The methods used to treat cancer are very powerful. It is hard to limit the effects of therapy so that only cancer cells are removed or destroyed. Because healthy cells also may be damaged, treatment often causes unpleasant side effects.
The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment. Also, each person reacts differently. Attempts are made to plan the therapy to keep side effects to a minimum. Patients are carefully monitored so that any problems which occur can be addressed.
Surgery for cancer of the esophagus is a major operation. Patients who have had trouble eating and drinking may need intravenous (IV) feedings and fluids for several days before and after the operation. They may need antibiotics to prevent or treat infections. Patients are taught special coughing and breathing exercises to keep their lungs clear. Discomfort or pain after surgery can be controlled with medicine. Patients should feel free to discuss pain relief with the doctor.
Patients receiving radiation therapy may become tired as treatment continues. Resting as much as possible is important. It is also common for the skin in the treated area to become red or dry. The skin should be exposed to the air but protected from the sun, and the patients should avoid wearing clothes that rub the area. Good skin care is important at this time. The doctor may suggest certain kinds of soap, and patients should not use any lotion or cream on the skin without the doctor’s advice. Radiation to the chest and neck can cause a dry, sore throat or a dry cough. Drinking extra liquids can be helpful, and doctors sometimes suggest cough medicine. If burning, tightness, or other pain makes it hard to swallow, the doctor may suggest a local anesthetic or soothing gargle for use before meals. Some patients find that antacids help relieve feelings of indigestion. A small number of patients feel short of breath during radiation therapy. The doctor may prescribe medicine to relieve this problem.
The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect cells that divide rapidly. These include blood cells, which fight infection, cause the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients can have a lowered resistance to infection, bruise or bleed easily, and have less energy. Cells in hair follicles and cells that line the digestive tract also divide rapidly. Chemotherapy can therefore cause hair loss and other problems such as poor appetite, mouth sores, nausea, and vomiting. These side effects usually go away gradually after treatment stops.
The patient’s weight is checked regularly because weight loss can be a serious problem for patients with cancer of the esophagus. Swallowing food can be difficult, and patients may not feel hungry if they are uncomfortable or tired. Yet, well- nourished patients generally feel better, have more energy, and are often better able to withstand the side effects of their treatment, so good nutrition is important. Patients with esophageal cancer are usually encouraged to have several small meals and snacks throughout the day, rather than to try to eat three large meals. It often helps to sit up for a while after eating, and the doctor may prescribe medicine to control nausea and vomiting and to relieve discomfort.
When swallowing is difficult, many patients can still manage soft, bland foods moistened with sauces or gravies. It can be helpful to prepare other foods in a blender. In addition, puddings, ice cream, and soups are nourishing and easy to swallow. Doctors, nurses, and dietitians may have other suggestions to help patients and their families choose foods that supply enough calories to control weight loss and enough protein to keep up strength and rebuild normal tissues. For example, they may suggest liquid dietary supplements or milkshakes made with extra protein powder or dry milk for patients who cannot swallow solid foods.
The health care team can explain the effects of esophageal cancer and its treatment, and they can suggest ways to deal with them. In addition, the NCI booklets Radiation Therapy and You, Chemotherapy and You, and Eating Hints provide helpful information about cancer treatment and coping with side effects.