Esophageal cancer

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Side effects of radiation therapy 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.

During radiation therapy, the healthcare team protects healthy cells in the treatment area as much as possible. Damage to these healthy cells may cause side effects. Side effects can happen any time during, immediately after or a few days or weeks after radiation therapy. Sometimes late side effects develop months or years after radiation therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of radiation therapy will depend mainly on:

  • the size of the area being treated
  • the specific area or organs being treated
  • the total dose
  • the treatment schedule
  • whether or not chemotherapy is given during the same time period as radiation therapy (called chemoradiation)

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

Skin reactions

Skin reactions happen because external beam radiation has to travel through the skin to reach the area being targeted for treatment. Skin reactions include redness, dryness, itchiness and skin darkening or thickening.

Most skin reactions occur within the first 2 weeks of receiving radiation therapy. They usually go away a few weeks after treatment ends. Some changes to the skin, such as skin darkening or thickening, can last a long time or become permanent.

Find out more about skin problems.

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Fatigue is one of the most common side effects of radiation therapy. Fatigue may be caused by anemia, poor appetite or depression. It may also be related to toxic substances that are made when cancer cells break down and die.

Radiation therapy to any area of the body can make you feel more tired than usual, but fatigue is more common when larger areas of the body are treated. Making daily trips for radiation treatments can also be tiring. During radiation therapy, the body uses more energy to heal itself, so fatigue will not always be relieved by rest.

Fatigue usually starts during or after the second week of radiation therapy. Symptoms of fatigue may get worse over the course of treatment. Fatigue usually goes away gradually after treatment has ended, but some people continue to feel tired for several weeks or months after radiation therapy.

Find out more about fatigue and anemia.

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Nausea and vomiting

Nausea and vomiting are not common problems with radiation therapy, but these side effects can occur when certain areas of the body are treated. People receiving radiation to the esophagus, stomach or the upper abdomen are more likely to have nausea and vomiting.

Nausea and vomiting occur a few hours after radiation treatment. They may also occur if chemotherapy is given during the same time period as radiation therapy (called chemoradiation).

Find out more about nausea and vomiting.

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Dry mouth

Dry mouth is also called xerostomia. It develops when radiation damages the salivary glands so they don’t make as much saliva or it doesn’t flow properly.

Dry mouth occurs within the first 2–3 weeks of treatment and can become worse as treatment goes on. Radiation therapy for esophageal cancer rarely is given directly to the salivary glands, so dry mouth should go away after treatment is finished. It may take months or years for the salivary glands to recover and saliva to return to normal. In rare cases, the salivary glands may not recover completely and dry mouth can become a permanent problem.

It is important to follow the radiation therapy team’s instructions for mouth care during and after treatment. They may prescribe artificial saliva and can suggest other ways to cope with a dry mouth.

Find out more about dry mouth and mouth care.

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Difficulty swallowing

Difficult or painful swallowing and heartburn can occur when the pharynx or esophagus is in the treatment area. Radiation can cause inflammation of the pharynx (called pharyngitis) or esophagus (called esophagitis), which can make swallowing difficult. Symptoms of pharyngitis or esophagitis usually start 2–3 weeks after radiation treatment starts. Difficulty swallowing because of these problems often goes away when treatment has ended and the inflammation has gone away.

Talk to your healthcare team or dietitian if difficult or painful swallowing makes it hard to eat. They may prescribe antacids or pain-relieving medicines to relieve pain from an inflamed esophagus or heartburn.

You may need to make changes to your diet, such as eating soft foods and taking nutritional supplements. If you aren’t getting enough nutrients because it is difficult to swallow, the healthcare team may place a stent or dilator in the esophagus before radiation therapy begins.

If you can’t swallow food at all, you may need tube feeding to make sure you’re getting enough nutrients. The doctor may place a temporary gastrostomy tube so nutritional supplements can be given directly into the stomach.

Find out more about difficulty swallowing and tube feeding.

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Sore mouth and throat

Rapidly growing cells in the mucous membranes lining the mouth and throat are sensitive to radiation. Radiation therapy can damage these cells and cause painful inflammation, which can lead to a sore mouth and throat. Painful mouth sores, ulcers in the mouth and mouth infections can also develop.

A sore mouth is also called stomatitis or oral mucositis. A sore mouth may occur if radiation therapy includes the mouth or if chemotherapy is given during the same time period as radiation therapy (called chemoradiation). Thorough, regular mouth care can help prevent a sore mouth and reduce infection. The healthcare team will give instructions about how often to clean and rinse the mouth and what to use. Pain-relieving medicines or special oral solutions may be needed to relieve pain.

A sore throat may occur if radiation is given to the upper part of the chest. Symptoms usually appear 2–3 weeks into radiation therapy and often improve a few weeks after treatment is finished.


Find out more about sore mouth and throat and mouth care.

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Diarrhea is an increase in the number and looseness of stools. Abdominal cramping may occur with the diarrhea. It often begins 2–3 weeks into radiation therapy and may occur if your upper abdomen is being treated. Diarrhea usually goes away once radiation therapy treatments are completed.

Tell the radiation therapy team if you have diarrhea. They may recommend a change in diet. They may also suggest over-the-counter or prescription medicines that can help to relieve diarrhea.

Find out more about diarrhea.

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Loss of appetite

Loss of appetite, or anorexia, can be caused by many factors, including:

  • a buildup of waste products as cancer cells die
  • difficulty swallowing
  • nausea and vomiting
  • indigestion
  • diarrhea
  • fatigue

Loss of appetite is a common side effect with radiation therapy to the neck or abdomen. It can lead to weight loss and malnutrition. Maintaining good nutrition during and after radiation therapy is important to help you recover from treatment. A registered dietitian can suggest ways to increase your appetite, eat more and maintain your nutrition. They may also suggest that you take nutritional supplements.

Find out more about loss of appetite.

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Narrowing of the esophagus

Radiation therapy for esophageal cancer can cause a narrowing, or stricture, of the esophagus. This is usually related to inflammation of the esophagus (called esophagitis), which is a common side effect of radiation therapy.

Narrowing of the esophagus is usually treated with dilation to open up the esophagus. If the cancer causes severe narrowing, your doctor may place a stent or dilator in the esophagus before radiation therapy begins. This helps to keep the esophagus open during treatment.

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Lung problems

Lung problems can occur when the trachea and bronchi are in the area treated with radiation therapy. These problems include:

  • coughing
  • mucus in the throat and chest
  • difficulty breathing
  • shortness of breath

Report these symptoms to the radiation therapy team. Treatment options for lung problems may include:

  • medicines to treat cough
  • physiotherapy to learn breathing techniques that may be helpful in coping with shortness of breath
  • oxygen therapy for shortness of breath

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A fistula is an abnormal opening or passage between 2 internal organs or between an internal organ and the surface of the body. Fistulas may develop between the esophagus and trachea (windpipe) in people treated with radiation therapy for esophageal cancer. This may cause some food to leak into the trachea, which can lead to infection and choking when eating.

 A stent is often needed to repair a fistula.

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The body’s protective response to injury or infection that includes redness, swelling, pain and warmth of the affected area.


The tube-shaped airway in the neck and chest that leads from the larynx (voice box) and branches to form the bronchi (the large tubes, or airways, that connect to each of the lungs).

Commonly called the windpipe.


The tube-shaped airway in the neck and chest that leads from the larynx (voice box) and branches to form the bronchi (the large tubes, or airways, that connect to each of the lungs).

Commonly called the windpipe.


I want everyone to win their battles like we did. That’s why I’ve left a gift in my will to the Canadian Cancer Society.

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Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.

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