Esophageal cancer
Esophageal cancer: Excerpt from Handbook of Diseases
Nearly always fatal, esophageal cancer usually develops in men over age 50. This disease occurs worldwide, but incidence varies geographically. It’s most common in Japan, China, the Middle East, and parts of South Africa.
Causes
The cause of esophageal cancer is unknown, but predisposing factors include chronic irritation caused by heavy smoking and excessive use of alcohol, stasis-induced inflammation, and nutritional deficiency. Esophageal tumors are usually fungating and infiltrating. Most arise in squamous cell epithelium, a few are adenocarcinomas, and fewer still are melanomas and sarcomas.
Esophageal cancer has a 5-year survival rate below 10%, and regional metastasis occurs early by way of submucosal lymphatics. Metastasis produces such serious complications as tracheoesophageal fistulas, mediastinitis, and aortic perforation. Common sites of distant metastasis include the liver and lungs.
Signs and symptoms
Patients are usually asymptomatic until they’re far advanced in the disease. Dysphagia and weight loss are the most common presenting symptoms. Dysphagia is mild and intermittent at first, but it soon becomes constant. Pain, hoarseness, coughing, and esophageal obstruction follow. Cachexia usually develops.
Diagnosis
X-rays of the esophagus, with barium swallow and motility studies, reveal structural and filling defects and reduced peristalsis. Endoscopic examination of the esophagus, punch and brush biopsies, and an exfoliative cytologic tests confirm esophageal tumors.
Treatment
Whenever possible, treatment includes resection to maintain a passageway for food. This may require such radical surgery as esophagogastrectomy with jejunal or colonic bypass grafts. Palliative surgery may include a feeding gastrostomy. Lash palliation decreases tumor size. Other therapies consist of radiation, chemotherapy with cisplatin, and the insertion of prosthetic tubes to bridge the tumor and alleviate dysphagia.
Treatment complications
Complications of treatment may be severe. Surgery may precipitate an anastomotic leak, a fistula, pneumonia, and empyema. Rarely, radiation may cause esophageal perforation, pneumonitis and pulmonary fibrosis, or myelitis of the spinal cord. Prosthetic tubes may dislodge and perforate the mediastinum or erode the tumor.
Special considerations
❑ Before surgery, answer the patient’s questions and let him know what to expect after surgery, such as gastrostomy tubes, closed chest drainage, and nasogastric suctioning.
❑ After surgery, monitor vital signs and watch for unexpected changes. If surgery included an esophageal anastomosis, keep the patient flat on his back to avoid tension on the suture line.
❑ Promote adequate nutrition, and assess the patient’s nutritional and hydration status to determine the need for supplementary parenteral feedings.
❑ Oral intake is usually initiated on the 6th day, with sips of water every 15 to 30 minutes.
❑ As diet advances, prevent aspiration of food by placing the patient in Fowler’s position for meals and allowing plenty of time to eat. Provide high-calorie, high-protein, pureed food as needed.
CLINICAL TIP: Because the patient will probably regurgitate some food, clean his mouth carefully after each meal. Keep mouthwash handy.
❑ If the patient has a gastrostomy tube, give food slowly, using gravity to adjust the flow rate. The prescribed amount usually ranges from 200 to 500 ml. Offer him something to chew before each feeding to promote gastric secretions and a semblance of normal eating.
❑ Instruct the family in gastrostomy tube care (checking tube patency before each feeding, providing skin care around the tube, and keeping the patient upright during and after feedings).
❑ Provide emotional support for the patient and his family; refer them to appropriate organizations such as the American Cancer Society.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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