Nutrition for Neuroendocrine Tumours

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Nutrition for Neuroendocrine Tumours

• Caley Schnaid R.D.
• NET Specialist Dietitian
• Royal Free Hospital

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INTRODUCTION

• Different types of neuroendocrine tumours (NETs)
• Problems differ depending on type of tumour
  treatment
• Little published evidence available for diet in
  NETs
• Recent review of literature and current practice
  dietitian and NET CNS

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CANCER DIETS

• Difference between good, evidence-based
  information and a miracle cure
• General cancer advice Cancer Backup, Macmillan
• NET patients have specific issues

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• If you have a good appetite and your weight is
  stable, dont change your diet
• BUT
• If you are losing weight, please seek advice!

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HEALTHY EATING

• Balanced diet food from each food group
• Dont exclude foods/food groups unless advised by
  your doctor or dietitian

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WEIGHT LOSS

• Possible causes
• Diarrhoea
• Sub-acute bowel obstruction
• Feeling full
• Search for underlying cause before addressing
  nutritional issues!

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DIARRHOEA

• Causes
• Malabsorption
• Surgery
• Medication
• Bacterial Overgrowth
• Infection
• Hormones released by NETs

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Malabsorption

• Due to surgery, medication, pancreas not working
  properly
• Steatorrhoea fat malabsorption
• Stools light colour, smell foul, float in
  toilet, difficult to flush
• Loss of energy ? weight loss
• Reduced absorption of fat-soluble vitamins,
  essential fatty acids

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Malabsorption

• Medication
• Slows bowel movement
• Help absorption of bile salts
• Pancreatic enzymes to correct fat malabsorption
• Nutrition
• Low fat diet initially, increase gradually
• Nutritional Supplements
• Parenteral (IV) nutrition if severe

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Surgery

• Location of surgery, amount of bowel removed ?
  diarrhoea
• Malabsorption
• Low fibre diet after ? increase gradually as
  bowel adapts

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Medication

• Antibiotics
• Rehydration
• Change type of antibiotic
• Somatostatin analogues
• Block pancreas from producing enzymes that help
  digest food
• Pancreatic enzymes

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Infection

• Sudden onset fever
• Recent travel
• Stool specimen
• Antibiotics
• Rehydration ? fluid and electrolytes

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Bacterial Overgrowth

• Increased bacteria in small bowel ? imbalance of
  normal bacteria in bowel
• Hydrogen breath test
• Antibiotics
• Probiotics?

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Hormones

• Released by NET
• Increased peristalsis
• Increased secretions
• Treat with Somatostatin analogues

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SUB-ACUTE BOWEL OBSTRUCTION

• Caused by
• Slow-moving bowel
• Blockage of the bowel
• Desmoplastic reaction
• Leads to weight loss and malnutrition

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SUB-ACUTE BOWEL OBSTRUCTION
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SUB-ACUTE BOWEL OBSTRUCTION

• May need surgical intervention
• Nil by mouth, IV fluids, parenteral (IV)
  nutrition
• Gradually build up diet
• fluids ? puree ? solids
• Frequent occurrence low fibre diet, soft foods

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EARLY SATIETY(Feeling Full)

• Reduced ability to accommodate food in the
  stomach
• Due to surgery, tumour bulk, ascites
• Small meals, frequent snacks
• High protein, high energy foods
• Avoid drinking with meals
• May require nutritional supplements

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BUILDING UP DIET

• For people who
• have poor appetite
• are unable to eat large amounts at once
• are losing weight
• Choose energy-dense food, foods high in protein
• Nutritional supplements if unable to meet
  nutritional requirements with food alone
• Referral to dietitian for assessment and advice

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Pancreatic Enzyme Replacement Therapy

• Doses timing very important
• Take WITH meals
• Adjust dose to amount of fat in meal
• Education!

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CURRENT PRACTICE

• Food symptom diary - trial error with
  dietetic monitoring
• Team decisions doctor, dietitian, nurse
• Diet booklet NET Patient Foundation

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PLANS FOR THE FUTURE

• More research!
• Professional advice appropriate and standardised