Gastrointestinal Cancer and Nutrition
Cancer of Gastrointestinal tract involves oesophagus, stomach, intestine and colon till rectum, which predominantly affect absorption of food, thus causing compromise in function of digestive function.
This leads to inadequate food consumption or malabsorption, which coupled with the adverse consequences of anti-cancer therapies, does physical and metabolic damage to the system and also is the prime cause for malnutrition. In addition to these challenges, the cancer negatively affects patient prognosis, and thus requiring a therapeutic approach to be initiated early through thorough assessment and specific nutritional guidance.
The initial need of nutritional therapy is to correct or prevent nutritional deficiencies, improve the immune system to thwart further infections, and maintain/improve quality of life. The ultimate goals are to improve response and tolerance to treatment, increase survival, reduce complications of malnutrition, and promote an early hospital discharge.
Effective forms of nutritional therapy include hyperproteic and hypercaloric oral supplements together with standard oral diet to achieve the nutritional requirements. When administered to malnourished patients it improves the immunologic and anti-inflammatory biomarkers, nutritional status, and increases fat free mass.
Parenteral nutrition is indicated if enteral nutrition is not feasible, contraindicated, or inadequate to meet the patient’s nutritional needs. Additionally, in those undergoing elective gastrointestinal surgery, peri-operative nutritional intervention can favourably modify the post-operative clinical outcome. The major indications of peri-operative specialized nutrition support are to prevent or reverse malnutrition before the surgical procedure and to minimize the effects of prolonged period of fasting in the peri-operative period which would have resulted in severe catabolism and intense inflammatory activity.
Importantly, strengthening the patient’s immune defences is a useful approach to help to reduce complications. Preoperative immuno-nutrition is associated with an improvement in the immune and anti-inflammatory response, nutritional status and in the reduction of postoperative complications in malnourished patients. In advanced incurable cancer, the objectives of nutritional intervention are aimed at promoting the quality of life.