This page was reviewed under our medical and editorial policy by
Pankaj Vashi, MD, AGAF, FASPEN, Vice Chief of Staff, City of Hope Chicago
This page was reviewed on December 12, 2022.
It may be difficult for some patients to get the nutrition they need during cancer treatment by eating healthy foods. If that’s the case, a feeding tube may be needed. The type of tube that’s appropriate depends on the type of cancer, prognosis and treatment plan.
A feeding tube is a flexible device that may be placed in a patient’s digestive organs (such as the stomach or bowel) to deliver nutrition when the patient is unable to eat, drink or take medications by mouth.
Weight loss and malnutrition are common challenges for cancer patients. Losing weight and not getting the nutrients needed may lower the tolerance for chemotherapy and raise the risk of infection. Good nutrition, on the other hand, helps patients stay healthy and maintain their energy levels. A feeding tube may help patients get the nutrition their bodies need during and after cancer treatment.
A feeding tube may be needed if:
If patients can’t swallow medicines, they may receive them through a feeding tube. Feeding tubes may also be used to relieve pressure (gastric decompression) by removing fluid caused by a blockage in the digestive tract.
Feeding tubes work by supplying liquid nutrition and medicine directly into the digestive tract via gravity, a syringe or a pump, depending on the type of tube. For example:
For all methods, it’s important that patients recline their upper body during and after the procedure. This helps reduce the risk of inhaling (or aspirating) the feeding liquid, which may cause pneumonia.
The care team will provide instructions on how the patient should use the feeding tube at home when necessary.
The type of feeding tube that the care team recommends will depend on factors such as the patient's diagnosis, preferences and abilities, as well as future treatment needs.
If patients only need a feeding tube for a short time, a doctor may suggest having a tube inserted through the mouth or nose and down the throat to the stomach or the beginning of the small intestines.
NG tubes are inserted through the nose and down into the stomach. They may be used when patients need the feeding tube for a few weeks.
OG tubes are inserted through the mouth and into the stomach. If the tube extends into the small intestine, it’s called an oroenteric tube.
NJ tubes run from the nose, through the stomach to the jejunum, the second part of the small intestine. Placement may be guided by fluoroscopy, a type of X-ray imaging that displays movement, or may be performed with an endoscope, a flexible, lighted probe through which a guide wire or other tools are inserted into the body.
ND tubes run from the nose to the duodenum, the first part of the small intestine. Both NJ tubes and ND tubes are types of nasoenteric tubes.
Other types of feeding tubes may be more invasive, including those listed below.
Also known as G-tubes, gastric tubes are inserted through the skin of the abdomen into the stomach for direct nutrition. They’re typically used if patients need a feeding tube for a longer time—for example, more than a month. When not being used for feeding, they aren’t connected to outside tubing. G-tubes are often used in children.
PEG tubes are placed using an endoscope for guidance and a small cut in the abdomen.
RIG tubes use fluoroscopy to guide placement of the tube into the stomach. Placement may be performed without sedation.
PEGJ or PEG-J tubes (also referred to as percutaneous endoscopic gastrostomy with jejunal extension) may be used if patients have gastric outlet obstruction (GOO), severe gastric reflux disease (GERD) or a history or high risk of aspiration, part of the stomach has been removed (gastric resection) or stomach feeding through a PEG tube has been unsuccessful. The J refers to an extension that reaches from an existing PEG tube in the stomach to the jejunum.
Also known as J-tubes, jejunostomy tubes are surgically placed through the abdomen and into the jejunum.
GJ tubes have separate ports on the abdomen for food or medicine to be administered into either the stomach or the jejunum.
Patients may ask their care team about any concerns or questions before the procedure. How patients prepare depends on the type of feeding tube used and how it’s placed.
Non-surgical placement: There’s little or no preparation needed for placement of an NG or OG tube, other than going over the insertion procedure with a doctor or other health professional.
Surgical placement: Preparing for a PEG or PEGJ tube is similar to preparing for other types of surgery. Patients need to stop eating and drinking before the surgery, usually at least eight hours in advance. Medications and herbal supplements may need to be stopped before the procedure. If going home immediately afterward, patients will need to arrange a ride to and from the hospital, as they may be drowsy from sedation.
Feeding tubes are placed in many different ways. Some require only local numbing, while others may require surgery.
Numbing medicine is often used in the nose or the back of the throat to reduce discomfort or gagging caused by the procedure. If patients are able to drink, they may be given a cup of water to sip from to help move the tube down the esophagus. Some stomach contents may be suctioned out to confirm the tube is in the right place. The tube is then taped to the nose or cheek.
The doctor makes a small incision into the patient’s abdomen and intestine, and then inserts the feeding tube through the skin. Once the J tube is in place in the patient’s intestine, it’s sutured into place.
The doctor uses an endoscope to guide placement of the tube in the stomach. Patients receive an IV and are sedated, and the doctor numbs the area on the abdomen where the tube will be inserted. The doctor may also spray the throat with numbing medicine to make placement of an endoscope easier. The medical team inserts the endoscope down the esophagus into the stomach to find the right spot for the tube, then makes a small incision in the skin of the abdomen to place the tube.
