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Supportive care for esophageal cancer
Supportive care helps people meet the physical, practical, emotional and spiritual challenges of esophageal cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.
Recovering from esophageal cancer and adjusting to life after treatment is different for each person. Recovery depends on the stage of the cancer, the type of treatments and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects.
Talk to your healthcare team about the following concerns. They can suggest ways to treat, manage or help you cope with these problems.
Self-esteem and body image
How people feel about or see themselves is called self-esteem. Body image is someone’s perception of their own body. Esophageal cancer and its treatments can affect a person’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:
- hair loss
- skin problems
- weight loss
- having a feeding tube
Some of these changes can be temporary, others will last for a long time and some will be permanent. Find out more about managing symptoms and side effects.
Many people with esophageal cancer have nutrition problems. This is because the cancer itself, treatments or side effects of treatments can affect your digestive system and make it difficult to eat and drink.
Because esophageal cancer can affect your nutrition, a dietitian is a key member of your healthcare team. A dietitian can counsel you to make sure you get proper nutrition throughout your cancer journey and, along with the other members of your healthcare team, help you maintain good nutrition during treatment and deal with any side effects that make it hard for you to eat.
Getting proper nutrition during cancer treatment is important, so talk to your healthcare team if you have any of the following. Find out more about nutrition for people with cancer.
People with esophageal cancer often have difficulty swallowing, or dysphagia. Difficulty swallowing can develop if cancer or its treatments affect the esophagus so it can’t open wide enough and food can’t pass through it. Food may remain in the esophagus, causing discomfort and undigested food to come back up (called regurgitation).
Difficulty swallowing may happen because:
- the tumour blocks, or obstructs, the esophagus
- the wave-like muscle contractions in the esophagus (called peristalsis) change so food doesn’t move as it normally would
- the esophagus is inflamed (called esophagitis) after radiation therapy or chemotherapy
- anastomotic stricture occurs
An anastomosis is the area where the 2 ends of the digestive tract are joined together. An anastomotic stricture occurs when the tissues around the anastomosis become narrowed after surgery or radiation therapy. This can make swallowing difficult or painful. The surgeon may treat the stricture by stretching the tissues around the anastomosis to open, or dilate, the esophagus.
Difficulty swallowing can affect how much food you eat and fluids you drink. This may lead to weight loss, malnutrition and loss of muscle mass (muscle wasting). Together these symptoms are called cachexia.
There are a number of endoscopic treatments that may be used to treat difficulty swallowing.
If you have swallowing problems, your healthcare team will do a swallowing assessment. Find out more about swallowing problems and how to manage them.
Weight loss is a very common problem for people with esophageal cancer. It is often the result of difficulty swallowing, dumping syndrome, diarrhea, loss of appetite and other problems caused by esophageal cancer and its treatments.
Advanced cancer leads to changes in the body that affect its ability to use the energy from food. As a result, the body burns energy at a faster rate. This increased energy use, along with a lower nutritional intake, leads to weight loss.
It is important for people with esophageal cancer to get proper nutrition and maintain their weight even if their appetite changes. Proper nutrition helps the body fight disease and cope with the effects of cancer treatments. Find out more about nutrition for people living with cancer.
If you lose a lot of weight, the healthcare team may suggest using a feeding tube. A feeding tube is a thin, flexible tube that is placed directly into the stomach or the first part of the small intestine (called the jejunum). Once the tube is in place, liquid nutritional supplements can be given through it. This is called enteral feeding. Feeding tubes can help make sure you get all the nutrition you need when it is too difficult to eat or drink. Find out more about tube feeding.
Dumping syndrome is a group of symptoms that develops when food moves from the stomach into the small intestine too quickly. These symptoms include diarrhea, sweating and flushing after eating. Dumping syndrome can develop if all or part of the stomach has been removed.
Find out more about dumping syndrome and how to manage it.
Many people with esophageal cancer have diarrhea. It can be caused by different treatments, including chemotherapy, radiation therapy or surgery.
In some cases, diarrhea is a symptom of dumping syndrome. It may also happen if the vagus nerve was cut during surgery to remove the tumour and lymph nodes. The vagus nerve controls the movement of food in the digestive system. Damage to this nerve can cause sudden diarrhea.
Making some changes in your diet can help to reduce diarrhea. One of the most important things in managing diarrhea is drinking enough fluids to stay hydrated.
Find out more about diarrhea and how to manage it.
Nausea and vomiting
Nausea and vomiting are common side effects of chemotherapy, radiation therapy or surgery for esophageal cancer.
Nausea and vomiting can happen after surgery to treat esophageal cancer. Surgery often includes removing part of the stomach. After surgery, the stomach doesn’t have as much room to stretch and store food, so it fills up quickly. Sometimes the vagus nerve is cut during surgery for esophageal cancer. The vagus nerve controls the movement of food in the digestive system. Damage to this nerve can affect the stomach so it takes longer to empty. This can make you feel sick and bloated.
Your doctor may prescribe antinausea drugs. Find out more about nausea and vomiting, including how to prevent and manage it.
Heartburn can develop after surgery from reflux. Reflux is when stomach contents back up into the esophagus. Many people have reflux when they are lying down.
Heartburn may be managed by medications and by:
- sitting upright after eating and drinking
- trying not to eat or drink a few hours before lying down
- keeping your head and shoulders elevated when lying down or sleeping
- avoiding spicy and acidic foods
- avoiding smoking and alcohol
Loss of appetite
Loss of appetite is common in people with esophageal cancer. Loss of appetite can be caused by surgery, radiation therapy to the chest, certain medicines, taste changes or the cancer itself.
Talk to your healthcare team if you lose your appetite. They can give you tips for coping with loss of appetite that can improve your interest in food and increase your appetite.
Feeling full after eating or drinking
Surgery to treat esophageal cancer often includes removing part of the stomach. Because the stomach is smaller, it can’t hold as much food as it did before surgery. You may feel full after eating or drinking only a small amount.
It is important to get enough nutrition during and after cancer treatment, so talk to your healthcare team if you feel full after eating or drinking. Try to eat small meals or snacks every 2–3 hours. This may be easier than trying to eat 2–3 large meals a day. Avoid drinking fluids with meals because this can fill the stomach quickly. Drink high-calorie or high-protein fluids between meals. Limit the amount of high-fibre foods, such as whole grain breads and cereals, you eat during each meal.
Many people with esophageal cancer experience fatigue. Fatigue may be caused by the cancer and can be made worse by difficulty swallowing and poor nutrition. It can be hard to cope when you feel very tired and don’t have a lot of energy, especially for a while after treatment or if the cancer is advanced.
Find out more about fatigue and how to manage it.
After seeing a Canadian Cancer Society call for volunteers in a newspaper, Rosemary knew that this was her opportunity to get started.
Support from someone who has ‘been there’
The Canadian Cancer Society’s peer support program is a telephone support service that matches cancer patients and their caregivers with specially trained volunteers.