Liver Cancer Nutrition Guidelines

When you are faced with a cancer diagnosis, nutrition can be an important part of your journey. Eating a well-balanced diet before, during, and after cancer treatment can help you feel better, maintain your strength, and speed your recovery.

  • Maintain a healthy weight. Aim to avoid losing or gaining much weight during treatment.

Strict dieting is not recommended during cancer treatment. Losing weight can lower your energy level and decrease your body’s ability to fight infection.

  • Eat small, frequent meals throughout the day. Eating frequent small meals will ensure your body is getting enough calories, protein, and nutrients to tolerate treatment. Smaller meals may also help to reduce treatment-related side effects such as nausea. Try eating 5- 6 small meals or “mini” meals about every three hours.
  • Choose protein-rich foods. Protein helps the body to repair cells and tissues.  It also helps your immune system recover from illness. Include a source of lean protein at all meals and snacks.  Good sources of lean protein include:
    • Lean meats such as chicken, fish, or turkey
    • Eggs
    • Low fat dairy products such as milk, yogurt, and cheese or dairy substitutes
    • Nuts and nut butters
    • Beans
    • Soy foods
  • Include whole grain foods. Whole grain foods provide a good source of carbohydrate and fiber, which help keep your energy levels up. Good sources of whole grain foods include:
    • Oatmeal
    • Whole wheat breads
    • Brown rice
    • Whole grain pastas
  • Eat a variety of fruits and vegetables every day. Fruits and vegetables offer the body antioxidants, which can help fight against cancer. Choose a variety of colorful fruits and vegetables to get the greatest benefit.  Aim to eat a minimum of 5 servings of whole fruits and vegetables daily. Fresh fruits and veggies may need to be cooked for patients with a weakened immune system.
  • Choose sources of healthy fat. Avoid fried, greasy, and fatty foods, Choose baked, broiled, or grilled foods instead. Healthy fats include:
    • Olive oil
    • Avocados
    • Nuts
    • Seeds
  • Limit sweets and added sugars. Foods high in added sugars like desserts and sweets provide little nutritional benefit and often take the place of other foods that are better for you.
  • Stay hydrated. Drinking enough fluids during cancer treatment is important for preventing dehydration. Aim to drink 64 ounces of fluid daily. Avoid drinking large amounts of caffeinated beverages. Too much caffeine can lead to dehydration.
  • Practice good food safety. Wash your hands often while preparing food. Use different knives and cutting boards for raw meat and raw vegetables. Be sure to cook all foods to their proper temperature and refrigerate leftovers right away.
  • Talk to your healthcare team before taking any vitamins or supplements.  Some medications and cancer treatments may interact with vitamins and supplements.  Choose food first as the main source for nutrients.
  • Drink alcohol in moderation, if at all.  Alcohol may contribute to dehydration, can lower the abilities of your immune system, and provides no beneficial nutrients.
  • Most importantly, know that your cancer journey is unique to you and your treatment. You may experience side effects that affect your ability to follow these suggestions. If you are struggling with any side effects, such as loss of appetite, nausea, diarrhea, vomiting, or any other nutrition concerns, your needs may be different.  A registered dietitian can suggest nutrition guidelines that will be appropriate for your cancer journey.

The outcomes of your surgery are directly related to your nutrition status prior to and after surgery. It is very important to eat a well-balanced diet prior to surgery including fruits, vegetables, whole grains, and an adequate amount of protein. Vitamins, minerals, and protein are vital to the healing process. A single nutrient deficiency can impair the immune system causing significant delays in the healing process and a decrease in ability for the body to fight an infection. Follow these guidelines beginning at least three weeks prior to surgery or as long as possible prior to surgery to optimize your nutrition for a faster recovery:

Eat 3-5 servings of fruits and vegetables every day.  Choose a wide variety of colors.

One serving of fruit is one piece of fruit (such as a medium orange or apple) or ½ cup of canned or frozen fruit. One serving of vegetables is ½ cup cooked or 1 cup raw.  Fruits and vegetables are excellent sources of B vitamins as well as antioxidants (vitamins A, C, and E). The vitamins in fruits and vegetables support the body’s immune system before, during, and after surgery. Frozen vegetables and fruit are good to have available when shopping frequently is not possible.

