Cancer of the Uterus - Dietetics

	Dietetics and Cancer of the Uterus
	What Should be Done During Treatment?
	Further Information

Dietetics and Cancer of the Uterus

Nutrition is an important component of any cancer care. Maintaining a well balanced diet that contains adequate nutrients will enhance the ability to maintain a strong immune system, maintain body weight, improve response to treatment, and aid recovery.

There is no specific diet or nutrition therapy that will prevent or cure gynaecological cancer. However, there are general recommendations for healthy eating that apply to gynaecological cancer patients and the general population. In addition, if you are having treatment there are some 'tips' that may help reduce the nausea and taste changes associated with treatment. These are outlined in the next section.

Fad diets and megavitamin regimes are not recommended during the treatment of cancer. Many diets and dietary supplements are promoted as preventing or curing cancer, but most lack the essential nutrients necessary to maintain good health. For people who have cancer, there is the added problem that these diets may be so restrictive that they lead to excessive weight loss. This in turn reduces the patient's overall well being, and interferes with treatment and recovery.

Excessive use of individual vitamins, foods or supplements is a dangerous practice, which can interfere with normal body function and have harmful effects. There is one form of food supplement, however, that can be used in conjunction with a healthy diet, or alone if food cannot be tolerated (as is sometimes the case with treatment). These are called "complete nutritional liquids or powders" and contain all the nutrients required for good health. Some examples of these are Sustagen, Ensure and Resource. A detailed description is given later, but consult a dietician or doctor if you are interested in using these products.

What Should Be Done During Treatment?

As discussed above, it is far better to have a well balanced healthy diet than to follow fad diets or take lots of vitamin supplements. A healthy diet is one that includes a wide variety of foods from the basic food groups. These include bread and cereal products, fruits and vegetables, meat or meat alternatives (such as beans, legumes, eggs, nuts etc), and dairy foods. Small amounts of added fat may be included in the diet, but should preferably be poly- or mono- unsaturated (eg oils such as olive, canola etc, or margarines).

Eating bread and cereal products that are wholemeal or mixed grain as well as fruits and vegetables that have the skins left on will increase the fibre content, and benefit the patient.

Phytochemicals

There is one group of chemicals in food that may have an important role to play in protection against some cancers. These are the phytochemicals. Even once cancer has developed they may be useful to include in an overall healthy diet. Phytochemicals are found in a wide variety of plant foods such as fruit, vegetables, legumes, grains and nuts, so be sure to include these in your diet.

Nutritional Supplements

Nutritional supplements, as discussed before, can be useful, particularly if you are losing weight or are not able to eat much. These supplements are developed by pharmaceutical companies, and contain all the nutrients needed for good health, along with the calories needed for maintaining weight and energy.

Dangerous Fad Diets

Dairy and Wheat Foods

As discussed earlier, it is important not to follow fad diets. Sometimes people with cancer will be told to cut dairy foods and wheat foods out of their diets. This can cause a reduction in the total calorie intake, as well as a reduction in the variety (and therefore nutrient content) of the diet. Dairy and wheat foods make up two of the five food groups, and are essential for good health due to the nutrients and calories they provide. Dairy foods are rich in protein, calcium, B group vitamins, some minerals and of course, calories. Wheat foods include bread, cereals, pasta, biscuits, etc, and are a good source of fibre, calories, B group vitamins, iron, and other vitamins and minerals. By cutting these foods out of the diet, a large number of essential nutrients are reduced, which can be detrimental to a patient's health.

Meat

Sometimes people are also told to cut out meat. Again, this is not necessary. Meat is the most important source of iron in the diet, as well as an important source of protein, calories, selenium and zinc. These all help to repair the body and maintain a healthy immune system. Iron is needed for healthy red blood cells. If you choose not to eat meat, then be sure to substitute with beans (such as kidney beans, baked beans, soy beans etc), legumes, nuts, and eggs. Vitamin C foods such as citrus fruits, tomatoes etc can help the absorption of iron from food. Having things like fruit juice with cereal, or tomato with meat, are good examples of how to achieve this.

Some Tips.

Eating well and maintaining a good nutritional status will help you to cope both physically and mentally with cancer and the side effects of various treatments. Here are some tips to help you to cope should any of the following occur as a result of your cancer or the treatments for it.

Nausea And Vomiting

	Try small frequent snacks rather than three main meals
	Cold dishes, eg sandwiches may be better tolerated than hot dishes.
	Avoid foods that are too sweet, fatty or spicy
	Try to drink plenty of fluids. Clear cool beverages such as jelly, soft drinks, dry ginger ale, cola drinks, Lucozade, ice cubes or water based ice blocks are best. Jelly and consomm�-type soups are also well tolerated
	Make use of nutritious convenience foods to avoid being nauseated by exposure to food during preparation, eg sandwiches, yoghurts, custards, ice cream, apple sauce, cheese and cottage cheese, pre-packaged fish, canned soups.
	If main meals are not tolerated try soup with dry toast or biscuits, rice/pasta, and desserts.

