mouth or esophagus.



• A fistula (hole) in the stomach or esophagus.



• Loss of body weight and muscle with enteral nutrition.

The catheter may be placed into a vein in the chest or in the arm.

A central venous catheter is placed beneath the skin and into a large vein in the upper chest. Placement of a central venous catheter is done by a surgeon.

A peripheral venous catheter is placed into a vein in the arm. Placement of a peripheral venous catheter is done by trained medical staff. This site may be used for short-term parenteral feeding.

The patient is checked often for infection or bleeding at the site (place) where the catheter enters the body.

Some drugs should not be given with parenteral formulas.

Many drugs and other substances do not mix safely with the formulas used for parenteral feeding. A pharmacist or doctor should be consulted before adding anything to the formula or using the catheter for another substance.

Trained medical staff should manage the use of parenteral nutrition.

The techniques and formulas involved in parenteral nutrition support are precise and require management by trained medical staff or a nutrition support team. Some of the serious complications that may occur with parenteral feeding include the following:

• Placement of the tip of the catheter into the wrong place.



• Blood clots.



• A collapsed lung.



• A high or low sugar level in the blood.



• A low potassium level in the blood.



• Elevated liver enzymes.

Parenteral nutrition support may continue after a patient leaves the hospital.

If parenteral nutrition is to be part of the patient's care after leaving the hospital, the patient and caregiver will be trained in the procedures and in care of the patient. The home must be clean and the patient must be monitored often by the nutrition support team.

Experienced medical staff should manage the patient's removal from parenteral nutrition support.

Going off parenteral nutrition support needs to be done gradually and under medical supervision. The parenteral feedings are reduced by small amounts over time as the patient is changed to enteral or oral feeding.

Nutrition Suggestions for Symptom Relief

When side effects of cancer or cancer treatment interfere with normal eating, adjustments can be made to ensure the patient continues to get the necessary nutrition. Medications may be given to stimulate the appetite. Eating foods that are high in calories, protein, vitamins and minerals is usually advised. Meal planning, however, should be individualized to meet the patient's nutritional needs and tastes in food.

Anorexia (lack of appetite) is one of the most common problems for cancer patients. The following suggestions may help cancer patients manage anorexia:

• Eat small high- protein and high- calorie meals every 1-2 hours instead of 3 larger meals.



• Have help with preparing meals.



• Add extra calories and protein to food (such as butter, skim milk powder, honey, or brown sugar).



• Take liquid supplements (special drinks containing nutrients), soups, milk, juices, shakes, and smoothies when eating solid food is a problem.



• Eat snacks that contain plenty of calories and protein.



• Prepare and store small portions of favorite foods so they are ready to eat when hungry.



• Eat breakfasts that contain one third of the calories and protein needed for the day.



• Eat foods with odors that are appealing. Strong odors can be avoided by using boiling bags, cooking outdoors on the grill, using a kitchen fan when cooking, serving cold food instead of hot (since odors are in the rising steam), and taking off any food covers to release the odors before entering a patient's room. Small portable fans can be used to blow food odors away from patients. Cooking odors can be avoided by ordering take-out food.



• Try new foods. Be creative with desserts. Experiment with recipes, flavorings, spices, types, and consistencies of food. Food likes and dislikes may change from day to day.

The following high-calorie, high-protein foods are recommended:

• Cheese and crackers.



• Muffins.



• Puddings.



• Nutritional supplements.



• Milkshakes.



• Yogurt.



• Ice cream.



• Powdered milk added to foods such as pudding, milkshakes, or any recipe using milk.



• Finger foods (handy for snacking) such as deviled eggs, cream cheese or peanut butter on crackers or celery, or deviled ham on crackers.

See the NCI Web site's ⁴Eating Hints for Cancer Patients: Before, During, and After Treatment ⁵ for recipes such as Lactose-Free Double Chocolate Pudding ⁶, Banana Milkshake ⁷, and Fruit and Cream ⁸. For a free copy of this booklet, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Changes in how foods taste may be caused by radiation treatment, dental problems, or medicines. Cancer patients often complain of changes in their sense of taste when undergoing chemotherapy, in particular a bitter taste sensation. A sudden dislike for certain foods may occur. This may result in food avoidance, weight loss, and anorexia, which can greatly reduce the patients' quality of life. Some or all of the sense of taste may return, but it may be a year after treatment ends before the sense of taste is normal again. Drinking plenty of fluids, changing the types of foods eaten and adding spices or flavorings to food may help.

The following suggestions may help cancer patients manage changes in taste:

• Rinse mouth with water before eating.



