Living with gullet cancer
Relieving difficulty in swallowing when you have oesophageal cancer
If you find swallowing difficult there is much that can be done to help make it easier. Your doctor may suggest one or more of the following treatments:
This involves the doctor stretching the oesophagus, using a tube to enlarge the space for food and fluid to pass through. Stretching is also often done after radiotherapy or surgery and you may need to have the procedure repeated. It is a simple and quick procedure, which may be carried out under general or local anaesthesia.
Intubation or stenting
A plastic or wire mesh tube (a stent) can be put into the oesophagus using an endoscope. The procedure is similar to oesophagoscopy. The tube helps to keep the oesophagus open and should enable you to eat more comfortably. It is important to take care with your diet to ensure the tube does not become blocked. Drinking fizzy drinks after eating will help to keep the tube clean and clear. Information on diet is available from the Oesophageal Patients Association.
Laser treatment can sometimes be used to remove enough of the tumour to allow food to pass down the oesophagus. This treatment can sometimes be given with a local anaesthetic, in which case you go home the same day. The procedure may be done under sedation and occasionally a general anaesthetic. It is carried out using an endoscope so is similar to having the oesophagoscopy. The procedure takes about 15 minutes.
It may take two or three sessions of laser treatment to clear your oesophagus enough for you to be able to swallow normally. Further treatments may be needed after 4–6 weeks. You are unlikely to feel any pain after the procedure; although there may be some temporary swelling in your oesophagus, which may make swallowing more difficult at first. You may also have some discomfort in your abdomen. If you have any pain, tell your doctor or nurse.
Alcohol injection aims to shrink enough of the tumour to allow food to pass down the oesophagus. Using an endoscope the tumour is injected with small amounts of ethanol alcohol. This usually makes it easier for people to swallow, though it can take a few days to work.
Photodynamic therapy (PDT) uses low-powered lasers combined with a light-sensitive drug to destroy cancer cells. In the UK it is only carried out in a few specialist hospitals.
Photodynamic therapy is given in two stages. First you will be given a drug that makes the cells of the cancer more sensitive to light (a photosensitiser). This is usually given as an injection into a vein in your arm (intravenously). For the second part of the treatment a laser is shone onto the cancer, using an endoscope. The laser activates the photosensitiser to destroy the cancer cells.
The treatment will make you sensitive to light and you will need to take precautions to avoid exposure to sunlight for a few days. PDT may also make the area in the oesophagus become temporarily inflamed and swell up. At first, this can make swallowing more difficult.
Although PDT is an established treatment to relieve the difficulty in swallowing caused by oesophageal cancer it is not widely used as a „first line‟ treatment. However, in December
2006, The National Institute for Health and Clinical Excellence (NICE) produced guidance for doctors on PDT as a treatment for early (stage one) oesophageal cancer. It was thought that PDT might be a possible alternative to surgery for some people.
The guidance says that more evidence is needed before we can really know how effective
PDT is for early oesophageal cancer. We don‟t yet know enough about how well it works and how it compares in the long-term with surgery. In the meantime, doctors may offer PDT for stage one cancer as long as they discuss the possible risks and benefits with people. NICE suggests that doctors use PDT within research trials if possible and also make sure that patients are followed up to check their progress.
Advice on diet for people affected by oesophageal cancer
While you are waiting for treatment it is important to eat well, using food supplements if necessary. You may be able to see a hospital dietitian for advice at the time of diagnosis and after surgery. If you are unable to swallow at all, you should let the hospital know immediately.
If you have had surgery that has not removed a major part of your stomach, you can start to eat as soon as your doctor says you can. You will usually start with a soft diet while you are still in hospital, and will often be advised to remain on this for a few weeks. This will naturally exercise the surgical join and help keep the passage open as it heals.
Gradually you will be able to start eating solid foods again, as long as there are no large lumps and you chew the food well. You may feel rather worried about eating solid foods at first but this will lessen as you become more used to a normal diet again. Your doctor or specialist nurse can give you further advice about this. Some people may have an allergic reaction to milk for a while.
When you eat, acidic liquid flows into the stomach to help digest the food. This can cause an uncomfortable feeling of indigestion because of the new position of your stomach.
If you have had part of your stomach removed, you will find that you feel full very quickly because your stomach will be smaller. To help prevent these problems, eat little and often rather than trying to eat large meals. It can also help to chew food well and eat slowly.
Bouts of diarrhoea are fairly common after any operation for cancer of the oesophagus. From time to time you may need to cut out some foods, such as fruit, vegetables, cereals and reduce the amount of milk you drink (or eat in food) to help deal with this problem.
If you have had radiotherapy, or a tube fitted in your oesophagus, you will probably need a softer diet. Avoid foods which may block the tube or which you may have difficulty in swallowing; such as raw fruit and vegetables, tough meat or crusty bread. Complan® and any powdered food supplement must be very thoroughly mixed. It is also a good idea to eat slowly and to have plenty to drink during and after meals.
After treatment for oesophageal cancer
After your treatment is completed, you will have regular check-ups and possibly scans. You will probably continue to have these for several years. Many people find that they get very anxious for a while before the appointments. This is natural and it may help to get support from family, friends or a support organisation.
These appointments are a good opportunity to discuss with your doctor any concerns or problems you may have. If you notice any new symptoms between check-ups, or are anxious about anything, contact your doctor or specialist nurse for advice.
After your treatment you may find that you feel more tired than usual and have a poor appetite. You are quite likely to feel very full; even after eating just small amounts. It can take several months to feel better after treatment and up to a year to adjust to the changes in your digestive system. It may be many months before you are able to eat a more normal- sized meal and the diarrhoea stops. If you find you have difficulties with swallowing again after treatment it does not necessarily mean that the cancer is coming back; it can be caused by the treatment itself. Your doctor may suggest dilatation to deal with this problem.
For people whose treatment is over apart from regular check-ups, our booklet on adjusting to life after cancer treatment gives useful advice on how to keep healthy and adjust to life after cancer.
It can be hard to judge the best time to go back to work. Your decision if and when to go back is likely to depend mainly on the type of work that you do and whether or not your income is affected. It is important to do what is right for you.
Getting back into your normal routine can be very helpful and you may want to return to work as soon as possible. Many people find that going back to work as soon as they feel strong enough gives them an opportunity to forget their worries, as they become involved with their job and colleagues again. Talk to your employer about your situation – it may be possible for you to work part-time or job share.
On the other hand it can take a long time to recover fully from treatment for oesophageal cancer, and it may be many months before you feel ready to return to work. Do not feel pressurised into taking on too much, too soon.
Your consultant or GP will be able to help you decide when and if you should return to work.
Living with and after cancer
Information on the emotions you might experience as a result of your cancer diagnosis, ways that you might manage them and other sources of support.
Advice on how to talk to other people, talking to children, relationships and sexuality
Note: JASCAP has booklets on the above subjects.