This article aims to guide families who have a loved one with esophageal cancer. Esophageal cancer is a type of cancer that starts in the esophagus, which is the tube that connects your mouth to your stomach. The esophagus helps you swallow food and drink.
There are two main types of esophageal cancer: adenocarcinoma and squamous cell carcinoma. Adenocarcinoma starts in the cells that make mucus in the lower part of the esophagus, while squamous cell carcinoma begins in the cells that line the inside of the esophagus. Both types of esophageal cancer can grow and spread to other parts of the body.
Esophageal cancer is not very common, but it is more common in some groups of people than others. Some of the factors that can increase the risk of esophageal cancer are:
Age: Esophageal cancer is more common in people who are older than 50 years.
Gender: Esophageal cancer is more common in men than in women.
Smoking: Smoking tobacco can damage the cells in the esophagus and make them more likely to become cancerous.
Drinking: Drinking alcohol can irritate the esophagus and increase the risk of esophageal cancer, especially when combined with smoking.
Obesity: Being overweight or obese can cause acid reflux when the stomach acid returns to the esophagus. This can damage the esophagus and increase the risk of adenocarcinoma.
Barrett’s esophagus: This is a condition where the cells in the lower part of the esophagus change and become more like the cells in the stomach. This can happen because of acid reflux or other reasons. People with Barrett’s esophagus have a higher risk of developing adenocarcinoma.
Some of the symptoms and signs of esophageal cancer are:
Difficulty swallowing: This is when you have trouble swallowing food or drink or feel like something is stuck in your throat. This can cause pain, choking, or coughing.
Weight loss: This is when you lose weight without trying because you eat less or have trouble absorbing nutrients from food.
Chest pain: This is when you feel pain or discomfort in your chest, especially when you swallow or eat.
Heartburn: This is when you feel a burning sensation in your chest or throat caused by acid reflux.
Hoarseness: This is when your voice sounds raspy or weak because of irritation or damage to your vocal cords.
Bleeding: This is when you cough up blood or have blood in your vomit or stool because of bleeding in your esophagus or stomach.
You should see a doctor immediately if you or your loved one have symptoms or signs. The doctor will ask you some questions about your health history and do some tests to find out if you have esophageal cancer or another condition. Some of the tests that the doctor may do are:
Endoscopy: This is when the doctor uses a thin, flexible tube with a light and a camera at the end, called an endoscope, to look inside your esophagus and stomach. The doctor may also take a small tissue sample, called a biopsy, to check for cancer cells under a microscope.
Barium swallow: This is when you drink a liquid that contains a substance called barium, which makes your esophagus and stomach show up better on an X-ray. The doctor will take X-rays of your chest and abdomen to see if there are any abnormal areas or blockages in your esophagus or stomach.
CT scan: This is when the doctor uses a machine that takes many pictures of your body from different angles, called a computed tomography scan, to create a detailed image of your chest and abdomen. The doctor may also inject a dye into your vein, called a contrast, to make the pictures clearer. The CT scan can show if the cancer has spread to other organs or lymph nodes.
PET scan: This is when the doctor uses a machine that detects a radioactive substance, called a tracer, injected into your vein, called a positron emission tomography scan, to create a picture of your body’s activity. The PET scan can show if the cancer cells use more energy than normal cells, indicating that the cancer has spread to other body parts.
The doctor will use the results of these tests to determine the stage of esophageal cancer, which is a way of describing how much the cancer has grown and spread. The stages of esophageal cancer are:
Stage 0: The cancer is only in the inner layer of the esophagus and has not spread to other layers or nearby tissues.
Stage I: The cancer has grown into the deeper layers of the esophagus but has not spread to nearby lymph nodes or other organs.
Stage II: The cancer has grown into the outer layer of the esophagus or has spread to nearby lymph nodes but has not spread to other organs.
Stage III: The cancer has grown into the surrounding tissues, such as the chest wall, the windpipe, or the lungs, or has spread to more lymph nodes but not to distant organs.
Stage IV: The cancer has spread to distant organs, such as the liver, the bones, or the brain.
Knowing the stage of esophageal cancer can help the doctor and the patient decide on the best treatment options and the outlook for the future.