• Try citrus fruits (oranges, tangerines, lemons, grapefruit) unless mouth sores are present.



• Eat small meals and healthy snacks several times a day.



• Eat meals when hungry rather than at set mealtimes.



• Use plastic utensils if foods taste metallic.



• Try favorite foods.



• Eat with family and friends.



• Have others prepare the meal.



• Try new foods when feeling best.



• Substitute poultry, fish, eggs, and cheese for red meat.



• Find nonmeat, high- protein recipes in a vegetarian or Chinese cookbook.



• Use sugar-free lemon drops, gum, or mints if there is a metallic or bitter taste in the mouth.



• Add spices and sauces to foods.



• Eat meat with something sweet, such as cranberry sauce, jelly, or applesauce.

Taking zinc sulfate tablets during radiation therapy to the head and neck may speed the return of normal taste after treatment.

Dry mouth is often caused by radiation therapy to the head and neck. Some medicines may also cause dry mouth. Dry mouth may affect speech, taste, ability to swallow, and the use of dentures or braces. There is also an increased risk of cavities and gum disease because less saliva is produced to wash the teeth and gums.

The main treatment for dry mouth is drinking plenty of liquids, about ½ ounce per pound of body weight per day. Other suggestions to manage dry mouth include the following:

• Eat moist foods with extra sauces, gravies, butter, or margarine.



• Suck on hard candy or chew gum.



• Eat frozen desserts (such as frozen grapes and ice pops) or ice chips.



• Clean teeth (including dentures) and rinse mouth at least four times per day (after each meal and before bedtime).



• Keep water handy at all times to moisten the mouth.



• Choose foods and drinks that are very sweet or tart, to stimulate saliva.



• Avoid mouth rinses containing alcohol.



• Drink fruit nectar instead of juice.



• Use a straw to drink liquids.

(Refer to the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation ⁹ for more information on dry mouth.

Mouth sores can result from chemotherapy and radiation therapy. These treatments target rapidly-growing cells because cancer cells grow rapidly. Normal cells inside the mouth may be damaged by these cancer treatments because they also grow rapidly. Mouth sores may become infected and bleed, making eating difficult. By choosing certain foods and taking good care of their mouths, patients can usually make eating easier. Suggestions to help manage mouth sores and infections include the following:

• Eat soft foods that are easy to chew and swallow, such as the following:
  • Soft fruits, including bananas, applesauce, and watermelon.
  • Peach, pear, and apricot nectars.
  • Cottage cheese.
  • Mashed potatoes.
  • Macaroni and cheese.
  • Custards; puddings.
  • Gelatin.
  • Milkshakes.
  • Scrambled eggs.
  • Oatmeal or other cooked cereals.



• Use the blender to process vegetables (such as potatoes, peas, and carrots) and meats until smooth.



• Avoid rough, coarse, or dry foods, including raw vegetables, granola, toast, and crackers.



• Avoid foods that are spicy or salty. Avoid foods that are acidic, such as vinegar, pickles, and olives.



• Avoid citrus fruits and juices, including orange, grapefruit, and tangerine.



• Cook foods until soft and tender.



• Cut foods into small pieces.



• Use a straw to drink liquids.



• Eat foods cold or at room temperature. Hot and warm foods can irritate a tender mouth.



• Clean teeth (including dentures) and rinse mouth at least four times per day (after each meal and before bedtime).



• Add gravy, broth, or sauces to food.



• Drink high- calorie, high- protein drinks in addition to meals.



• Numb the mouth with ice chips or flavored ice pops.

Using a mouth rinse that contains glutamine may reduce the number of mouth sores. Glutamine is a substance found in plant and animal proteins.

(Refer to the PDQ summary on Oral Complications of Chemotherapy and Head/Neck Radiation ⁹ for more information on mouth sores and infections.)

Nausea caused by cancer treatment can affect the amount and kinds of food eaten. The following suggestions may help cancer patients manage nausea:

• Eat before cancer treatments.



• Avoid foods that are likely to cause nausea. For some patients, this includes spicy foods, greasy foods, and foods that have strong odors.



• Eat small meals several times a day.



• Slowly sip fluids throughout the day.



• Eat dry foods such as crackers, breadsticks, or toast throughout the day.



• Sit up or lie with the upper body raised for one hour after eating.



• Eat bland, soft, easy-to-digest foods rather than heavy meals.



• Avoid eating in a room that has cooking odors or that is overly warm. Keep the living space at a comfortable temperature and with plenty of fresh air.



• Rinse out the mouth before and after eating.



• Suck on hard candies such as peppermints or lemon drops if the mouth has a bad taste.