Eat 6-11 servings of whole grain foods every day.

One serving is considered one slice of 100% whole wheat bread, ½ cup cooked brown rice, ½ cup whole wheat pasta, or ½ cup of whole grain cereal. Whole grains also contain B vitamins essential to building the immune system and aids the healing process.

Eat a variety of protein containing foods at meals and snacks.

Protein contains essential amino acids that are vital to the healing process. The body’s protein status prior to surgery also influences the recovery time. Good sources of protein include meat, fish, eggs, cheese, beans, nuts, tofu, and dairy products.

Use fats, oils, and sweets sparingly.

Choose healthier fats such as canola and olive oil. Avoid fried foods. Excess fat and sugar contain empty calories that do not provide the body with any nutrients. Too many empty calories and not enough nutritious food may have an effect on the immune system.

Drink plenty of water in the 3 weeks prior to surgery.

Staying well hydrated will help in the recovery process. It will also help during the period of time right before surgery that water is not allowed. A general goal for daily water consumption is eight to ten 8-ounce glasses per day.

Establish consistent eating habits.

Eat a good breakfast everyday including a good source of protein like eggs, peanut butter, or Greek style yogurt. Lunch should include a protein source, whole grains, vegetables, and fruit. The evening meal should be similar to lunch. Remember to include healthy snacks like fruit, trail mix, hummus and carrot sticks or whole grain crackers with cheese or peanut butter.

Goes grocery shopping the week before surgery.

If you are not able to go to the grocery store yourself, send someone with a list to shop for you. Shopping for healthy foods right before surgery will allow you to keep up your healthy eating plan after surgery during the recovery period. Focus more on shelf-stable items, and buy fewer perishable items. Shelf-stable items such as peanut butter, canned fruit in its own juice, and low-sodium canned soups are good to have available when you return home from the hospital.

Get some exercise.

Walking is not only good for the body it is also good for the brain. Exercise may help in “clearing your head” when you begin to get anxious. It will also help you to maintain lean body mass (muscle). Muscle loss may occur after surgery due to physical inactivity. It is important to try to get back to doing some exercise as soon as possible after recovering. Your surgeon can advise you as to when it is safe for you to resume or begin exercising.

Tell your doctor about any vitamins, minerals, herbs, or other over-the-counter products and medications you take.

Some of these may be harmful during surgery and it is best to stop taking them prior to surgery. Examples of herbal supplements to discontinue as soon as your surgery is scheduled are: echinacea, ephedra, garlic, ginger, ginkgo biloba, ginseng, kava, licorice, saw palmetto, St. John’s wort, and valerian root.

Follow the pre-surgery instructions given by your doctor.

The pre-surgery instructions given by your doctor are meant to help minimize complications before and after surgery. Follow these instructions carefully. Most likely there will be some restrictions on food and beverage intake as the surgery date approaches.

Talk to a registered dietitian if you have lost weight or have any eating problems that are keeping you from eating healthy.

A registered dietitian will assess you and make recommendations for you to optimize your nutrition prior to surgery.  Sometimes a liquid nutrition supplement may be beneficial.

The pancreas is an essential gland in the body that secretes insulin. It is located near the stomach, small intestine, gallbladder, and the duodenum. The pancreas plays a large role in the digestion of foods. In particular, the insulin that is secreted by the pancreas aids in the digestion of carbohydrates. The pancreas also secretes enzymes that help in the digestion of protein, carbohydrates, and fats. Pancreatic cancer may be treated with surgery, chemotherapy, radiation therapy, or a combination. The most common surgical procedure performed to remove cancer from the pancreas is called a Whipple procedure. A Whipple procedure involves the removal of the head of the pancreas, duodenum, gallbladder, and part of the bile duct. Regardless of treatment type, pancreatic cancer takes quite a toll on the body in terms of diet and nutrition.