Treatment Options
The goal of esophageal cancer treatment is to get rid of the cancer or stop it from growing and spreading. The treatment also aims to relieve your symptoms and improve your quality of life. The best treatment for you depends on many factors, such as the type and stage of the cancer, your overall health, and your preferences.
There are different types of treatment for esophageal cancer, such as:
Surgery: This is an operation to remove the part of the esophagus that has the cancer and sometimes the nearby lymph nodes and part of the stomach. Surgery can be done through a large cut in the chest or abdomen or through several small cuts with a special tool called a laparoscope. Surgery can cure the cancer if it is found early and has not spread to other parts of the body.
Chemotherapy involves using drugs to kill or stop cancer cells from growing. It can be given by mouth or through a vein. Chemotherapy can be used before or after surgery or together with radiation therapy to make the treatment more effective. It can also be used to control the cancer if it has spread to other parts of the body or if surgery is not possible.
Radiation therapy: This uses high-energy rays or particles to destroy the cancer cells or stop them from growing. Radiation therapy can be given from a machine outside the body (external beam radiation) or a device placed inside the esophagus (brachytherapy). Radiation therapy can be used before or after surgery or together with chemotherapy to make the treatment more effective. Radiation therapy can also be used to relieve symptoms such as pain or bleeding if the cancer has spread to other parts of the body or if surgery is not possible.
Targeted therapy: This is the use of drugs that target specific features of cancer cells that make them different from normal cells. It can be given by mouth or through a vein. Targeted therapy can be used together with chemotherapy or alone to treat some types of esophageal cancer that have certain gene changes. It can help shrink the tumor or slow down its growth.
Immunotherapy: This is the use of drugs that help your immune system fight cancer. It can be given by mouth or through a vein. Immunotherapy can be used to treat some types of esophageal cancer that have specific gene changes or that have not responded to other treatments. It can help shrink the tumor or slow down its growth.
Endoscopic treatments: These procedures use a thin, flexible tube with a light and a camera (endoscope) to look inside the esophagus and treat the cancer. Endoscopic treatments can be used to remove very small tumors, destroy the cancer cells with heat, cold, or laser, or place a stent (a metal or plastic tube) to keep the esophagus open. They can also be used to treat early-stage cancer or to relieve symptoms such as difficulty swallowing or bleeding.
Treatment Decisions
Choosing the best treatment for you can be challenging. You may want to talk to your doctor and your family about the benefits and risks of each option. You may also want to get a second opinion from another doctor who specializes in esophageal cancer. Some questions that you may want to ask your doctor are:
What is the type and stage of my esophageal cancer?
What are the treatment options for my esophageal cancer?
What are the goals of each treatment option?
What are the chances of curing the cancer or controlling it for a long time with each treatment option?
What are the possible side effects and complications of each treatment option?
How will each treatment option affect my quality of life and daily activities?
How often will I need tests or visits during and after the treatment?
How much will the treatment cost, and will my insurance cover it?
Are there any clinical trials or new therapies that I can join?
Esophageal cancer treatment can cause side effects and complications that may affect your health and well-being. Some of the common side effects and complications are:
Pain, bleeding, infection, or leakage at the surgery site
Nausea, vomiting, mouth sores, diarrhea, constipation, loss of appetite, hair loss, or low blood counts from chemotherapy
Skin irritation, fatigue, difficulty swallowing, or inflammation of the esophagus, lungs, or heart from radiation therapy
Rash, diarrhea, liver problems, or high blood pressure from targeted therapy
Fever, chills, fatigue, or allergic reactions from immunotherapy
Infection, bleeding, or perforation (a hole) of the esophagus from endoscopic treatments
Difficulty swallowing, reflux, or dumping syndrome (rapid emptying of the stomach) from surgery or stent placement
Your doctor will monitor you closely and give you medicines or other treatments to prevent or manage the side effects and complications. You should tell your doctor if you have any new or worsening symptoms or problems. It would help if you also cared for yourself by eating well, drinking enough fluids, resting, and avoiding infections.
Treatment Outcomes
The outcome of esophageal cancer treatment depends on many factors, such as the type and stage of the cancer, the response to the treatment, and your overall health. Your doctor will check your progress and the effect of the treatment by doing tests such as blood tests, endoscopy, or imaging tests. You may need to have regular follow-up visits and tests for several years after the treatment to watch for any signs of the cancer coming back or spreading to other parts of the body.