(Refer to the PDQ summary on Nausea and Vomiting ¹⁰ for more information.)

Diarrhea may be caused by cancer treatments, surgery on the stomach or intestines, or by emotional stress. Long-term diarrhea may lead to dehydration (lack of water in the body) and/or low levels of salt and potassium, important minerals needed by the body.

The following suggestions may help cancer patients manage diarrhea:

• Eat broth, soups, sports drinks, bananas, and canned fruits to help replace salt and potassium lost by diarrhea.



• Avoid greasy foods, hot or cold liquids, and caffeine.



• Avoid high- fiber foods--especially dried beans and cruciferous vegetables (such as broccoli, cauliflower, and cabbage).



• Drink plenty of fluids through the day. Room temperature liquids may cause fewer problems than hot or cold liquids.



• Limit milk to 2 cups or eliminate milk and milk products until the source of the problem is found.



• Limit gas-forming foods and beverages such as peas, lentils, cruciferous vegetables, chewing gum, and soda.



• Limit sugar-free candies or gum made with sorbitol (sugar alcohol).



• Drink at least one cup of liquid after each loose bowel movement.

Taking oral glutamine may help keep the intestines healthy when taking the anticancer drug fluorouracil.

(Refer to the PDQ summary on Gastrointestinal Complications ¹¹ for more information.)

Cancer patients may have a low white blood cell count for a variety of reasons, some of which include radiation therapy, chemotherapy, or the cancer itself. Patients who have a low white blood cell count are at an increased risk of infection. The following suggestions may help cancer patients prevent infections when white blood cell counts are low:

• Check dates on food and do not buy or use the food if it is out of date.



• Do not buy or use food in cans that are swollen, dented, or damaged.



• Thaw foods in the refrigerator or microwave. Never thaw foods at room temperature. Cook foods immediately after thawing.



• Refrigerate all leftovers within 2 hours of cooking and eat them within 24 hours.



• Keep hot foods hot and cold foods cold.



• Avoid old, moldy, or damaged fruits and vegetables.



• Avoid unpackaged tofu sold in open bins or containers.



• Cook all meat, poultry, and fish thoroughly. Avoid raw eggs or raw fish.



• Buy foods packed as single servings to avoid leftovers.



• Avoid salad bars and buffets when eating out.



• Avoid large groups of people and people who have infections.



• Wash hands often to prevent the spread of bacteria.

Hot flashes occur in most women with breast cancer and men with prostate cancer. When caused by natural or treatment-related menopause, hot flashes can be relieved with estrogen replacement. Many women, however, (including women with breast cancer), are not able to take estrogen replacement. Eating soy foods, which contain an estrogen -like substance, is sometimes suggested to relieve hot flashes in patients who cannot take estrogen replacement, but no benefit has been proven. (Refer to the PDQ summary on Fever, Sweats, and Hot Flashes ¹² for more information.)

The body needs plenty of water to replace the fluids lost every day. Long-term diarrhea, nausea and vomiting, and pain may prevent the patient from drinking and eating enough to get the water needed by the body. One of the first signs of dehydration (lack of water in the body) is extreme tiredness. The following suggestions may help cancer patients prevent dehydration:

• Drink 8 to 12 cups of liquids a day. This can be water, juice, milk, or foods that contain a large amount of liquid such as puddings, ice cream, ice pops, flavored ices, and gelatins.



• Take a water bottle whenever leaving home. It is important to drink even if not thirsty, as thirst is not a good sign of fluid needs.



• Limit drinks that contain caffeine, such as sodas, coffee, and tea (both hot and cold).



• Drink most liquids after and/or between meals.



• Use medicines that help relieve nausea and vomiting.

Constipation is defined as fewer than 3 bowel movements per week. It is a very common problem for cancer patients and may result from lack of water or fiber in the diet; lack of physical activity; anticancer therapies such as chemotherapy; and medications.

Prevention of constipation is a part of cancer care. The following suggestions may help cancer patients prevent constipation:

• Eat more fiber-containing foods on a regular basis. The recommended fiber intake is 25 to 35 grams per day. Increase fiber gradually and drink plenty of fluids at the same time to keep the fiber moving through the intestines.



• Drink 8 to 10 cups of fluid each day. Water, prune juice, warm juices, lemonade, and teas without caffeine can be very helpful.



• Take walks and exercise regularly. Proper footwear is important.

If constipation does occur, the following suggestions for diet, exercise, and medication may help correct it:

• Continue to eat high-fiber foods and drink plenty of fluids. Try adding wheat bran to the diet; begin with 2 heaping tablespoons each day for 3 days, then increase by 1 tablespoon each day until constipation is relieved. Do not exceed 6 tablespoons per day.



