A B C D E F G H I J K L M N O P R S T U V W

CANCER OF THE OESOPHAGUS

What is Cancer of the Oesophagus ?

A cancer of the oesophagus is a malignant growth of the gullet. This is the tube through which food and fluid moves from the back of the mouth to the stomach. The commonest symptom is difficulty in swallowing. There is a sensation of food sticking behind the breast bone or sternum. This occurs because the growth produces a narrowing of the gullet. Initially the difficulty occurs when solid foods are eaten. Later it may occur also with liquids. Weight may be lost as a result of the inability to swallow. Growths may also produce ulceration in the gullet causing a silent loss of blood and anaemia. Long-standing growths may spread to the glands of the neck or to the liver.

Why does Cancer of the Oesophagus occur ?

The cause is not known, but growths of the oesophagus are commoner in patients with long-standing iron deficiency anaemia.

Treatment Involved for Cancer of the Oesophagus

PREOPERATIVE

The extent of the growth is determined by oesophagoscopy, an examination of the gullet using a flexible telescope. You will receive some sedation and local anaesthesia to the back of the mouth before the telescope is introduced into the gullet. At this examination, an ultrasound scan may be performed through the telescope. This helps to assess the extent of the growth. The technique uses a type of sound wave to record a radar-like picture. This will show up the wall of the gullet and the growth. Samples of the growth (biopsy) may also be taken at this time and sent for microscopic examination. This will indicate whether the growth is likely to respond to radiotherapy or if surgery is more likely to be effective. Generally, growths at the upper end of the oesophagus are more often treated with radiotherapy and those of the lower end by operation. The extent of the growth may be further assessed by special x-rays (CT scanning), by magnetic (MRI) scan of the chest, lungs and liver and by bone scan, using very low dose radioactive isotopes.

SURGERY

Involves removing part or most of the oesphagus and replacing it with another part of the intestine. Frequently a combination of incisions in the abdomen and chest (and sometimes in the neck) are required to provide good access. You will be admitted to hospital a few days prior to surgery. This will allow a full assessment of the heart and lungs and general state of nutrition. Poorly nourished patients may require a period of intravenous feeding or oral supplements to their diet before surgery. The physiotherapist will assess lung function and teach you breathing exercises which will be required after surgery. Intensive care treatment may be needed on the first post-operative night.

POSTOPERATIVE

After waking up from the anaesthetic, you may have a number of tubes in place. Intravenous drips may be in the neck and the others in the arm. These will allow blood, fluids or antibiotics to be given. The drips are continued until fluid and food can be taken by mouth. A tube is passed through the nose into the stomach to withdraw juices from the stomach and so reduce the chances of vomiting. This nasogastric tube is left until bowel activity has returned to normal. A urinary catheter (tube) will have been introduced into the bladder. This removes the need to pass urine in the immediate post-operative period. Chest and abdominal drain tubes are also positioned at the time of surgery to remove accumulations of air or fluid, as required. They are removed between 2 and 7 days later. Oral fluids and food are withheld until the surgeons are sure that bowel activity has returned to normal and the internal stitches have healed. This usually takes between 7 and 10 days. At this stage, a light diet may be started and gradually built up over the next week. Radiotherapy , if required, involves a 4 6 week course of treatment. Some growths cannot be treated surgically and either do not respond to, or recur, after radiotherapy. Swallowing in this case may then be restored by opening the narrowed oesophagus under local or general anaesthetic by internally stretching it (dilatation). Laser treatment may also offer a useful method for cutting a channel through the tumour to provide a way through for food. In some patients, it may be appropriate to place a tube into the gullet at the level of the growth to maintain a way through for solids and liquids.

During Treatment for Cancer of the Oesophagus

The length of hospital stay for surgery for such a growth is approximately 2 weeks from the time of operation. This will depend on the general state of nutrition and how much pre-operative treatment has been required. Any chest infections usually respond well to physiotherapy and antibiotics. A failure of internal stitches to heal may delay convalescence. Provided the internal stitches heal satisfactorily, a great improvement in swallowing ability will be noted.

After Treatment for Cancer of the Oesophagus

You will often continue to lose weight even following discharge from hospital. As food intake increases, you will eventually gain weight. With the creation of a new gullet, some of the normal mechanisms that prevent food from coming back up may be lost. This frequently improves on its own but may require further medication. If difficulty in swallowing returns, this should be reported to your doctor. It may indicate that some narrowing has occurred again which may require simple dilatation. This can be performed as a day case, with good effect.

If Cancer of the Oesophagus is Left Untreated

Cancer of the oesophagus is a very serious condition. If the condition is not treated, the tumour may ulcerate and produce major bleeding or involve nearby structures such as the windpipe or lungs. The difficulty in swallowing would progress and there would be overflow of saliva into the mouth. These juices could get into the lungs and produce pneumonia.

Effects on Family of Cancer of the Oesophagus

Having such major surgery requires much reassurance and moral support. On returning home, you will have lost weight and feel extremely weak and tired for the first month. During this time particular attention should be paid to diet. This will be discussed with you before discharge by the hospital dietitian. Small, high calorie snacks and drinks should be encouraged. Should there be any initial difficulty with swallowing solids, a liquidizer or blender may be useful.