The survival rate of esophageal cancer is the percentage of people who live for a certain period after being diagnosed with the cancer. The survival rate is based on statistics from large groups of people and may not reflect your situation. The survival rate of esophageal cancer depends on the stage of the cancer at the time of diagnosis. According to the American Cancer Society, the 5-year survival rate for people with esophageal cancer is:
About 50% of people with cancer that is only in the esophagus
About 25% of people with cancer that has spread to nearby lymph nodes or organs
About 5% of people with cancer that has spread to distant parts of the body
These estimates may change as new treatments are developed and more people are diagnosed and treated. Your doctor can give you more information about your prognosis (outlook) based on your specific condition and treatment.
I hope this information helps you understand esophageal cancer and its treatment options. If you have any questions or concerns, don’t hesitate to contact your doctor or cancer care team. They are there to support you and your family through this grim time. Remember that you are not alone and that many resources and people can help you cope with esophageal cancer. I wish you all the best.
Changes to Expect Over Time
Esophageal cancer can cause many changes in your loved one’s physical and emotional health. These changes may vary depending on the stage and type of the cancer, the treatment options, and the individual response. Some of the changes may be temporary, while others may be permanent. It is essential to be aware of these changes and how to cope.
Physical Changes
Your loved one may experience some of the following physical changes as the cancer progresses or as a result of the treatment:
Difficulty swallowing: This is when your loved one has trouble swallowing food or drink or feels like something is stuck in their throat. This can cause pain, choking, or coughing. Your loved one may need to eat smaller, softer, or liquid foods, or use a feeding tube to get enough nutrition.
Weight loss: This is when your loved one loses weight without trying because they eat less or have trouble absorbing nutrients from food. Your loved one may need to eat more often, add high-calorie or high-protein foods, or take supplements to maintain weight and strength.
Chest pain: This is when your loved one feels pain or discomfort in their chest, especially when they swallow or eat. The tumor can cause this, the treatment, or other conditions. Your loved one may need to take pain medicines, avoid spicy or acidic foods, or raise their head when sleeping to ease the pain.
Heartburn: This is when your loved one feels a burning sensation in their chest or throat caused by acid reflux. The tumor can cause this, the treatment, or other factors. Your loved one may need to take antacids, avoid alcohol or caffeine, or eat smaller meals to reduce heartburn.
Hoarseness: This is when your loved one’s voice sounds raspy or weak because of irritation or damage to their vocal cords. The tumor can cause this, the treatment, or other conditions. Your loved one may need to rest their voice, drink plenty of fluids, or use a humidifier to soothe their throat.
Bleeding: This is when your loved one coughs up blood or has blood in their vomit or stool because of bleeding in their esophagus or stomach. The tumor can cause this, as well as the treatment or other factors. Your loved one may need to take medicines to stop the bleeding, get a blood transfusion, or have a procedure to seal the bleeding area.
Fatigue is when your loved one feels tired or weak and has no energy to do their usual activities. It can be caused by cancer, treatment, or other factors. Your loved one may need to rest more, pace themselves, or ask for help with daily tasks.
Emotional Changes
Your loved one may experience some of the following emotional changes as they cope with the cancer and its impact on their life:
Sadness: This is when your loved one feels unhappy, hopeless, or depressed and has trouble enjoying things they used to like. It can be caused by cancer, treatment, or changes in their life. If your loved one feels overwhelmed by sadness, they may need to talk to someone they trust, join a support group, or seek professional help.
Worry is when your loved one feels anxious, nervous, or fearful and has trouble sleeping or concentrating. It can be caused by cancer, treatment, or uncertainty about the future. Your loved one may need to learn more about their condition, make plans for their care, or practice relaxation techniques to calm their worry.
Frustration: This is when your loved one feels angry, irritated, or resentful and has trouble coping with the challenges they face. It can be caused by cancer, treatment, or the loss of control over their life. Your loved one may need to express their feelings, find healthy ways to vent, or seek help to resolve any conflicts they have.
Isolation: This is when your loved one feels lonely, disconnected, or misunderstood and has trouble maintaining their relationships. Cancer, treatment, or changes in roles and responsibilities can cause it. Your loved one may need to contact family and friends, join a support group, or find new ways to socialize and have fun.