• Maintain physical activity.



• Include over-the-counter constipation treatments, if necessary. This refers to bulk-forming products (such as Citrucel, Metamucil, Fiberall, FiberCon, and Fiber-Lax); stimulants (such as Dulcolax tablets or suppositories and Senokot); stool softeners (such as Colace, Surfak, and Dialose); and osmotics (such as milk of magnesia). Cottonseed and aerosol enemas can also help relieve the problem. Lubricants such as mineral oil are not recommended because they may prevent the body's use of important nutrients.

Good food sources of fiber include the following:

4 or more grams of fiber per serving

• Legumes (½ cup, cooked).
  • Kidney beans.
  • Navy beans.
  • Garbanzo beans.
  • Lima beans.
  • Split peas.
  • Pinto beans.
  • Lentils.
• Vegetables and fruit
  • Corn (½ cup).
  • Pears with skin (one medium-sized pear).
  • Popcorn (3 cups popped).
• Cold cereals (1 ounce)
  • Whole-grain cereals.
  • Bran cereals.
• Hot cereals (1/3 cup before cooking).
  • Oatmeal.
  • Oat bran.
  • Grits.

2 or more grams of fiber per serving

• Vegetables (½ cup cooked or 1 cup raw).
  • Asparagus.
  • Green beans.
  • Broccoli.
  • Cabbage.
  • Carrots.
  • Cauliflower.
  • Greens.
  • Onions.
  • Peas.
  • Spinach.
  • Squash.
  • Green peppers.
  • Celery.
  • Canned tomatoes.
• Fruit (½ cup serving or one medium-sized fruit).
  • Apples with the skin.
  • Bananas.
  • Oranges.
  • Strawberries.
  • Peaches.
  • Blueberries.
• Breads.
  • Whole wheat bread (one slice).
  • Whole grain bagel (one half of medium-sized bagel).
  • Whole wheat pita (½ portion).
  • Whole grain crackers (see package for serving size).

Legumes, broccoli, and cabbage may cause gas. Over-the-counter enzyme tablets may be helpful.

Other Nutrition Issues

Advanced Cancer

Nutrition-related side effects may occur or become worse as cancer becomes more advanced.

The following are the most common nutrition -related symptoms in patients who have advanced cancer:

• Cachexia (a wasting syndrome that causes weakness and a loss of weight, fat, and muscle).
• Weight loss of more than 10% of normal body weight.
• Feeling too full to eat enough food.
• Bloating.
• Anorexia (the loss of appetite or desire to eat).
• Constipation.
• Dry mouth.
• Taste changes.
• Nausea.
• Vomiting.
• Inability to swallow.

The usual treatment for these problems in patients with advanced cancer is palliative care to reduce the symptoms and improve the quality of life.

Palliative care includes nutrition therapy (see the Nutrition Suggestions for Symptom Relief ² section) and/or drug therapy (see the Drug-Nutrient Interactions ¹³ section).

Eating less solid food is common in advanced cancer. Patients usually prefer soft foods and clear liquids. Those who have problems swallowing may do better with thick liquids than with thin liquids. Terminally ill patients often do not feel much hunger at all and may be satisfied with very little food.

When cancer is advanced, food should be viewed as a source of enjoyment. Eating should not just be about calories, protein, and other nutrient needs.

Dietary restriction is not usually necessary, as intake of “prohibited foods” (such as sweets for a patient with diabetes) is not enough to be of concern. Some patients, however, may need certain diet restrictions. For example, patients who have pancreatic cancer, uterine cancer, ovarian cancer, or another cancer affecting the abdominal area may need a soft diet (no raw fruits and vegetables, no nuts, no skins, no seeds) to prevent a blockage in the bowel. Diet restrictions should be considered in terms of quality of life and the patient’s wishes.

The benefits and risks of nutrition support vary for each patient.

Decisions about using nutrition support should be made with the following considerations:

• Will quality of life be improved?



• Do the possible benefits outweigh the risks and costs?



• Is there an advanced directive? An advanced directive is a written instruction about the provision of health care or power of attorney in the event an individual can no longer make his or her wishes known.



• What are the wishes and needs of the family?

Cancer patients and their caregivers have the right to make informed decisions. The healthcare team, with guidance from a registered dietitian, should inform patients and their caregivers about the benefits and risks of using nutrition support in advanced disease. In most cases, the risks outweigh the benefits. However, for someone who still has good quality of life but also physical barriers to achieving adequate food and water by mouth, enteral feedings may be appropriate. Parenteral support is not usually appropriate. Advantages and disadvantages of enteral nutrition include the following:

Benefits

• May improve alertness.
• May provide comfort to the family.
• May decrease nausea.
• May decrease hopelessness and fears of abandonment.

