Cancer of the Oesophagus

Cancer of the oesophagus or gullet develops as a result of cell changes in the lining of the oesophagus.

 

There are two main types of cancer of the oesophagus: squamous carcinoma, which is more common at the upper end of the gullet, and adenocarcinoma, which is more common at the lower end, particularly around the junction between the gullet and the stomach.
There has been a recent increase in the proportion of tumours arising close to the junction of the stomach and gullet, but the reasons for this are not yet known.

Causes

Smoking and drinking alcohol: Smoking tobacco and drinking a lot of alcohol are some of the main risk factors for oesophageal cancer in the Western parts of the world. Cigarettes contain nitrosamines and other chemicals that increase the risk of cancer. Cigar and pipe smoking also increase the risk. When you smoke, you always swallow some of the smoke as well as breathing it into your lungs.

Obesity: Obesity roughly doubles the risk of adenocarcinoma of the oesophagus. This may be because obese people are more likely to suffer from acid reflux and this is a risk factor for oesophageal cancer in itself.

Diet: A poor diet may increase your risk of oesophageal cancer. This may be due to lack of zinc, or other vitamins and minerals. If you eat a well balanced diet, with plenty of high protein foods, such as meat, fish, eggs and dairy products, you are unlikely to be short of zinc.

Other medical conditions

1. Barrett's oesophagus or acid reflux
2. Tylosis - a rare skin condition
3. Achalasia - a condition causing problems with the valve between the oesophagus and stomach
4. Plummer-Vinson syndrome - a condition causing difficulty swallowing
5. Some pollutants and chemicals
6. Helicobacter pylori infection
7. Drugs and other medical treatments

Symptoms of oesophageal cancer

The symptoms of cancer of the oesophagus (food pipe or gullet) include the following

Difficulty in swallowing
Weight loss
Pain or discomfort in the throat or back
Acid indigestion
Hoarseness, or chronic cough
Vomiting
Coughing up blood

Diagnosis

It can be diagnosed by using X-rays using special dye.
Endoscopy
CT scan
for definitive diagnosis Biopsy can be performed

Treatment

Treatment types

Cancer of the oesophagus can be treated using surgery, chemotherapy or radiotherapy. The choice of treatment will depend upon the exact type of oesophageal cancer, its stage, position and size, as well as your age and general health. The treatments can be used alone or in combination. When diagnosing and treating cancer doctors consider the oesophagus in three sections: upper, middle and lower.
Other treatments may be used to ease any swallowing difficulties you may have. These include: intubation or stenting (inserting a tube into the oesophagus to keep it open), dilatationlaser treatment and photodynamic therapy. You may be offered one or more of these treatments, which are described in greater detail on the difficulty in swallowing section. (stretching the oesophagus),

Treatment planning

In most hospitals a team of specialists will discuss with you the treatment that they feel is best for your situation. This multidisciplinary team (MDT) will include a surgeon who specialises in oesophageal cancers, a medical oncologist (chemotherapy specialist), a clinical oncologist (radiotherapy specialist and chemotherapy specialist) and may include a number of other healthcare professionals such as a:

• nurse specialist
• dietitian
• physiotherapist
• occupational therapist
• psychologist or counsellor.

Treatment choices

If two treatments are equally effective for your type and stage of cancer, your doctors may offer you a choice of treatments. Sometimes people find it very hard to make a decision. If you are asked to make a choice, make sure that you have enough information about the different treatment options, what is involved and the side effects you might have, so that you can decide which is the right treatment for you.

Talking about treatment

Remember to ask questions about any aspects that you don’t understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your cancer specialist, nurse specialist or with the nurses at Cancerbackup.
If you have any questions about your treatment, don't be afraid to ask your doctor or nurse. It often helps to make a list of questions and to take a close friend or relative with you.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any other treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need their treatment to be explained more than once.
It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go for your appointment.
People often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.
If you feel unable to make a decision about the treatment when it is first explained to you, you can always ask for more time. You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it.

Benefits and disadvantages of treatment

Many people are frightened at the thought of having cancer treatments, particularly because of the potential side effects that can occur.
Although many of the treatments can cause side effects, knowledge about how treatments affect people – and improved ways of reducing or avoiding many of these problems – have made most of the treatments easier to cope with.
Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation.

Early-stage oesophageal cancer

In people with early-stage cancer of the oesophagus, treatment may be given with the aim of curing the cancer. Occasionally additional treatments are given to reduce the risk of it coming back.

Advanced-stage oesophageal cancer

If the cancer is at a more advanced stage, treatment may only be able to control it, leading to an improvement in symptoms and a better quality of life. Unfortunately, for some people the treatment will have little effect upon the cancer and they will get the side effects without many of the benefits.

Surgery

The surgery performed on the oesophagus to remove cancer cells is called an esophagogastrectomy. The doctor performing the surgery reforms the portion of the oesophagus that contains cancer cells, as well as the nearby lymph nodes and the top of the stomach. The oesophagus and remaining stomach area are then reattached, using, in some cases, a piece of the colon. This allows food to continue to pass from the throat to the stomach using the oesophagus.

Prognosis

Overall, the outlook is very poor. The five-year survival rate for cancer of the oesophagus is less than 10 per cent. Survival rates are higher in younger patients who are fit enough for intensive treatment, with cure rates of 20 per cent or more.

Nursing care plan

Assessment and physical examination
Obtain an accurate history of risk factors, including race, cultural background, use of cigarettes and alcohol, or any esophageal problems.

Nursing Considerations

Acute pain related to the clinical conditions associated  with Ca Oesophagus
Altered nutrition: Less than body requirements related to dysphagia.
Fatigue related to less nutritional intake.

Nursing care plan discharge and home health care guidelines

The patient should be able to state the name, purpose, dosage, schedule, common side effects, and importance of taking her or his medications.
Teach the patient to report any dysphagia or odynophagia, which may indicate a regrowth of the tumor.
Teach the patient to inspect the wound daily for redness, swelling, discharge, or odor, which indicates the presence of infection.
Teach family members to assist the patient with ambulation, splinting the incision, and chest physiotherapy.
Educate caregivers on nutritional guidelines, food preparation, tube feedings, and parenteral nutrition, as appropriate.
Inform the patient and family about the availability of high-caloric, high-protein, liquid supplements to maintain his or her weight.

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