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, depending on the stage of the cancer, what type of treatment you had 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. A person who has been treated for esophageal cancer may have the following concerns.

Most people with esophageal cancer have difficulty swallowing (dysphagia). It can develop if:

• the tumour blocks the esophagus
• food doesn't move down the esophagus because the wave-like muscle contractions in the esophagus (called peristalsis) have changed
• the esophagus is inflamed because of radiation therapy

You may also have difficulty swallowing if you develop an anastomotic stricture. An anastomotic stricture is a narrowing of the area where the end of the esophagus is joined to the end of the stomach. This narrowing can be caused by scar tissue that develops after surgery or after radiation therapy to the chest.

If you have difficulty swallowing, you may be offered an endoscopic treatment such as:

• esophageal dilation
• placement of an esophageal stent
• radiofrequency ablation (RFA)
• laser surgery
• photodynamic therapy (PDT)
• electrocoagulation or argon plasma coagulation (not available in all Canadian treatment centres)

Find out more about difficulty swallowing and how to manage it.

Most people with esophageal cancer will lose a lot of weight. Severe weight loss is called cachexia.

Weight loss can happen if you have problems swallowing caused by the tumour or by treatments for esophageal cancer. Some side effects of esophageal cancer treatment that can also cause weight loss include:

• dumping syndrome
• diarrhea
• loss of appetite

You may also lose weight if you have been diagnosed with advanced esophageal cancer. 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 eating less, leads to weight loss.

It's important for you to eat well and maintain your weight during and after treatment for esophageal cancer. Eating well can help your body fight disease and cope with the effects of cancer treatments.

To help with weight loss, your healthcare team may suggest that you are given a feeding tube. A feeding tube is a thin, flexible tube that is placed directly into your stomach or the upper part of the small intestine. Once the tube is in place, you can be given liquid nutritional supplements through it.

People are often given a feeding tube when they are first diagnosed with esophageal cancer because they have lost so much weight. You may also be given a feeding tube before you start treatments like chemoradiation, which can make it difficult for you to swallow and maintain your weight.

If you have lost more than 10% of your body weight, your healthcare team may suggest parenteral nutrition (sometimes called total parenteral nutrition or TPN). It provides fluids and essential nutrients directly into the bloodstream through an intravenous (IV) catheter.

Find out more about tube feeding and parenteral nutrition.

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 help to make sure you get proper nutrition during and after treatment.

Many people with esophageal cancer have fatigue. Fatigue may be caused by the cancer itself of by the treatments for it. Fatigue can be made worse if you haven't been able to eat well because you have had difficulty swallowing or if you have lost a lot of weight. People with advanced esophageal cancer may also have a lot of fatigue.

Find out more about fatigue and how to manage it.

To make decisions that are right for you, ask your healthcare team questions to ask about supportive care.