Risks

• May cause diarrhea or constipation.



• May increase nausea.



• Requires surgery for the placement of a tube through the abdomen.



• Increases risk of choking or pneumonia.



• Increases risk of infection.



• Creates a greater burden on the caregiver.

Some foods do not mix safely with certain drugs.

Cancer patients may be treated with a number of drugs throughout their care. Some foods or nutritional supplements do not mix safely with certain drugs. The combination of these foods and drugs may reduce or change the effectiveness of anticancer therapy or cause life-threatening side effects. The following table provides information on some of the drug-nutrient interactions that may occur with certain anticancer drugs:

Some herbs do not mix safely with certain drugs or foods.

The combination of some herbs with certain foods and drugs may reduce or change the effectiveness of anticancer therapy or cause life-threatening side effects. The following table provides information about herbs commonly taken by cancer patients. The information provided covers known interactions only; additional side effects are possible for these herbs. A pharmacist or updated herbal supplement references may provide more information.

The United States Department of Agriculture (USDA) developed Nutrition and Your Health: Dietary Guidelines for Americans ¹⁶ that offers diet and fitness recommendations that support good overall health. The USDA Food Guide Pyramid ¹⁷ shows five food groups and the number of servings to be eaten each day to provide the nutrients and calories needed. The food groups shown are grains, vegetables, fruits, dairy, and meat and nonmeat protein. Small amounts of fats, oils, and sweets are advised.

Current guidelines for promoting general health and well-being include the following:

• Eat nutrient-rich foods within calorie limits.



• Maintain a healthy body weight.



• Exercise regularly.



• Eat a variety of fruits, vegetables, whole grains, and low-fat dairy products each day.



• Eat less fat and avoid trans fatty acid (trans fats).



• Choose fiber -rich fruits, vegetables, and whole grains often.



• Eat fewer foods high in salt. Choose more foods high in potassium (like bananas, spinach and potatoes).



• Those who choose to drink alcoholic beverages should do so in moderation. Certain individuals should avoid alcohol entirely.



• Keep food safety in mind when preparing, storing, and serving foods.

Healthy food choices and physical activity may help reduce the risk of cancer. The American Cancer Society and the American Institute for Cancer Research have both developed cancer prevention guidelines that are similar.

The following diet and fitness guidelines may help reduce the risk of cancer:

• Eat a plant-based diet. Eat at least 5 servings of fruit and vegetables daily. Include beans in the diet and eat grain products (such as cereals, breads, and pasta) several times daily.



• Choose foods low in fat.



• Choose foods low in salt.



• Get to and stay at a healthy weight.



• Be at least moderately active for 30 minutes on most days of the week.



• Limit alcoholic drinks.



• Prepare and store food safely.



• Do not use tobacco in any form.

Nutrition guidelines for cancer prevention may also help cancer survivors prevent the development of a second cancer. The relationship between diet and cancer continues to be studied.

Study findings have shown the following associations between diet and lung cancer:

• Eating more than 5 servings per day of fruits and vegetables may reduce the risk of lung cancer.



• Taking beta-carotene supplements may increase the risk of lung cancer in male smokers.

Study findings have shown the following associations between diet and prostate cancer:

• Diets high in saturated fat and meat or animal fat may increase the risk of advanced prostate cancer.



• Taking daily vitamin E supplements may reduce the risk of death from prostate cancer.



• Taking daily beta-carotene supplements may reduce the chance of dying from prostate cancer. Taking beta-carotene supplements is not advised for smokers, however, as it may increase their risk of developing prostate cancer.

Study findings have shown the following associations between diet and breast cancer:

• High- calorie, high-fat diets may increase the risk of recurrence.



• Drinking beer may increase the risk of recurrence and death.



• Obesity (having too much body fat) may increase the risk of recurrence.



• Lack of physical activity may increase the risk of recurrence.



• Taking vitamin C above the RDA may reduce the risk of recurrence.



• A diet high in vegetables and fruits may reduce the risk of recurrence.



• A diet rich in foods that contain beta-carotene (such as dark orange vegetables and fruits) may reduce the risk of death from breast cancer.

The effect of soy on breast cancer or breast cancer recurrence is unknown. Studies are under way.

Study findings have shown that a long-term diet rich in whole grains may reduce the risk of colon cancer.

Study findings have shown the following associations between diet and esophageal or gastric (stomach) cancer:

• A diet rich in cereal fiber may reduce the risk of gastric cancer.



