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By Karen Alexander, Oncology Wellness Specialist


What to eat during radiation treatment for esophageal cancer

Esophageal cancer is the eighth most common cancer in the world, and is seen more in men than in women. The American Cancer Society estimates there will be about 17,290 new esophageal cancer diagnoses this year.

Esophageal cancer is one of the most common types of head and neck cancers, and it usually starts when there is an abnormal growth of cells in the esophagus. There are two types of cells that line the esophagus, so cancer in this part of the body can be either squamous cell carcinoma (SCC) or adenocarcinoma (AC). AC is usually found at the bottom of the esophagus near the stomach, while SCC is usually found in the middle or top part of the esophagus.

Symptoms include difficult or painful swallowing, weight loss, pain behind the breastbone, hoarseness and cough, indigestion, and heartburn. Unfortunately, these symptoms may appear when cancer is in advanced stages. When diagnosed with esophageal cancer, preventing malnutrition is key. Malnutrition is significantly linked with an increased risk of treatment toxicity and complications after surgery.

Risk factors for esophageal cancer:

  • Being over 55 years old
  • Gastroesophageal reflux disease (GERD)
  • Barrett’s esophagus
  • Tobacco use
  • Excessive alcohol intake
  • Achalasia
  • HPV infection

Treatment for esophageal cancer depends on the tumor size, location, and cancer stage. Some patients undergo an esophagectomy where they remove some or most of the esophagus, followed by chemotherapy or chemoradiation. Others may receive chemotherapy and radiation before an esophagectomy. Proton beam therapy is an advanced form of radiation that can reduce side effects and improve quality of life for many patients with oral, head and neck cancers. 

It is essential to meet your nutritional needs and avoid malnutrition as you prepare to begin treatment or undergo surgery. Maintaining your weight during radiation helps deliver treatment in the same place effectively. Some side effects that you may experience include fatigue, taste changes, dry mouth, difficult or painful swallowing, and inflammation of the mucous membranes lining the mouth and the esophagus. These symptoms may occur after a week of radiotherapy and could continue until about 2 – 3 weeks after treatment ends. It’s important to prevent esophageal irritation by limiting acidic, citric and spicy foods and beverages.

Below are some dietetic recommendations that may help you manage radiation side effects:

  • To sooth painful swallowing, eat soft, bland, moist, lukewarm or cool foods.
  • Avoid spicy, tart, acidic, salty, and coarse foods that can burn or scrape your esophagus.
  • Choose foods that are easy to chew and swallow such as creamy soups, oatmeal, ricotta or cottage cheese, apple sauce, yogurt, smoothies and pastas with creamy sauces (without tomato) such as Alfredo pasta or Mac & Cheese.
  • Cook foods until they are soft or tender so they are easier to swallow. You can use a pressure cooker or a slow cooker to make your food super tender and keep it moist.
  • Take small bites that are easy to chew.
  • Puree your favorite food in a blender or food processor to make it easier to swallow by adding low sodium broths (chicken or vegetable) or milk.
  • Serve foods at room temperature or lukewarm, rather than hot since it will cause irritation. Some people can tolerate cold foods or liquids better. This depends on your personal preference.
  • Avoid alcohol and tobacco.
  • Avoid mouthwashes that contain alcohol.
  • Look for foods and beverages that are high in calories and proteins in order to maintain your calorie intake, weight, and lean body mass, and to keep your energy level up. Oral nutrition supplements (such as Kate Farms®, Orgain ®, Ensure ®, Boost ®, Core Power ®) or healthy smoothies are a good option.

How to Prepare a Healthy Homemade Smoothie in Five Steps:

  1. Choose a milk: Whole milk, soy milk, coconut milk, evaporated milk, half & half, etc.
  2. Choose a protein: Whey protein powder, plant-based protein powder, Greek yogurt, or any oral nutrition supplements.
  3. Choose a fat: Sunflower oil, MCT oil, creamy peanut butter or almond butter, whole milk ice cream, etc.
  4. Choose a fruit: Fresh or canned (avoid acidic fruits). Canned or jar peaches and pears are usually well tolerated. You can also add spinach, kale or other veggies.
  5. Add flavor or extra calories: Pumpkin puree, honey or vanilla essence, baby cereal oatmeal, or any other ingredient you would like based on your tolerance.


Karen Alexander, BSND, MSCN

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