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Fibre restriction for bowel obstruction

Bowel obstruction, a possible complication of ovarian cancer, is caused by several factors: the tumour itself may invade bowel or "sticky" tissue (adhesions) may form after surgery and obstruct food passing down the gut. Women who have experienced bowel obstruction or are at risk are often advised to restrict fibre in the diet. Not all doctors recommend a low-fibre diet, so if you are not sure if this applies to you, then check with your own doctor or surgeon.

Why restrict dietary fibre?

Dietary fibre (sometimes referred to as roughage) is the part of food which is not digested but passes down into the lower part of the gut. Here, harmless bacteria ferment the fibre and produce gas (wind!). In fact, at any one time the gut usually contains the equivalent of a teacup (200 ml) of gas and every day we pass approximately 1-3° pints (400-2000 ml) of this gas out as flatus.*

The idea behind a fibre-restricted diet is to reduce the amount of wind produced and therefore help to ease symptoms such as bloating and stomach discomfort. There is also some suggestion that it may reduce the risk of the bowel becoming obstructed.

Will the diet work?

Unfortunately it is very difficult to study the benefit of fibre-restricted diets for bowel obstruction, although this will certainly be looked at more closely in future. In fact, most of the evidence for these diets comes from the experience of the doctors, nurses and dieticians working with women with ovarian cancer who are in obstruction.

What is a fibre-restricted diet?

The diet includes low-fibre foods such as meat, fish, diary products, eggs, fruit juices and refined cereals, such as cornflakes, rice crispies, biscuits, cakes and white bread, pasta and rice. It is necessary to restrict the intake of fruit, vegetables and wholemeal products such as wholemeal bread, rolls and crackers. The level of restriction depends on:

What about constipation?

A fibre-restricted diet still contains some fibre; however, it is worth talking to a doctor if you are concerned about constipation as you may require laxatives. Generally, in order for our bowel to work properly, it is important to have enough to drink. Normally, we need about 8-10 cups or glasses of liquid each day.

What about vitamins and minerals?

When some foods are restricted, it can be difficult to meet vitamin and mineral requirements, so a multi-vitamin and mineral supplement may be necessary. There are a vast number in pharmacies, and even most supermarkets stock a wide range. Some contain unnecessary high doses of vitamins and minerals, so, it is always a good idea to speak to a dietician who will advise you on whether you need to take one in the first place and recommend the type to buy.

What if the diet is too difficult to follow?

As part of a healthy diet, we are all encouraged to eat more fibre. Many women with ovarian cancer eat lots of fruit and vegetables, wholemeal bread and high-fibre breakfast cereals, so a fibre-restricted diet is miles from their normal diet and some just find it too difficult and stressful. If so, it is important to contact the dietician for appropriate advice on reintroducing small amounts of high-fibre foods.

If your bowel is bloated and uncomfortable it is often difficult to eat a normal-sized meal and this can lead to weight loss. It is usually better to have small meals and snacks throughout the day. If you do have a poor appetite and have lost weight, try to choose foods high in fat and sugar, as they are very energy-dense and will contribute significantly to your energy requirements. There are a number of nourishing drinks and prescribable supplements which can be very useful.

Is a fibre-restricted diet suitable for all women with ovarian cancer?

A fibre-restricted diet is certainly not appropriate or necessary to all women with ovarian cancer. It will benefit only those who are at risk of bowel obstruction. Check with your doctor, if you are not sure whther this applies to you.

Further information

There are no general publications on bowel obstruction and fibre-restricted diets. However, if you have been advised to follow such a diet it is important that your hospital doctor or GP refers you to a dietician so that you can be well informed and supported.
Jane Power
Senior Dietician, Royal Marsden, London

 

Taxol press conference

A press conference in May revealed the result of UK clinical trial of Taxol in advanced ovarian cancer. Taxol is commonly used (with a platinum drug) as a component of first-line treatment in the US, but UK doctors were awaiting results from UK trials before making similar recommendations for its use here.

The new data show that Taxol offers a worthwhile survival advantage (an additional year) when used as first-line treatment for advanced disease. The Medical Consensus group in the UK, which conducted the trials, now unanimously agrees that, given the weight of evidence, a fundamental change in the treatment of ovarian cancer is in order, and that Taxol should become the new "gold standard" for appropriate patients. This includes women with advanced ovarian cancer, but not those with early disease (Stages IA or IB) or borderline tumours.

Taxol, like other agents, has side effects and it is important to discuss these with a consultant. Like any treatment, what may be right for one woman may not be right for another. These are informed choices which you should make with someone familiar with your history.

In some cases funding for Taxol treatment has been inconsistent around the country, either in anticipation of new evidence to support its use or because of local or regional funding issues. It's estimated that offering Taxol to more women could cost the NHS £20M, far more than it currently spends on chemotherapy for ovarian cancer. If you think you are eligible for Taxol but are not receiving it because of funding issues, you can approach your local MP, or Ovacome can send you a list of MPs who have signed the petition calling for equal access to care.