The doctor uses an X-ray to guide placement of the tube. Before the procedure, patients drink barium, which shows up on X-ray machines. If swallowing is difficult, the barium may be placed into the stomach via an NG tube. This tube may also be used to inflate the stomach with air, which may help with placing the tube. Using local anesthesia, the surgeon makes a small incision in the abdomen and inserts the feeding tube.
Tubes may also be placed using laparoscopic or open surgery. Laparoscopy uses small incisions, while open surgery uses large incisions. Patients receive general anesthesia for open surgery and most laparoscopic feeding tube placement.
It may seem like a big decision to get a feeding tube. Feeding tubes may be used to help patients get the vitamins, minerals, calories, other nutrients and medicines their bodies need to stay healthy during and after cancer treatment. Making sure the body has what it needs may help the patients stay active and maintain the activities they previously enjoyed. Patients may regain weight or strength or live longer with a feeding tube, but results depend greatly on overall health and how much the cancer has progressed.
If it’s likely the patient will be able to drink and swallow again, a feeding tube may be a temporary solution. In some circumstances, patients may be able to take some nourishment by mouth while having a feeding tube. This is particularly the case for many children on NG tubes. Once they have improved, they may wean off tube feedings and a doctor will direct the return to solid food.
If it appears that the patient isn’t going to regain the ability to swallow, then a feeding tube may be more permanent, something to rely on for months or even years. A feeding tube may be removed when it’s no longer needed or if problems with the tube occur. However, if the patient is in the final stages of cancer or another fatal disease, a feeding tube is not likely to prolong life.
Many factors influence longevity rates for patients on feeding tubes—notably age and health. A 2018 study in Postgraduate Medical Journal found that many patients were living with their PEG tubes after five years, for example. However, being 70 or older was associated with shorter longevity, and choosing to remove a tube and failing tubes were associated with lower survival.
Overall, the stage of disease, age, other health conditions and many other factors determine how long one might live with a feeding tube.
While there are risks to any procedure, placing a feeding tube is typically safe and has few complications. Patients may feel some discomfort or pain when the feeding tube is first placed.
Using an NG tube for an extended period of time may irritate the nose or the lining of the digestive tract, which could cause bleeding in the stomach. An NG tube may also cause sinusitis.
Sometimes a feeding tube may cause diarrhea, constipation, bloating, nausea and vomiting, but medical and nutrition teams can work with patients to adjust how much of the liquid formula they use and how long it takes to do the feeding. More serious complications, such as aspiration pneumonia or damage to the intestinal wall, are also possible.
Other complications include:
Patients learn how to care for their feeding tube from an expert care team. Feeding tubes inserted through the abdomen need to be flushed with sterile water regularly, and patients need to check the opening (stoma) for any signs of infection. Unless a doctor advises otherwise, ointments, creams and powders around the stoma should be avoided. If a patient needs a feeding tube for a long time, the tubes themselves may need to be replaced. A PEG tube may last two or three years, while a balloon gastrostomy tube may be replaced every nine months.
Caring for some of the more common types of tubes include employing the strategies listed below.
G-tubes: Clean the skin around the tube with mild soap and water one to three times daily. Gently wipe with a clean, soft cloth or gauze in circles, starting next to the tube and working outward to push dirt and germs away from the stoma. Change any absorbent pad at the stoma at least daily.
J-tubes: Clean the skin around the stoma daily or more often, if needed. Discard used dressings and check to see whether stitches remain in place, and check for redness, pus, pain or odor. Use a cotton swab or towel to gently clean the area one to three times daily. If drainage has leaked out, put a small piece of gauze under the exterior disc after cleaning. Following directions from the doctor or nurse, put fresh gauze or bandages and tape them in place and flush the tube using a syringe filled with warm water inserted into the tube’s side opening.
PEG and PEGJ tubes: Clean the skin around the tube with mild soap and water one to three times a day, and gently remove any crusting. Rinse afterward with water, and dry the skin. If the care team has ordered the use of an absorbent pad or gauze around the tub site, change daily or more often if it gets dirty. It’s important to use the fixation device or tape to keep the tube secure. If the tube comes out, the stoma may close up. To prevent the interior bumper of a PEG tube from getting stuck in the lining of the digestive tract, push it in and turn it periodically. PEGJ tubes don’t have to be turned, but they do need to be pushed in on a scheduled basis.
Patients may need to adjust to life with a feeding tube, because it may alter how they spend meal time with family, as well as changing how they sleep, dress and bathe. It’s important to talk to the care team about how to manage these changes
Some patients may worry about how a feeding tube may affect intimacy, independence and the ability to perform certain activities. Feeding tubes can usually be hidden under clothes, so they aren’t visible to others. Patients may want to talk to their partners and caregivers about their feeding tube and show them how it works. This may help others find that they’re less worried about how it affects their loved one.