• Taking daily supplements of vitamins C and E and beta-carotene may reduce the risk of esophageal cancer.

Resources

Books

• American Cancer Society’s Healthy Eating Cookbook: a Celebration of Food, Friends, and Healthy Living. 3rd ed. Atlanta, GA: The American Cancer Society, 2005.



• Bloch A, Cassileth BR, Holmes MD, Thomson CA, eds.: Eating Well, Staying Well During and After Cancer. Atlanta, GA: American Cancer Society, 2004.



• Ghosh K, Carson L, and Cohen E: Betty Crocker’s Living With Cancer Cookbook: Easy Recipes and Tips Through Treatment and Beyond. New York, NY: Hungry Minds, 2002.



• Weihofen DL, Robbins J, Sullivan PA: Easy-to-Swallow, Easy-to-Chew Cookbook: over 150 Tasty and Nutritious Recipes for People Who Have Difficulty Swallowing. New York, NY: John Wiley & Sons, Inc., 2002.



• Wilson JR: I-Can’t-Chew Cookbook: Delicious Soft-Diet Recipes for People With Chewing, Swallowing, or Dry-Mouth Disorders. Alameda, Calif: Hunter House Inc., 2003.

• American Botanical Council

  800-373-7105

  www.herbalgram.org

• American Cancer Society

  800-ACS-2345

  www.cancer.org

• American Dietetic Association

  800-877-1600

  www.eatright.org

• American Institute for Cancer Research

  800-843-8114

  www.aicr.org

• American Society for Parenteral and Enteral Nutrition

  800-727-4567

  www.clinnutr.org

• National Cancer Institute

  www.cancer.gov

• National Center for Complementary and Alternative Medicine (NCCAM)

  888-644-6226 (clearing house)

  866-464-3615 (toll free TTY)

  www.nccam.nih.gov ¹⁸

• Office of Dietary Supplements

  301-435-2920

  http://ods.od.nih.gov

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Chat online

The NCI's LiveHelp® ¹⁹ online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write to us

For more information from the NCI, please write to this address:

NCI Public Inquiries Office

Suite 3036A

6116 Executive Boulevard, MSC8322

Bethesda, MD 20892-8322

Search the NCI Web site

The NCI Web site ⁴ provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator ²⁰. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (08/22/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

Questions or Comments About This Summary

If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form ²¹. We can respond only to email messages written in English.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ⁴. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ²². Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

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

Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

An enclosed collection of pus in tissues, organs, or confined spaces in the body. An abscess is a sign of infection and is usually swollen and inflamed.

Acquired immunodeficiency syndrome. A disease caused by the human immunodeficiency virus (HIV). People with AIDS are at an increased risk for developing certain cancers and for infections that usually occur only in individuals with a weak immune system. Also called acquired immunodeficiency syndrome.

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

A drug used to treat depression.

A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention.

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

A substance found in yellow and orange fruits and vegetables and in dark green, leafy vegetables. The body can make vitamin A from beta carotene. Beta carotene is being studied in the prevention of some types of cancer. It is a type of antioxidant.

A drug used to treat skin problems caused by cutaneous T-cell lymphoma that have not gotten better after other treatment. It is also being studied in the treatment of other types of cancer. Bexarotene is a type of retinoid. Also called LGD1069 and Targretin.

An eastern North American perennial herb. A substance obtained from the root of the plant has been used in some cultures to treat a number of medical problems. It is being studied in the treatment of hot flashes and other symptoms of menopause. The scientific name is Cimicifuga racemosa. Also called black snakeroot, rattlesnake root, bugwort, and bugbane.

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

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

A drug that helps prevent blood clots from forming. Also called an anticoagulant.

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

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

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

Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

Loss of body weight and muscle mass, and weakness that may occur in patients with cancer, AIDS, or other chronic diseases.

A mineral found in teeth, bones, and other body tissues.

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

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

CIS. The Cancer Information Service is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER (1-800-422-6237), or by using the LiveHelp instant-messaging service at https://cissecure.nci.nih.gov/livehelp/welcome.asp. Also called CIS.

A sugar molecule. Carbohydrates can be small and simple (for example, glucose) or they can be large and complex (for example, polysaccharides such as starch, chitin or cellulose).

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

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

A tube surgically placed into a blood vessel for the purpose of giving intravenous fluid and drugs. It also can be used to obtain blood samples. This device avoids the need for separate needle insertions for each infusion or blood test. Examples of these devices include Hickman catheters, which require clamps to make sure the valve is closed, and Groshong catheters, which have a valve that opens as fluid is withdrawn or infused and remains closed when not in use.

