[Specialized nutrition support for the patients with advanced or recurrent carcinoma of the gastrointestinal tract]

Various nutritional disorders can occur in patients with advanced or recurrent carcinoma of the gastrointestinal tract due to the disease itself or the absence of the organs after surgery. Routine parenteral nutrition for cancer patients who undergo chemotherapy results in no benefit and troublesome complications such as catheter sepsis. Consequently, it is important to provide sufficient and proper specialized nutritional support to patients who need it, taking into account the pathologic status resulting from malignant disease. Patients with advanced or recurrent carcinoma of the gastrointestinal tract are likely to be deficient in folate and/or vitamin B12 for various reasons. Neurological disorders in vitamin B12 deficiency should worsen when folate is administered without supplementation of vitamin B12. This phenomenon should be avoided when 5-fluorouracil is used with reduced folate in cancer chemotherapy. The indications for specialized nutritional support for patients with advanced or recurrent carcinoma of the gastrointestinal tract are the same as for malnourished patients without cancer. The initial dose and formula of nutrition for cancer patients with malnutrition and various metabolic disorders should be calculated to avoid overloading. The oral intake of normal food is desirable for such patients. The placement of a central venous catheter to prevent the toxicity of chemotherapy or for venous access is contraindicated. Jejunal feeding or percutaneous endoscopic gastrostomy is performed in patients who cannot eat even a liquid diet. Total parenteral nutrition should be introduced when these accesses cannot be used. If any bowel obstruction occurs in the small intestine and/or colon, it is necessary to discuss the efficacy of surgery to resolve the obstruction.