Suggestions If Vomiting Is Persistent

See your doctor

Start with clear fluids:

	Broth or Beef Tea
	Dry Ginger Ale or Coca Cola drinks
	Water of jelly

When clear fluids are tolerated - introduce other beverages:

	Half and half mixture of trim milk with soda water
	Diluted fruit juices
	Weak tea and sugar and lemon

When fluids are managed, small amounts of solids can be introduced Try:

	plain dry biscuits
	Thin crisp toast with vegemite or jam
	Boiled rice or lemon sago
	Soft stewed fruit
	Junket/yoghurt

Slowly reintroduce small, regular meals aiming for 6 meals per day

Diarrhoea

	Diarrhoea may be the result of treatment or due to other reasons, therefore it is first best to consult your doctor
	For diarrhoea associated with treatment, a low residue and or a low lactose diet may be required
	Eating smaller, more regular meals can be better tolerated
	Avoiding foods that may cause gas and cramps helps - beer, carbonated beverages, baked beans, cabbage, spicy or highly seasoned foods.
	Decrease fatty foods, i.e. deep fried foods, fatty meats, pastries, etc
	Replace fluids, sodium and potassium lost by including beverages that are high in these minerals, eg buillon stock and fruit juices and vegetable juices.
	Caffeine and alcohol can aggravate diarrhoea. Omit until the problem clears
	Pectin, a thickening agent, found in apple sauce, has been effective in some cases.

Loss Of Appetite

Aim to achieve your nutritional needs with small, frequent meals 6-8 per day

Make the most of times when your appetite is better, eg breakfast may be the meal when most food is tolerated.

Try to include calorie / nutrient dense foods when meals are taken

If it is difficult to eat solid foods, try high protein supplements in between meals, eg Sustagen or Ensure Plus

Add variety to the diet - both in flavour and presentation. For example, if savoury fluids are desired, try tomato/vegetable juices, broths and soups. Attractive presentations can be achieved using colours and garnishes.

Try to increase the nutritional value of meals by taking more nutritious beverages, for example fruit juices or milk rather than tea/coffee.

Aim to follow a well-balanced diet as much as possible in order to achieve enough of all nutrients required by the body.
Some suggestions are:

	Pumpkin/vegetable and broth based soup
	Cream of Chicken Soup
	Yoghurts; ice cream; custard; mousses; milk jellies; sorbets
	Souffl�, Quiche, Scrambled egg
	Liver pate and cold pasta salad
	Frozen mango / tropical fruit / berry iceblocks
	Fresh pureed fruit drinks, for example banana, apple juice, melons, custard apples
	Canned peaches in syrup and cottage cheese.
	Salmon with cheese sauce or pureed fruit sauce, OR Steamed fish in cream and dill/parsley sauce
	Soft meat, eg veal and chicken minced with cream/mildly seasoned sauce.

Ulceration Or Soreness Of The Mouth

As in mucositis, chelosis, glossitis, stomasatitis, esophagitis.

	Altering the consistency of foods taken can help facilitate a better intake. This can range from a soft diet, very soft diet, pureed meals or thickened fluids.
	The use of a blender or a Mouli can help obtain the consistency required
	Avoid foods that may irritate (Citrus juices, crisp or raw foods, soft bread products, granular textured foods, salty or spicy foods.
	Soft, easy to swallow foods include Broth based soups, fruit based drinks (Mango nectar, soft drinks, frozen grapes, melons, eggs, pasta dishes, quiches, canned fruits, ice creams, yoghurts and jellies
	Try foods cold or at room temperature (Ice blocks and ice cream)
	A straw may help with swallowing
	High energy/protein drinks may help to supplement your intake

Loss Or Alteration Of Taste

An increased use of flavourings and seasonings in food preparation can help.

Eg: seasonings and spices may be used to disguise altered tastes. If a decreased sensitivity to sweet taste exists, enjo9yment of food my be enhanced by the addition of sugar or honey

Meat aversion sometimes occurs. Try to use alternative sources of protein in its place, (egg, cheese, Soya or baked beans and fish)

Strongly flavoured boiled lollies, lemon or lime juice added to a beverage may help to freshen the mouth

Highly flavoured snacks such as olives, gherkins may well be accepted

A preference for cold foods may also include foods such as cold fluids, berry flavoured ices, gelatines, watermelons, grapes and peeled cucumbers, cold meat platters, ice cream and salted nuts. Cold foods such as sandwiches, fruit or salad plates may be preferred.

Further Information

Text books such as:

Manual of Dietetic Practice (author: Briony Thomas)
Human Nutrition and Dietetics (author; J. Garrow and W. James)

General nutrition books such as:

	Food Secrets (author: Australian Nutrition Foundation)
	Nutrition for Life (author: Catherine Saxelby)
	Complete Book of Food and Nutrition (author: Rosemary Stanton)
	Food and Nutrition in Australia (author; Mark Wahlqvist)