Dr. M.J. Bazos, MD
Patient Handout
ESOPHAGEAL
TUMORS
About Your
Diagnosis
The esophagus is the part of the digestive tract
that connects the throat with the stomach. Cancer of the esophagus is more
common in Asia and China than in the United States. Approximately 12,000 new
cases of esophageal cancer were diagnosed last year in the United States. The
cause of esophageal cancer is unknown, but there are risk factors, such as heavy
alcohol and tobacco use, that increase your chances of getting this cancer. Acid
reflux (back up) from the stomach to the esophagus that occurs over a long time
can lead to Barrett’s esophagus, which can convert to esophageal cancer.
Esophageal cancer is not contagious. The cancer is detected by means of one of
two radiographic (xray) studies, a barium swallow examination or esophagography.
The easiest way for a physician to diagnose esophageal cancer is to obtain
tissue with an endoscope (a lighted tube passed through the mouth into the
esophagus). The tissue is examined with a microscope.
Living With Your
Diagnosis
Most cancers of the esophagus
occur in the lower part of the esophagus. Difficulty in swallowing solid foods
is the typical symptom. As the tumor grows, liquids become difficult to swallow,
and you can have pain with swallowing. The cancer usually spreads to nearby
structures (lung, windpipe, lymph glands, and liver). This can cause hoarseness,
coughing, coughing of blood, vomiting of blood, and chest
pain.
Treatment
Once
the diagnosis is made, you undergo a staging process. Staging of esophageal
cancer tells you the extent of the disease and whether it has spread. Staging
usually includes a physical examination, blood tests, radiographs (x-rays) of
the chest, and computed tomography (CT) of the chest and abdomen. Laryngoscopy
(examination with a lighted tube passed into the voice box) can be performed if
it looks like the cancer has spread into the larynx (voice box). Bronchoscopy
can be performed if it is believed the cancer has spread into the lungs or the
tubes that lead into the lungs (trachea and bronchi). Esophageal cancer is a
difficult cancer to cure unless it is detected in its earliest stage. Therapy
for esophageal cancer depends on the extent of disease; it can include surgical,
radiation, and chemotherapy. An operation on the esophagus is called
esophagectomy. In the operation the surgeon removes the part of the
esophagus with the tumor and nearby lymph glands. If the cancer completely
blocks the esophagus, tubes are placed to reopen the esophagus and allow
nutrition. Complications of surgical treatment are infection, pneumonia, and
breathing and swallowing problems. Radiation therapy is used instead of surgical
treatment when the tumor is too large to remove or when the patient cannot
withstand an operation. The side effect of radiation therapy is dry, red,
itchyburning skin over the treated area. If the irradiation was over the neck
and chest, dry mouth, sore throat, cough can occur. Chemotherapy can be used
with radiation if surgical treatment is not possible. Sometimes radiation and
chemotherapy are tried before surgical intervention. The patient and oncologist
decide this together. Side effects of chemotherapy can be easy bruising,
bleeding, fever, nausea, vomiting, and hair
loss.
The
DOs
• Report any symptoms of pain
or difficulty swallowing.
• Ask for
second opinions.
• Ask about your
prognosis. This is a difficult cancer to
cure.
• Understand that nutrition is
important both before and after the operation. Because there are difficulty and
pain with swallowing, marked weight loss occurs before and especially the days
to weeks after the operation. It is important to eat high-calorie foods and
nutritional supplements. A nutritionist can be a good
resource.
• Ask for emotional support
groups, psychiatrists, and social workers to help with coping, rehabilitation,
travel, financial issues, and home
care.
The
DON’Ts
• Do not
smoke.
• Do not drink alcohol in
excess.
• Do not miss follow-up
appointments with your physicians. You have a team of physicians and health care
providers, including a primary care physician, surgeon, oncologist, radiation
oncologist, nutritionist, physical therapist, and social
worker.
When to Call Your
Doctor
• If you are having pain
with swallowing, difficulty swallowing, or food becoming stuck after
eating.
• If you cough up blood or
vomit blood.
• If you are short of
breath, coughing, and have a fever.
•
If you have a fever after
chemotherapy.
• If you cannot eat and
continue to lose weight.
• If you
have pain.