If you had a Whipple procedure or other surgery to remove any part of your pancreas as part of your cancer treatment, follow these guidelines after your surgery:

Pancreatic Enzymes
  • Your doctor will write you a prescription for pancreatic enzymes. Take pancreatic enzymes as prescribed.
  • These enzymes are designed to take the place of the enzymes that your pancreas would normally produce to digest protein, carbohydrates, and fat.
  • If you have questions about your pancreatic enzymes, consult a registered dietitian.
Solid Food
  • Gradually increase food intake until eating a normal solid food diet.
    • The progression will most likely be from clear liquids to full liquids, and eventually to soft solids. This progression will vary from person to person.
    • Avoid fried, greasy and fatty foods. These foods are hard to digest with an altered pancreas.
    • Choose baked, broiled, or grilled foods instead.
    • After a Whipple procedure, it is often recommended to limit fat intake to no more than 40-60 grams per day.

Nutrient Dense Foods

  • Eat as healthy as possible as allowed by the digestive system.

Nutrient dense foods are foods that contain protein, complex carbohydrates, healthy fat, vitamins, and minerals all needed by the body to function and heal.

  • Fruits, vegetables, lean protein, and whole grains are all nutrient dense foods.
  • Consult a registered dietitian for specific recommendations based on your level of food tolerance.

Eat small, frequent meals. Try to eat something every 2-3 hours. Smaller amounts of food are more easily digested and nutrients are better absorbed. Smaller meals have less potential to cause gas or bloating.

  • A common side effect from a Whipple procedure is a delay in stomach emptying called gastroparesis. Smaller meals reduce the feeling of excessive fullness.
  • Include a protein source with each meal and snack. Protein can be found in the form of meats, dairy products, nuts, or beans.

Fluid Intake

  • Drink plenty of fluids to avoid dehydration.
  • A good starting point is to strive for 8 8-ounce glasses per day.
  • Only take small sips with meals to avoid excessive bloating, gas or feeling too full to eat.
  • The best time to drink fluids is an hour before or after a meal.
  • Choose beverages that contain calories and nutrients such as juices, smoothies, or liquid nutrition supplements.

Alcoholic Beverages

  • Avoid all alcoholic beverages.

Management of Nausea

  • Limit liquids and choose dry, easy-to-digest foods such as crackers, toast, dry cereal, oatmeal or a plain baked potato.
  • Liquids should be sipped 1 hour before or after food is eaten.
  • Your doctor can also prescribe a medicine to help with managing your nausea.
  • Limit or reduce excess fiber and gas forming foods such as beans, whole grains, raw vegetables, and fruit.
  • Avoid sweets and foods containing a lot of sugar.

Increase fluid intake to avoid dehydration.

  • Strive for 5-6 small meals of low fiber foods such as applesauce, bananas, white toast, oatmeal, crackers, or a plain baked potato.

Avoid dairy products other than yogurt containing live cultures called probiotics.

Loss of Appetite

  • This is a common occurrence after a Whipple procedure.

Foods also may not taste that same as before.

Be patient and re-introduce easy-to-digest foods slowly.

  • You may also need to eat when you are not feeling hungry in order to meet the nutritional needs of your body. This will help you recover faster.
  • Appetite typically improves 4-6 weeks after surgery.

Food Journal

  • Keep a journal of eating times, foods consumed, and if the food caused any digestive problems. This will help you determine which foods are best tolerated.

Liquid Nutrition Supplements

  • Due to altered digestion, absorption, and limitations on solid food intake, a liquid nutrition supplement may be an appropriate addition to help you meet your nutritional needs.
  • Consult a registered dietitian for the best recommendation and the amount of supplement needed by your body.

Vitamins and Mineral Supplements

  • You may experience symptoms of fat malabsorption which can be determined by the frequency of bowel movements and the appearance of stools.
  • Fat containing stools are often bulky, frequent, foul smelling, and have an oily appearance.
  • These symptoms warrant the need for vitamin A, D, E, and K supplements as well as a multivitamin. You may also need a calcium supplement.
  • Ask your oncologist about vitamin B12 injections and iron to avoid becoming anemic.
    • Your healthcare team can advise you on choosing vitamins and supplements as well as the correct dosage.

Weight Loss

  • It is normal to lose up to 5-10% of your body weight after having a Whipple procedure.  If you are continuing to lose weight exceeding 5-10% of your pre-surgery weight, you may need to consult a registered dietitian for recommendations on increasing your calorie intake.