Your loved one should tell their healthcare team if they have any new or worsening symptoms or problems. Your loved one should also care for themselves by eating well, drinking enough fluids, resting, and avoiding infections.
Providing Care for Your Loved One
Your loved one may need your help and care during and after treatment. You can provide care for your loved one by:
Being there for them. Spending quality time together can show your love and support. You can do things you and your loved one enjoy, such as watching a movie, playing a game, or listening to music. You can also listen to their feelings and concerns and share your own. You can offer comfort and encouragement and respect their choices and preferences. You can let them know you are doing this together and not going anywhere.
Helping with daily tasks. Your loved one may have difficulty eating, bathing, and other daily activities. You can assist them with these tasks or arrange for someone else to help them. You can help them follow their treatment plan and doctor’s instructions. You can watch for any signs of infection, bleeding, or other problems and report them to the healthcare team. You can also help them get to and from appointments, tests, or treatments.
Self-care for you. Taking care of yourself is also essential. You may feel overwhelmed, exhausted, or helpless at times. You may also have your fears, worries, or grief. You need to take breaks when you need to and get some rest. If you feel overwhelmed, you must talk to someone, such as a friend, family member, or counselor. It would help if you did things that make you happy, such as reading, gardening, or playing games. It would help if you were kind to yourself and did not blame yourself for things that were not your fault.
Self-Care Tips for Families
As a family, you can also care for yourselves and each other. You can support each other and cope with the stress and anxiety of living with esophageal cancer. Here are some tips for self-care for families:
Stay active. Physical activity can help you feel better physically and mentally. Even short walks can boost your mood and energy. You can also do other exercises that you like, such as biking, swimming, or dancing. You can do these activities alone or with your loved one or other family members.
Get rest. Sleep is essential for your health and well-being. Make sure you and your loved one get enough sleep. Try to have a regular sleep schedule and avoid caffeine, alcohol, or screens before bedtime. You can also take naps during the day if you feel tired. You can use pillows, blankets, or fans to make your sleeping area comfortable and cozy.
Talk to someone. Sharing your feelings and thoughts can help you cope with the emotions and stress of living with esophageal cancer. You can talk to your friends, family, or a counselor. You can also join a support group or an online forum to meet others who are going through the same thing. You can express your emotions, whether positive or negative. You can also ask for and offer advice, tips, or resources.
Providing End-of-Life Care
There may come a time when the cancer treatment is no longer working, and your loved one is nearing the end of life. This can be an exceedingly difficult and emotional time for both of you. You may feel sad, angry, scared, or numb. You may also have many questions and concerns about what will happen and how to help your loved one. This section will give tips on providing end-of-life care and ensuring comfort and peace for your loved one.
Hospice Care: Hospice care focuses on making your loved one as comfortable as possible in the last months, weeks, or days of life. Hospice care does not try to cure cancer or prolong life but rather to relieve pain and other symptoms, such as nausea, shortness of breath, or anxiety. Hospice care also provides emotional and spiritual support for your loved one and family. Hospice care can be given at home, in a hospital, or at a hospice facility, depending on your loved one’s needs and preferences. You can help your loved one by:
Talking to the doctor about hospice care. You can ask the doctor if your loved one is eligible for hospice care and when it might be appropriate to start. You can also ask the doctor for a referral to a hospice program in your area. You can find more information about hospice care from the National Hospice and Palliative Care Organization or the American Cancer Society.
Choosing a hospice program that meets your loved one’s needs. You can compare hospice programs based on their services, staff, costs, and location. You can also visit the hospice facility or talk to the staff to understand their philosophy and approach. You can ask questions such as:
What services do you offer, and how often?
Who will be part of the hospice team, and how will they communicate with us?
How do you manage pain and other symptoms?
How do you provide emotional and spiritual support?
How do you involve the family in the care plan?
How do you handle emergencies or after-hours calls?
How do you coordinate with other healthcare providers?
How do you bill for your services, and what insurance do you accept?
Working with the hospice team to create a care plan. The hospice team will include a doctor, a nurse, a social worker, a chaplain, a counselor, a home health aide, and a volunteer. They will work with you and your loved one to create a care plan that reflects your loved one’s wishes and goals. The care plan will include details such as:
What medications and treatments will your loved one receive, and how will they be administered?
What equipment and supplies will your loved one need, and how will they be delivered?
