Acta Oncologica (2002) reports that the survival and the outcome for gastrointestinal cancer are poor, but with the introduction of several new therapies, there seem to be positive results in the future. Multimodal therapy aimed at overall management of the patient could prove to be of greater use in cancer therapy. Acta Oncologica reported several trials were showing greater effectiveness of radiotherapy and chemotherapy in treating gastric cancers compared to pancreatic cancers. Surgery was not of much effect in case of gastric cancer.
In gastric cancer, as the tumor bed, margins and the regional lymph nodes were more often defined through various studies, the extent radiation delivered could be determined. On the other hand in patients affected with pancreatic cancer, the tumor bed and the margins could be determined. The regional lymph nodes are invariable involved in pancreatic cancers, and there are also greater chances for distance metastasis (Giarelli, 2006). As the chances of treating the patient seem to be better in GI cancer than pancreatic cancer, several procedures are indicated.
Frequently there are a lot factors associated with malnutrition including poor food intake, increased metabolism, greater malabsorption, surgical procedures, use of chemotherapy and radiotherapy, hospitalization, etc, which can occur in the cancer patients. About 50 % of the patients hospitalized and about 40 % are malnourished on admission and 78 % for staying in the hospital for more than a week. The outcome for surgery and many other procedures performed on the GI system would be compromised in case the patients are suffering from malnutrition.
Following surgeries, several morbidities such as intra-abdominal sepsis, fistula, wound infection, renal problems, cardiac problems, etc, are common and malnutrition can also result in several problems such as an increased length of stay, re-operations, re-admissions, mortalities, etc. Hence, treatment of malnutrition at the peri-operative period is very important. It is vital to determine the nutritional issues related to the cancer patient and accordingly develop a nutritional plan.
To develop a nutritional plan requires using several nutritional assessments (which includes a comprehensive assessment carried out by the nurse or the nutritionist). Several aspects need to be taken into consideration including the past history, dietary history, biochemical parameters, etc. Ideally, the nutritional plan should be chalked out during the early stages of admission of the patient (Aydin, 2005). Observations made through several nutritional studies in the past need to be taken into consideration whilst planning for a patient suffering from GI cancer.
Some of the nutritional studies involved changing the substrate and nutrients that are present in either enteral or parenteral nutrition. These included using n-3 PUFA instead of n-6 PUFA, medium chain triglycerides, omega-3 fatty acids, and glutamine. Studies have shown that with certain substances in the diet such as omega-3 fatty acids and arginine there was a greater amount of omega 3 fatty acids compared to omega-6 fatty acids and also a decrease in inflammatory provokers such as prostaglandins (Agnelo, 2006).
In most of the patients, provision of nutritional support through methods such as enteral nutrition and total parenteral nutrition (TPN) may not be required and does not have potential benefits. It is only in a small group of patients that such forms of nutrition be actually required and provides benefits. Some of these conditions include prolonged gastrointestinal toxicity that can cause reduction in oral intake, severe malnutrition or following major surgeries. In such cases TPN or enteral nutrition is required as a mode of therapy in cancer patients (D’Agnelo, 2000).