Treatment with drugs that kill cancer cells.

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

Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

In medicine, a medical problem that occurs during a disease, or after a procedure or treatment. The complication may be caused by the disease, procedure, or treatment or may be unrelated to them.

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

A member of the family of vegetables that includes kale, collard greens, broccoli, cauliflower, cabbage, Brussels sprouts, and turnips. These vegetables contain substances that may protect against cancer.

To heal or restore health; a treatment to restore health.

A condition caused by the loss of too much water from the body. Severe diarrhea or vomiting can cause dehydration.

A disease in which the body does not properly control the amount of sugar in the blood. As a result, the level of sugar in the blood is too high. This disease occurs when the body does not produce enough insulin or does not use it properly.

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

Frequent and watery bowel movements.

The things a person eats and drinks.

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

A health professional with special training in nutrition who can help with dietary choices. Also called a nutritionist.

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

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

A drug that prevents blood cell clumping and enhances the effectiveness of fluorouracil and other chemotherapeutic agents.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

A drug that increases the production of urine.

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

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

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

The injection of a liquid through the anus into the large bowel.

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

A protein that speeds up chemical reactions in the body.

Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

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

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

A type of hormone made by the body that helps develop and maintain female sex characteristics and the growth of long bones. Estrogens can also be made in the laboratory. They may be used as a type of birth control and to treat symptoms of menopause, menstrual disorders, osteoporosis, and other conditions.

ERT. Hormones (estrogen, progesterone, or both) given to postmenopausal women or to women who have had their ovaries surgically removed. Hormones are given to replace the estrogen no longer produced by the ovaries. Also called ERT.

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

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

An abnormal opening or passage between two organs or between an organ and the surface of the body. Fistulas may be caused by injury, infection, or inflammation, or may be created during surgery.

Liquid.

A drug used as a treatment for cancer. It is a type of antimetabolite. Also called 5-FU.

Cancer that forms in tissues lining the stomach. Also called stomach cancer.

The stomach and intestines. The gastrointestinal tract is part of the digestive system, which also includes the salivary glands, mouth, esophagus, liver, pancreas, gallbladder, and rectum.

Official nonbrand names by which medicines are known. Generic names usually refer to the chemical name of the drug.

An herb with a root that has been used in some cultures to treat certain medical problems. It may have anticancer effects.

An amino acid used in nutrition therapy. It is also being studied for the treatment of diarrhea caused by radiation therapy to the pelvis.

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

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

A sudden, temporary onset of body warmth, flushing, and sweating (often associated with menopause).

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

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

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

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

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

A hormone made by the islet cells of the pancreas. Insulin controls the amount of sugar in the blood by moving it into the cells, where it can be used by the body for energy.

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

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

One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.

A substance that promotes bowel movements.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

An oily or slippery substance.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

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

The time of life when a woman's menstrual periods stop. A woman is in menopause when she hasn't had a period for 12 months in a row. Also called change of life.

A drug used to treat some types of cancer, severe skin conditions such as psoriasis, and rheumatoid arthritis. Methotrexate stops cells from making DNA. It is a type of antimetabolite. Also called amethopterin and Rheumatrex.

A nutrient required to maintain health.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

NCCAM. A federal agency that uses science to explore complementary and alternative medicine (CAM) practices, trains CAM researchers, and provides authoritative information about CAM to professionals and the public. NCCAM awards grants for research projects, training, and career development in CAM; sponsors conferences, educational programs, and exhibits; studies ways to use proven CAM practices along with conventional medical practice; and supports adding CAM to medical, dental, and nursing school programs. NCCAM is part of the National Institutes of Health. Also called NCCAM.

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

A health professional trained to care for people who are ill or disabled.

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

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

Having an abnormally high, unhealthy amount of body fat.

By or having to do with the mouth.

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

A measure of weight (one-sixteenth pound) and volume (one-eighth cup).

Having to do with the ovaries, the female reproductive glands in which the ova (eggs) are formed. The ovaries are located in the pelvis, one on each side of the uterus.

A medicine that can be bought without a prescription (doctor's order). Examples include analgesics (pain relievers) such as aspirin and acetaminophen. Also called nonprescription and OTC.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, supportive care, and symptom management.

A glandular organ located in the abdomen. It makes pancreatic juices, which contain enzymes that aid in digestion, and it produces several hormones, including insulin. The pancreas is surrounded by the stomach, intestines, and other organs.

A disease in which malignant (cancer) cells are found in the tissues of the pancreas. Also called exocrine cancer.

A protein secreted by the pancreas that aids in the digestion of food.