Remember that optimal treatment involves, including appropriate drug treatment and access to skilled, specialised and multi-disciplinary teams who are equipped and experienced in treating ovarian cancer. It is within your rights in the NHS to ask for a second opinion and referral to such specialist centres. While this may be a difficult subject to broach with your physician, Ovacome members who have done so have found that it helped them take more control of their treatment. So ask, if you think you need to!


Familial Ovarian Cancer

Recent media attention has focused on two of the genes involved in familial breast cancer, creating a great deal of public interest in genetic testing. These genes are also involved in familial ovarian cancer and many families are looking for information on the possibility of genetic testing for ovarian cancer.

Screening to try and detect ovarian cancer early has also been well publicised recently, resulting in many enquiries about the availability of screening. Ian Jacobs and Karen Sibley outlined the advantages and disadvantages of screening in a recent edition of this newsletter. In this article Dr James MacKay, Consultant in Cancer Genetics, Addenbrooke’s Hospital, Cambridge, summarises the present knowledge on genetic testing for ovarian and breast cancer, and looks at screening currently available for ovarian cancer when two or more relatives have developed ovarian or breast cancer.

Can anyone have a genetic test to tell if they will develop ovarian cancer?

Most cancer genetics centres offer testing to families with at least three people affected with ovarian or breast cancer.

The two genes involved in ovarian and breast cancer – BRCA1 and BRCA2 – are long genes and a fault may occur anywhere in the gene. Different families have different faults. To detect a faulty gene we have to take a blood sample from someone with ovarian or breast cancer in the family and work our way along the gene until we have identified the fault responsible in that particular family. Once we have found the family fault in someone with ovarian or breast cancer we can offer genetic testing to others in that family to tell if they have inherited the faulty gene.

Genetic testing is a two-stage process. The first is to identify the faulty gene in the family, and the second to test other family members, if they wish. Because detecting a faulty gene is difficult and time-consuming, most centres offer to search for a faulty gene in families where it is probable that a faulty gene is present, i.e. those with three or more affected people and where one person in the family is willing to give a blood sample to allow us to start the faulty gene search.

If a faulty gene is found in my family, do I have to have a genetic test?

Once a faulty gene has been identified in your family you will be offered a genetic test, but you do not have to take up the offer: it is entirely up to you and there will be no pressure on you at all.

If a faulty gene is found and my test shows I have it, what options are available?

If you have the faulty gene then you have two possible options:

If you have a faulty BRCA1 or BRCA2 gene you are also at increased risk of breast cancer, and again the options are similar:

It is likely that a third option –taking different drugs in research studies to try and prevent the development of these cancers – will become available soon. One study, the International Breast Cancer Intervention Study (IBIS), offers a trial of Tamoxifen or a dummy tablet to those with a family history of breast cancer. There are no drug studies for women with a family history of ovarian cancer, or for women who have had a genetic test which proves they carry the faulty BRCA1 or BRCA2 genes.

If a faulty gene is found, but my genetic test shows I do not have it, what happens then?

If you do not have the faulty gene which runs in your family, your chance of developing ovarian or breast cancer is no higher than anyone else your age in the population, and therefore extra screening will be stopped. You will still be encouraged to join the National Breast Screening Programme when you are 50.

If my mother and my aunt both developed ovarian cancer, will I never be offered gene testing?

As techniques for identifying faulty genes improve, it is very likely that many more people will be offered testing.

Where do I get more information on genetic testing?

Information on genetic testing is available from CancerBACUP, the Cancer Research Campaign or the Imperial Cancer Research Fund. If you wish for advice on genetic testing you can write to Dr James MacKay, Consultant in Cancer Genetics, Addenbrooke’s Hospital, Cambridge, or Mr Ian Jacobs, Ovarian Cancer Screening Unit, St Bartholomew’s Hospital, London.

We will publish a list of cancer genetics centres offering testing in a future newsletter.

My mother has ovarian cancer, but no one else in the family has ovarian or breast cancer. Should I be screened?

If your mother is the only person in the close family with ovarian or breast cancer, then your risk of developing ovarian cancer is only slightly increased. You may wish to take part in one of the screening studies outlined in the article by Karen Sibley and Ian Jacobs on screening covered in a recent newsletter.

Who can get screening because of their family history?

The UKCCCR National Familial Ovarian Screening Study offers screening with annual ultrasound and annual CA125 measurement to women between the ages of 25 and 65, who come from an "at risk" family.
An "at risk" family is defined as:

A first-degree female relative is mother, daughter or sister.
A second-degree female relative is grandmother, granddaughter, aunt or niece.

You will be offered screening in this study if you come from an "at risk" family and you have a first degree relative who has breast or ovarian cancer.

If you think you are eligible for this study ask your general practitioner to refer you to your nearest participating centre.

If you would like more information on this study or are unclear whether you are eligible, telephone Diana Briscoe, Family History Study Co-ordinator, on 01223 330019.

 


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