Esophageal cancer

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Side effects of surgery for esophageal cancer

Side effects can happen with any type of treatment for esophageal cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

 

Side effects can develop any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on:

  • the type of surgery
  • your overall health
  • the effect of other treatments

Tell your healthcare team if you have these side effects or others you think might be from your surgery. The sooner they are aware of any problems, the sooner they can suggest ways to help you deal with them.

Pain

Pain often occurs after surgery because of trauma to the tissue. Surgery for esophageal cancer is a major operation. It may take time for pain to go away after surgery. How much pain you have will depend on the type of surgery, how you heal and how well you tolerate pain.

Your healthcare team will prescribe pain-relieving medicines to control pain. Check with your doctor if pain does not go away or pain medicines don’t relieve the pain.

Find out more about pain.

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Bleeding

Bleeding, or hemorrhage, can occur if a blood vessel is not sealed off during surgery or if you have a blood-clotting disorder. Nursing staff frequently check bandages and drains for bleeding right after surgery. If bleeding occurs and is heavy enough, you may need to go back into the operating room so the surgeon can find where the bleeding is coming from and stop it.

A small amount of bloody drainage may be expected after surgery. Report heavy bleeding to the doctor or the healthcare team.

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Lung problems

Lung problems can develop after surgery for esophageal cancer. The main types of lung problems are:

  • lung infection (called pneumonia)
  • a buildup of fluid in the pleural cavity, which is the space between the lungs and the walls of the chest (called pleural effusion)
  • collapsed lung (called atelectasis)

You can greatly reduce your risk of developing these lung problems if you stop smoking at least 2 weeks before surgery. The healthcare team will also give you breathing exercises to do after surgery to help lower your risk of developing these problems.

Tell your healthcare team if you have shortness of breath, fever and a dry or productive cough (coughing up mucus or blood).

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Anastomotic leak or stricture

An anastomosis is the area where the 2 ends of the digestive tract are joined together.

In rare cases, the stitches (sutures) or staples holding the 2 ends together may break or come apart. When this happens, the fluids inside the digestive tract leak out (called anastomotic leak). Symptoms of an anastomotic leak include chills, fever and abdominal pain. The discharge from drains may also change. If you have an anastomotic leak, you may need to have more surgery to repair it.

An anastomotic stricture is when the tissues around the anastomosis narrow. This may occur after surgery or an anastomotic leak. An anastomotic stricture can make it difficult or painful for you to swallow. The surgeon may treat the stricture by stretching, or dilating, the tissues around the anastomosis.

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Infection

Some people may develop a wound infection after surgery for esophageal cancer. This is not a common side effect, but it can happen after any type of surgery. Sometimes your doctor will place tubes into the wound to drain extra fluid or open the wound and pack it with sterile gauze. Your doctor may also prescribe antibiotics to help prevent or treat an infection.

Tell your healthcare team if you have signs of infection, such as redness, pus, foul-smelling drainage, fever and increased swelling or tenderness at the incision site.

Find out more about infection.

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Weight loss

Weight loss is a common problem for people with esophageal cancer before and after surgery. The tumour may make it difficult to swallow before surgery. If part of the stomach is removed during surgery, you may no longer be able to eat large meals.

Other treatment side effects like dumping syndrome, diarrhea, loss of appetite, reflux and stricture also make it difficult for people to maintain weight after surgery for esophageal cancer.

Find out more about nutrition for people with cancer.

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Nausea and vomiting

Nausea and vomiting can occur if the stomach empties too slowly or if you are constipated. The stomach may empty too slowly if some of the nerves that supply the stomach are damaged during surgery. The anesthetic given during surgery can affect the intestines so they don’t work properly after surgery, which can cause constipation. Nausea and vomiting may also be caused by the anesthetic or certain medicines, such as pain-relieving medicines, antibiotics or iron supplements.

Find out more about nausea and vomiting.

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Bringing up food or bile

After surgery for esophageal cancer, you may bring up, or regurgitate, food or bile. This is because reconstructive surgery changes the position of the structures in the gastrointestinal (GI) tract. As a result, food might not move through these structures as fast as it used to.

The healthcare team will talk to you about changes you can make to your diet to help treat regurgitation. You can also try the following:

  • Sit upright for 2–3 hours after eating.
  • Don’t eat too late in the evening.
  • Eat smaller meals more often during the day.

If you have a lot of trouble with regurgitation, your healthcare team may prescribe medicines to help you digest food.

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Heartburn

When the ring of muscle (called a sphincter) in the lower esophagus is removed during surgery, the stomach contents can back up into the remaining esophagus and cause heartburn.

Sitting up for a couple of hours after eating and sleeping with your head and back on pillows may help to prevent heartburn. If you have heartburn, talk to your healthcare team about medicines that can help stop and prevent it.

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Blood clots

A blood clot in the legs is called a deep vein thrombosis (DVT). A DVT can occur immediately after surgery because you can’t move around very well, along with other factors. The signs and symptoms of a blood clot in the leg are a swollen, painful and red calf.

In the most serious cases, a blood clot can break away and travel to the lungs (called a pulmonary embolus, or PE). This can cause shortness of breath, coughing up blood and low oxygen levels in the blood. In the most serious cases, PE can cause heart failure.

Taking blood thinners (called anticoagulants) and applying compression stockings during and after surgery helps to prevent DVT and PE. The healthcare team will also recommend exercises to help prevent blood clots from forming.

Tell your healthcare team if you have any redness, swelling, pain or cramps in the calf of the leg, shortness of breath or coughing up blood.

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Dumping syndrome

Dumping syndrome occurs when food moves from the stomach into the small intestine too quickly. This may occur after surgery for esophageal cancer if all or part of the stomach has been removed. Dumping syndrome can cause diarrhea, sweating and flushing after eating.

Dumping syndrome can be managed by a change in diet or with medicines.

Find out more about dumping syndrome.

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Hoarseness

Hoarseness may develop if the recurrent laryngeal nerve in the neck is damaged during surgery for esophageal cancer. Hoarseness is usually temporary if the nerve isn’t too damaged. It will usually go away on its own within 6 months. If damage is severe enough, you may need to have surgery to repair it.

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Chylothorax

Chylothorax is when chyle leaks into the space between the pleural membranes that cover the lungs and line the chest cavity. Chyle is a fat-containing fluid that is taken up from the small intestine into the lymph vessels during digestion. If the thoracic duct (a major lymph vessel in the chest) is damaged during surgery for esophageal cancer, it can cause chylothorax.

A change in diet, along with tube feeding or parenteral nutrition (nutrients given through intravenous), may allow the chylothorax to heal within a couple of weeks. If damage is severe enough, you may need surgery to tie off the thoracic duct.

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Heart problems

Heart problems can occur after surgery for esophageal cancer. The main types of heart problems are abnormal heart beat (called arrhythmia), heart attack (called myocardial infarction) or heart failure.

Your healthcare team will monitor your heart function. They may prescribe medicines to help prevent these heart problems.

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dumping syndrome

A condition in which food or liquid moves through the stomach and small intestine too quickly. Signs and symptoms include cramps, nausea, diarrhea and dizziness.

Dumping syndrome may occur when part or all of the stomach is removed.

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