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

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

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

An exam of the body to check for general signs of disease.

Medical doctor.

A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called a thrombocyte.

A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may cause a decrease in the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia is usually caused by infection but may also be caused by radiation therapy, allergy, or irritation of lung tissue by inhaled substances. It may involve part or all of the lungs.

A metallic element that is important in body functions such as regulation of blood pressure and of water content in cells, transmission of nerve impulses, digestion, muscle contraction, and heartbeat.

Used to prevent disease.

A drug that is used to treat cancer. It belongs to the family of drugs called alkylating agents.

The likely outcome or course of a disease; the chance of recovery or recurrence.

In medicine, the course of a disease, such as cancer, as it becomes worse or spreads in the body.

A gland in the male reproductive system. The prostate surrounds the part of the urethra (the tube that empties the bladder) just below the bladder, and produces a fluid that forms part of the semen.

Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men.

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

A specialist who can talk with patients and their families about emotional and personal matters, and can help them make decisions.

A device that is used to give a controlled amount of a liquid at a specific rate. For example, pumps are used to give drugs (such as chemotherapy or pain medicine) or nutrients.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

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

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

Giving off radiation.

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

The last several inches of the large intestine. The rectum ends at the anus.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrent cancer.

RBC. A cell that carries oxygen to all parts of the body. Also called RBC and erythrocyte.

A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.

In medicine, an improvement related to treatment.

A drug used to treat some types of cancer, severe skin conditions such as psoriasis, and rheumatoid arthritis. Rheumatrex stops cells from making DNA. It is a type of antimetabolite. Also called methotrexate and amethopterin.

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

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

Refers to a new primary cancer in a person with a history of cancer.

A hormone found in the brain, platelets, digestive tract, and pineal gland. It acts both as a neurotransmitter (a substance that nerves use to send messages to one another) and a vasoconstrictor (a substance that causes blood vessels to narrow). A lack of serotonin in the brain is thought to be a cause of depression. Also called 5-hydroxytryptamine.

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

The part of the digestive tract that is located between the stomach and the large intestine.

A professional trained to talk with people and their families about emotional or physical needs, and to find them support services.

A diet consisting of bland foods that are softened by cooking, mashing, pureeing, or blending.

Glycine max. A plant of Asian origin that produces beans used in many food products. Soy products contain isoflavones (estrogen-like substances) that are being studied for the prevention of cancer, hot flashes that occur with menopause, and osteoporosis (loss of bone density). Soy products in the diet may lower cholesterol levels and reduce the risk of heart disease. Also called soya, soybean, and Glycine max.

An herbal product sold as an over-the-counter treatment for depression. It is being studied for its ability to lessen certain side effects of cancer treatment. Also called Hypericum perforatum.

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

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

A surgically created opening from an area inside the body to the outside.

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

The material in a bowel movement. Stool is made up of food that was not digested, bacteria, mucus, and cells from the intestines. Also called feces.

Adding nutrients to the diet.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called palliative care, comfort care, and symptom management.

A doctor who removes or repairs a part of the body by operating on the patient.

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

One who remains alive and continues to function after overcoming difficulties or life-threatening diseases like cancer.

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

A set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.

A drug used to treat certain types of breast cancer in women and men. It is also used to prevent breast cancer in women who have had ductal carcinoma in situ (abnormal cells in the ducts of the breast) and are at a high risk of developing breast cancer. Tamoxifen is also being studied in the treatment of other types of cancer. It blocks the effects of the hormone estrogen in the breast. Tamoxifen is a type of antiestrogen. Also called tamoxifen citrate and Nolvadex.

A drug that is used to treat certain types of brain tumors in adults and is being studied in the treatment of other types of cancer. It belongs to the family of drugs called alkylating agents. Also called Temodar.

Treatment.

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

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

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

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a baby grows. Also called the womb.

A key nutrient that the body needs in small amounts to grow and stay strong. Examples are vitamins A, C, and E.

A nutrient that helps the body use calcium and phosphorus and make strong bones and teeth. It is found in fatty fish, eggs, and dairy products. The skin can also make vitamin D when exposed to sunshine. Not getting enough vitamin D can cause a bone disease called rickets. Vitamin D is being studied in the prevention and treatment of some types of cancer. Also called cholecalciferol.

A substance used in cancer prevention. It belongs to the family of drugs called tocopherols.

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

A drug that prevents blood from clotting. It belongs to the family of drugs called anticoagulants (blood thinners).

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

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

A substance required for cell growth and tissue repair. It is being studied as a way to prevent or decrease mucositis caused by radiation therapy.