A Whipple procedure is a surgery used to treat cancer involving the pancreas or area around it. This surgery includes the removal of the head of the pancreas, the surrounding lymph nodes, the gallbladder, the duodenum and often part of the stomach.

With the loss of part of your digestive tract, your meals are not absorbed as well. Your surgeon may prescribe digestive enzymes and vitamins after surgery. Your surgeon will also recommend a special diet to help keep you nourished.

Immediately after surgery, you may need intravenous (IV) feeding or a feeding tube leading to your digestive tract. As you begin to recover from surgery, you will first need to follow a clear liquids diet. Finally, your surgeon will recommend a Whipple diet.

The Whipple diet is low-fat, low-sugar, and low-fiber soft foods. The Whipple diet may be short term. If this is the case, your surgeon will recommend that you slowly add in new foods to your diet as you being to feel better. The Whipple diet may also be long term and need to be adopted as a lifestyle change.

For a meal plan to meet your specific needs and food habits, ask your healthcare team for a referral to a registered dietitian who specializes in oncology. If you continue to lose weight or don’t have enough energy, a registered dietitian can help you develop a healthy meal plan.

The immune system is weakened during all types of cancer treatment. Unfortunately, chemotherapy medications are not able to tell the difference between healthy cells and cancer cells. For this reason, perfectly healthy red and white blood cells are damaged or killed during treatment and shortly thereafter. The result of this is that body is not as good at fighting illness and infection. A common term used to refer to a very low neutrophil (white blood cell) count is neutropenia. Paying special attention to food safety during cancer treatment to reduce the risk of exposure to food borne illness may also be referred to a neutropenic diet. The following are some simple tips to reduce exposure and avoid unnecessary infection and/or illness during the time the immune system is compromised.

Keep EVERYTHING Clean
  • Wash hands often and thoroughly especially before handling any food as well as after. Be sure to wash hands with warm water and soap for at least 20 seconds. Pay special attention to finger nails and the backs of the hands.
  • Keep raw and cooked foods separate. Do not reuse any utensils, cutting boards, plates, dishes, etc. once they have been touched by raw meat or eggs. Utensils, cutting boards, plates, dishes, etc. that have been used for preparing raw meats or eggs should be washed in hot, soapy water. It is best to keep a separate cutting board for meat and fruits/vegetables. Have an extra clean cutting board available for additional preparation as well.
  • When shopping for and storing raw meats, keep them away from other foods and cover the packages with extra plastic wrap or use plastic bags. This will prevent any liquids from leaking onto other foods or surfaces. Store meats and eggs toward the bottom of the refrigerator to prevent any dripping on other foods below.
  • Avoid raw meat such as sushi, undercooked eggs (make sure eggs are at least “over easy” and not “sunny side up”), and other meats that have not been cooked to a proper internal temperature.
  • Cook all eggs until both the white and the yolk are firm.
Cook Food Thoroughly

Use a meat thermometer to make sure that all meats are cooked to the proper internal temperature prior to eating.

Foods To Avoid

  • Raw or undercooked meats
  • Unpasteurized milk and juices
  • Soft cheeses made with unpasteurized milk such as feta, blue cheese, Roquefort, Stilton, brie, or Farmer’s cheese
  • Processed meats such as luncheon meats as well as anything else from a deli counter
  • Refrigerated meat spreads or paté
  • Smoked fish or precooked shrimp or crab meat
  • Sprouts such as bean sprouts, alfalfa sprouts, or broccoli sprouts
  • Pre-cut fresh fruit and vegetables. Buy them whole, wash, and cut them yourself using proper sanitary techniques as outlined above.
  • Unwashed fresh fruits and vegetables
  • Unroasted or raw nuts and seeds
  • Raw tofu or tempeh
  • Food from salad bars of buffets
  • “Fresh” salad dressings, salsas, sauces, etc. sold in the refrigerated section of the grocery store.
  • Raw apple cider
  • Raw honey
  • Unrefrigerated cream filled pastries

The guidelines above were created with those who have severely weakened immune systems in mind. Consult your physician or health care team for regular updates on your blood counts and the status of your immune system.