What comfort measures and complementary therapies will your loved one use, such as massage, music, or aromatherapy?
What emotional and spiritual support will your loved one and your family receive, such as counseling, prayer, or rituals?
What legal and financial matters must your loved one and your family address, such as advance directives, wills, or funeral arrangements?
Providing care and support for your loved one. You will be the primary caregiver for your loved one, but you will not be alone. The hospice team will visit your loved one regularly and be available by phone 24/7. They will teach you how to care for your loved one, such as giving medications, changing dressings, or using equipment. They will also monitor your loved one’s condition and adjust the care plan. You can also ask for help from other family members, friends, or volunteers. You can help your loved one by:
Giving them their medications and treatments as prescribed and on time. Do not skip or change the doses without consulting the hospice team.
Keeping track of their pain and symptom level and how well the medications and treatments are working. Report any changes or concerns to the hospice team.
Providing comfort measures, such as massage, heat, ice, or distraction. You can also help them find a comfortable position, use pillows or cushions, or adjust the lighting or temperature in the room.
Being there for them emotionally and spiritually. Listen to their feelings and concerns without judging or interrupting. Try to be positive and hopeful but also realistic and honest. Share your feelings and fears with your loved one or someone you trust. You can also seek professional help from a counselor or therapist if you or your loved one are feeling overwhelmed, depressed, or anxious.
Emotional Well-being: The end of life can be a time of mixed emotions for your loved one and family. Your loved one may feel grateful, peaceful, or relieved but also sad, angry, or scared. They may also have regrets, unfinished business, or unfulfilled dreams. You can help your loved one by:
Help them find meaning and purpose in their lives. You can help them reflect on their life story, achievements, values, and legacy. You can also help them express their gratitude, forgiveness, or love to those who matter to them. You can use different methods like writing, drawing, recording, or making a scrapbook.
Helping them cope with their fears and worries. You can help them identify and address their sources of fear and worry, such as pain, suffering, loss of control, or the unknown. You can also help them find ways to reduce their anxiety and worry, such as talking, praying, meditating, or breathing. You can also help them find comfort and hope in their faith, beliefs, or philosophy.
Helping them create cherished memories. You can help them make the most of their time with their loved ones. You can help them plan and enjoy special occasions like birthdays, anniversaries, or holidays. You can also help them create meaningful gifts, such as letters, videos, or jewelry, for their loved ones to remember them.
Conclusion
Esophageal cancer can be a challenging disease for both the patient and the family and caregivers. But there are also ways to cope and find hope. Here are some of the main takeaways and messages for families and caregivers of esophageal cancer patients:
Learn as much as you can about esophageal cancer and its treatment. Knowing what to expect can help you prepare and plan. You can get reliable information from your healthcare team and cancer organizations.
Watch for symptoms and signs of esophageal cancer, such as difficulty swallowing, weight loss, chest pain, heartburn, hoarseness, or bleeding. If you or your loved one have any of these symptoms or signs, see a doctor as soon as possible. Early diagnosis and treatment can improve the chances of survival and quality of life.
Expect changes over time in your loved one’s physical and emotional health. Esophageal cancer and its treatment can cause many side effects and complications, such as nausea, vomiting, mouth sores, diarrhea, constipation, loss of appetite, hair loss, fatigue, pain, infection, or leakage. Your loved one may also feel depressed, anxious, angry, or hopeless. Be supportive and understanding of your loved one’s feelings and needs. Help them cope with the stress and anxiety of living with cancer. Please encourage them to express their emotions, find ways to relax, and stay hopeful.
Remember to take care of yourself too. Being a caregiver can be rewarding but also stressful and exhausting. You may have your fears, worries, or grief. You need to take breaks when you need to and get some rest. If you feel overwhelmed, you must talk to someone, such as a friend, family member, or counselor. It would help if you did things that make you happy, such as reading, gardening, or playing games. It would help if you were kind to yourself and did not blame yourself for things that were not your fault.
Seek support and guidance from others who have been through the same thing. You are not alone in this journey. Many resources and people can help you and your loved one live with esophageal cancer. You can find support groups or counseling services through your hospital, community, or online. You can also get practical help from your family, friends, neighbors, or co-workers. You can also seek professional help from a home health aide, a nurse, or a social worker if needed.
